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Accessory Navicular Syndrome

What is the accessory navicular?

  • The accessory navicular (os navicularè / os tibiale externum) is an extra bone/cartilage located on the inner side of the foot just above the arch. Normally but not always it is incorporated within the posterior tibial tendon, which attaches in this area. 


How is it commonly injured?

Because of its exposure on the inside of the foot this accessory can be aggravated by :

  • Trauma 

  • Chronic friction/irritation from footwear

  • Overuse the tibias posterior tendon from excessive foot hyper pronation

Classification and Signs and Symptoms of this injury

  • Often there is a visible bump on the inside of the arch as seen in the picture here.

  • Sometimes this bump can become intensely painful to push on and it enlarges due to the progression of the injury and is swollen and red

  • This can ache, throb and occasionally reduce power of the tibias posterior muscle during testing.

  • Diagnosis of this injury normally happens with a plain Xray


Currently management techniques

  • RICE

  • Reduce all friction and pressure to this areas of the foot

  • Taping and padding of the arch can reduce tibialis posterior tension

  • Physical Therapy - this must include soft tissue massage to the tibias posterior muscle and strengthening 

  • Orthotics - Custom foot orthoses may also provide relief

  • Medications - Oral non-steroidal anti-inflammatory drugs may be prescribed

  • Surgery - if conservative measures fail there are surgical procedures to remove the accessory bone


Global Rehabilitation Network

  • We provide a complete online program of 12 consecutive weeks of instructions on how to conservatively manage this injury

  • We provide a global network of therapists that can chat remotely via our Telehealth services to guide you through the process week by week for minimal cost.

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