07
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Recovery From Accessory Navicular Bone Removal
07.05.2017 12:14
Overview

he accessory navicular (os navicularum or os tibiale externum)is an extra bone or piece of cartilage located on the inner sideof the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people. What is Accessory Navicular Syndrome? People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated.

Accessory Navicular Syndrome

Causes

An injury to the fibrous tissue connecting the two bones can cause something similar to a fracture. The injury allows movement to occur between the navicular and the accessory bone and is thought to be the cause of pain. The fibrous tissue is prone to poor healing and may continue to cause pain. Because the posterior tibial tendon attaches to the accessory navicular, it constantly pulls on the bone, creating even more motion between the fragments with each step.

Symptoms

Perhaps the most common of the extra bones in the foot, the accessory navicular bone is estimated to be present in 7 to 19 percent of the population. Zadek and Gold maintained that the bone persisted as a distinct, separate bone in 2 percent of the population. Also be aware that the accessory bone normally fuses completely or incompletely to the navicular. It is this incomplete fusion which allows for micromotion, which, in turn, may cause degenerative changes that can also contribute to the pain.

Diagnosis

Your podiatrist will most likely diagnose accessory navicular syndrome by making a visual study of the area, checking whether the shape of your foot and your ability to move it indicate there?s an accessory navicular lurking around. He or she may push on the prominence on your foot to check to see if it hurts, and may ask you to walk around in order to ascertain how your gait is affected. In order to get a certain diagnosis, your podiatrist will need some way to see the inside of your foot, which will most likely involve getting X-rays, or possibly an MRI or some other scan of your foot?s interior.

Non Surgical Treatment

Fortunately, surgery is not the only answer when it comes to relieving symptoms of accessory navicular syndrome. The physician may recommend wearing a cast or walking boot for a period of time so the foot can recover from the inflammation. Ice may be used to relieve swelling, too, although it should be wrapped to avoid direct contact with the skin.

Accessory Navicular

Surgical Treatment

If all nonsurgical measures fail and the fragment continues to be painful, surgery may be recommended. The most common procedure used to treat the symptomatic accessory navicular is the Kidner procedure. A small incision is made in the instep of the foot over the accessory navicular. The accessory navicular is then detached from the posterior tibial tendon and removed from the foot. The posterior tibial tendon is reattached to the remaining normal navicular. Following the procedure, the skin incision is closed with stitches, and a bulky bandage and splint are applied to the foot and ankle. You may need to use crutches for several days after surgery. Your stitches will be removed in 10 to 14 days (unless they are the absorbable type, which will not need to be taken out). You should be safe to be released to full activity in about six weeks.

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