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Accessory Navicular Syndrome
Overview The accessory navicular is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. While present in up to 10% of the population, most people are unaware of its existence unless it becomes painful—a condition known as Accessory Navicular Syndrome (ANS). This syndrome often emerges during adolescence and is aggravated by physical activity, trauma, or improper footwear. |
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Conservative treatment is typically the first-line approach for managing pain and inflammation associated with ANS. Understanding these non-surgical options can help patients recover and avoid or delay surgery.
Common Symptoms
Conservative Treatment Options
1. Activity Modification
Reducing or avoiding activities that aggravate symptoms is often the first step. Running, jumping, and prolonged standing should be limited during flare-ups.
2. Immobilization
Short-term immobilization with a walking boot or cast can allow inflammation to subside. This may last 2–6 weeks depending on symptom severity.
3. Orthotics and Arch Support
Custom orthotics or supportive arch inserts reduce stress on the posterior tibial tendon and help realign foot mechanics. A medial arch support can minimize the pulling force on the accessory bone.
4. Ice and NSAIDs
Applying ice for 15–20 minutes several times a day and using over-the-counter NSAIDs (e.g., ibuprofen) can reduce inflammation and pain.
5. Physical Therapy
Targeted exercises to strengthen the posterior tibial tendon and foot intrinsic muscles may be beneficial. Therapists may also use modalities such as ultrasound or manual therapy.
6. Footwear Modifications
Supportive shoes with a stiff sole and adequate arch support can significantly decrease symptoms. Avoid shoes with poor support or tight medial pressure.
When Conservative Treatment Fails
If symptoms persist after several months of conservative care, surgical options may be considered, such as excision of the accessory bone (Kidner procedure) or tendon repair. However, many patients find relief without surgery if early and consistent conservative management is implemented.
Prognosis
Most patients experience significant improvement with conservative care. Adolescents, whose bones are still developing, often respond particularly well to non-operative treatments. Long-term success depends on compliance with arch support and avoidance of aggravating activities.
- Pain or throbbing along the arch or inner midfoot
- Swelling or redness over the accessory navicular
- Pain when wearing tight shoes or after physical activity
- Difficulty with prolonged walking or standing
Conservative Treatment Options
1. Activity Modification
Reducing or avoiding activities that aggravate symptoms is often the first step. Running, jumping, and prolonged standing should be limited during flare-ups.
2. Immobilization
Short-term immobilization with a walking boot or cast can allow inflammation to subside. This may last 2–6 weeks depending on symptom severity.
3. Orthotics and Arch Support
Custom orthotics or supportive arch inserts reduce stress on the posterior tibial tendon and help realign foot mechanics. A medial arch support can minimize the pulling force on the accessory bone.
4. Ice and NSAIDs
Applying ice for 15–20 minutes several times a day and using over-the-counter NSAIDs (e.g., ibuprofen) can reduce inflammation and pain.
5. Physical Therapy
Targeted exercises to strengthen the posterior tibial tendon and foot intrinsic muscles may be beneficial. Therapists may also use modalities such as ultrasound or manual therapy.
6. Footwear Modifications
Supportive shoes with a stiff sole and adequate arch support can significantly decrease symptoms. Avoid shoes with poor support or tight medial pressure.
When Conservative Treatment Fails
If symptoms persist after several months of conservative care, surgical options may be considered, such as excision of the accessory bone (Kidner procedure) or tendon repair. However, many patients find relief without surgery if early and consistent conservative management is implemented.
Prognosis
Most patients experience significant improvement with conservative care. Adolescents, whose bones are still developing, often respond particularly well to non-operative treatments. Long-term success depends on compliance with arch support and avoidance of aggravating activities.
Recommended DIY Products
- provide direct support in arch, can use in or out of shoes, pressure relief with walking, arch support, off loading tarsometatarsal and midfoot joints, etc...
References
- Huang J, Zhang Y, Li Y, et al. Accessory navicular bone: a clinical and radiological review. Clin Anat. 2014;27(8):1234-1240. doi:10.1002/ca.22433
- Miller TT. Painful accessory bones of the foot. Semin Musculoskelet Radiol. 2002;6(2):153-161. doi:10.1055/s-2002-33042
- Tarsus M, Richardson EG. The accessory navicular. Foot Ankle. 1986;7(2):81-87. doi:10.1177/107110078600700207
- Mahadev A, Faraj A, Helmy N. Conservative management of symptomatic accessory navicular in children: a prospective study. J Pediatr Orthop B. 2006;15(1):20-23. doi:10.1097/01202412-200601000-00005
- Dodd L, McElroy T. Rehabilitation and orthotic intervention for accessory navicular syndrome. J Orthop Sports Phys Ther. 2005;35(9):571. doi:10.2519/jospt.2005.35.9.571