05 May 2017 ~ 0 Comments

Foot Accessory Navicular Excision

Overview

This condition has been observed in multiple family members and has propensity to occur slightly more in females than males. For most individuals this condition is a non-issue and most people who have them never have a problem with them. Over the years when x-raying patients for other problems I will point out that they have an extra bone in their foot and the usual response from the patient is nothing more than a yawn.

Accessory Navicular Syndrome

Causes

It is commonly believed that the posterior tibial tendon loses its vector of pull to heighten the arch. As the posterior muscle contracts, the tendon is no longer pulling straight up on the navicular but must course around the prominence of bone and first pull medially before pulling upward. In addition, the enlarged bones may irritate and damage the insertional area of the posterior tibial tendon, making it less functional. Therefore, the presence of the accessory navicular bone does contribute to posterior tibial dysfunction.

Symptoms

Not everyone who has an accessory navicular will develop these problems. When problems do occur, they may begin in early adolescence. The obvious indication is a painful bump on the inside of the foot, which hurts to touch, and causes problems that gradually become worse, and which are aggravated by activity, walking, etc., leading to all the problems discussed here. Pain may be worse towards the end of the day, and continue into the night. Among adults, symptomatic accessory navicular is more common in women than in men, with onset typical at 40 years of age or greater. Among symptomatic children, the mean age of onset for maels is 6 years, and for females, 4.5 years. In general, symptoms may occur between 2 and 9 years of age.

Diagnosis

Diagnosis starts by speaking with the patient about symptoms. The physician will look at the foot and examine it for signs of an accessory navicular. By putting pressure on the area, the doctor may determine its presence simply by the presence of pain. The muscle, joint, and the overall structure of the foot may be considered, as well as the way in which the patient walks. If a diagnosis of accessory navicular syndrome is made, an X-ray or MRI may be ordered to confirm diagnosis.

Non Surgical Treatment

Excess weight will increase the force on the posterior tibial tendon as it inserts into the accessory navicular and will tend to precipitate or aggravate symptoms. If a patient with a symptomatic accessory navicular is overweight, then losing weight can be very helpful. Even losing 5-10lbs will decrease the amount of force going through the foot with each step by as much as 15-30lbs. This is because the foot acts like a lever serving to magnify the force absorbed by the foot with each step.

Accessory Navicular Syndrome

Surgical Treatment

In my experience, the Modified Kidner procedure is one of the most reliable operations for reducing arch pain associated with an accessory navicular bone (a.k.a. os tibial externum). You can also use this procedure to treat a prominence at the inner aspect of the arch, which has been caused by an enlarged navicular bone. The most common patients to visit our office with these problems are between the ages of 8 and 15 and are involved in activities like ice skating, ballet and soccer.

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