Accessory navicular

NewsBot · Oct 18, 2022

Prevalence and classification of accessory navicular bone: a medical record review
Ghadeer Abdullah Alsager et al
Ann Saudi Med. 2022 Sep-Oct;42(5):327-333

Background: The accessory navicular bone (ANB) is one of the most common accessory bones in the foot. Certain pathologies, such as posterior tibial tendon insufficiency are associated with ANB, and should be differentiated from midfoot and hindfoot fractures such as navicular tuberosity avulsion fractures. There are few studies addressing the prevalence and types of ANB in Saudi Arabia.

Objectives: Determine the prevalence and morphological variations of ANB and its relation with age and sex in patients visiting foot and ankle clinics.

Design: Medical record review SETTING: Orthopedic foot and ankle clinic at a university hospital.

Patients and methods: The presence of ANB was retrospectively analyzed in radiographs from patients who presented to the orthopedic foot and ankle at our university hospital from February 2010 to December 2020. The patients were stratified according to sex, age, and diagnosis. For each ANB, recorded information included site, size, classification, subtypes, and symptomatology. Purposive sampling was used to select the patients for the study (non-probability sampling).

Main outcome measures: Prevalence of ANB in patients attending a foot and ankle clinic.

Sample size: 117 patients and 194 feet.

Results: ANB was analyzed in 1006 radiographs from 503 patients. ANB was detected in 117 (23.3%) patients and 194 (19.3%) feet Prevalence was significantly higher in females (67.5%) than in males (32.5%) (Z=5.359, P<.001). The ages ranged from 19 to 86 years, with a mean age of 48.26 (14.5) years. The most common site was bilateral (77 patients, 65.8 %). Type I was the most common type, with a prevalence of 42.1%. There were no significant differences in types in relation to sex, but all types and subtypes differed significantly from each other.

Conclusion: ANB was common among patients presenting to the foot and ankle clinic, with an overall prevalence of 23.3%. It should be considered among the differential diagnosis in chronic foot pain, and should be differentiated from midfoot and hindfoot fractures. Further studies with a larger, randomized sample are needed, for more accuracy and to confirm the reported results.
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NewsBot · Jan 19, 2023

Clinical Outcomes of Fusion in Type II Accessory Naviculars With or Without Asymptomatic Flatfeet
Nian Sun, MD, et al
Source

Background:
Few studies have reported the clinical outcomes of fusion surgeries for type II accessory naviculars. Whether the combination of accessory naviculars and asymptomatic flatfoot will result in worse outcomes in accessory navicular surgeries remains to be elucidated. Our study aims to report the clinical outcomes of fusion for type II accessory naviculars and make a subgroup comparison among accessory navicular patients with or without asymptomatic flatfeet.
Methods:
From May 2017 to June 2021, all painful type II accessory naviculars with or without asymptomatic flatfeet in our inpatient center were reviewed, and those who only underwent fusion surgeries were included in the retrospective study. Visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores, Tegner activity level scores, complications, patient-reported satisfaction, and imaging results (Meary angle in the weightbearing lateral view, talo–first metatarsal angle and talonavicular coverage angle in the weightbearing anteroposterior view) were used to describe outcomes.
Results:
Thirty-two eligible patients responded to the latest follow-up request and were included in this study. The mean follow-up duration was 37.1 ± 16.0 months. The average VAS pain score improved from 4.7 ± 1.8 preoperatively to 0.9 ± 1.2 at the latest follow-up (P<.001). The average AOFAS midfoot score improved from 67.1 ± 8.5 preoperatively to 90.2 ± 10.7 at the latest follow-up (P<.001). The preoperative and postoperative Tegner activity level scores were similar (3.3 ± 1.5 vs 3.5 ± 1.6, P=.136). The overall complication rate was 37.5%. The most common complication was nonunion (31.3%). The overall satisfaction rate was 90.6%. Similar outcomes were observed between the flatfoot and the nonflatfoot subgroups.
Conclusion:
Fusion for painful type II accessory naviculars resulted in good symptom relief, function improvement, and patient satisfaction at midterm follow-up, but the nonunion rate was relatively high. Fusion for painful type II accessory naviculars with or without asymptomatic mild to moderate flatfoot brought about similar clinical outcomes.
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NewsBot · May 17, 2023

Is Kidner procedure necessary during subtalar arthroereisis for pediatric flexible flatfoot that combined with symptomatic type 2 accessory navicular? A retrospective comparative study
Ting-Jiang Gan et al
Foot and Ankle Surgery; 16 May 2023

Background
Kidner procedure is thought to be able to eliminate the medial foot pain and contribute to restoring the medial longitudinal foot arch, making it particularly suitable for surgical treatment of pes planus that combined with symptomatic type 2 accessory navicular (AN). However, controversy remains, and the clinical evidence is still lacking. The aim of the current study is to verify the necessity of Kidner procedure during subtalar arthroereisis (STA) for pediatric flexible flatfoot (PFF) that combined with symptomatic type 2 AN.

Methods
Forty pediatric patients (72 feet) who had undergone STA for flexible flatfoot and were also diagnosed with symptomatic type 2 AN concomitantly were reviewed retrospectively and divided into two groups (STA + Kidner vs STA alone). The visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Oxford ankle foot questionnaire for children (OAFQC), and the radiographic parameters that quantified pes planus were evaluated as primary outcomes. Secondary outcomes included the incidence of complications.

Results
There were 35 feet in the STA + Kidner group and 37 feet in the STA alone group, with mean follow-up periods of 2.7 years and 2.1 years, respectively. The VAS, AOFAS, OAFQC scores and radiographic parameters presented no significant difference between the two groups both preoperatively and at final follow-up (P > 0.05 for each). The complications of STA surgery occurred equally in both groups, and Kidner procedure could lead to more incision problems (22.9% vs. 2.7%) and a longer time to return to activity.

Conclusion
Kidner procedure may be unnecessary during surgical treatment of PFF when combined with painful type 2 AN. Correction of the PFF while leaving the AN alone has a high possibility of relieving the pain in the AN region, and TPT rerouting hardly aids in reconstruction of the medial foot arch.
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NewsBot · Oct 3, 2023

Is the Small Ossicle of Type 1 Accessory Navicular a Cause of Foot Pain?-A Case Report
Takuji Yokoe et al
Medicina (Kaunas). 2023 Aug 28;59(9):1562

Background and objectives: An accessory navicular (AN) bone is often classified into types 1-3 according to the Veitch classification, and symptomatic type 1 patients usually receive non-surgical treatment. However, there are cases in which AN cannot be classified into one of these three types using this classification system, and the small ossicle of type 1 AN may not be the cause of foot pain. This report aimed to present a case of symptomatic type 1 AN that required surgical treatment without the excision of the small ossicle after long-term conservative treatment had failed. Case presentation: A 15-year-old girl who was diagnosed with symptomatic type 1 AN was referred to our department. Medial-side foot pain had prevented her from playing soccer well. She had been treated conservatively for type 1 AN for more than 12 months at several orthopedic clinics. Tenderness of the prominent navicular tubercle was identified, and computed tomography and magnetic resonance imaging findings suggested that the cause of her foot pain was derived from the prominent navicular tubercle not the small ossicle itself. Osteotomy of the prominent navicular tubercle with the advancement of the tibialis posterior tendon, without excision of the ossicle, was performed. At the 12-month follow-up examination, she was completely free from foot pain, and the patient-reported outcome measures were excellent. She now plays soccer at the pre-injury level. Conclusions: We report the case of a patient with symptomatic type 1 AN who underwent osteotomy of the prominent navicular tubercle with advancement of the tibialis posterior tendon, without excision of the ossicle, and who showed favorable short-term clinical outcomes. The evaluation of symptomatic patients with AN based on the Veitch classification alone may lead to inappropriate management. The small ossicle of type 1 AN was not the cause of foot pain in the present case.
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NewsBot · Oct 12, 2023

Plantar Pressure Characteristics and Prevention of
Painful Accessory Navicular in Military Recruits
Xiaopeng Pu et al
J Musculoskelet Neuronal Interact 2023

Objective: The objective of this study was to provide practical guidance for the prevention of painful accessory navicular
among recruits by comparing and analyzing the plantar pressure parameters of individuals with normal foot, flat foot, and
accessory navicular. Methods: After training, a total of 90 military recruits were included in this study, comprising 30 with
normal foot, 30 with flat foot, and 30 with painful accessory navicular. The plantar pressure distribution was measured
for all participants. Results: In individuals with flat feet, there was an increase in plantar pressure on the medial side of
the forefoot, as well as a significant increase in pressure on the medial side of the heel and arch (P<0.05). Conversely,
there was a significant decrease in pressure on the lateral side of the heel and arch (P<0.05). In patients with painful
accessory navicular, the medial pressure on the foot arch showed a further increase (P<0.001), while the lateral pressure
on the foot arch exhibited a further decrease (P<0.001), indicating highly significant differences. Conclusion: Compared
to participants with flat feet, participants with accessory navicular demonstrated faster and more impulsive impact on the
ground within the same stress area, resulting in more noticeable pain caused by the injury to the accessory navicular.
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NewsBot · Oct 25, 2023

Comparison of the effectiveness of two kinds of surgeries for treatment of flexible flatfoot combined with painful accessory navicular bone in children
Mingming Deng et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Oct 15

Objective: To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children.

Methods: The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation.

Results: Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05).

Conclusion: Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.
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NewsBot · Dec 17, 2023

A modified method for reconstruction of posterior tibial tendon after resection of juvenile painful type II accessory navicular
Haoli Gong, Yuyin Xie, Zhenqi Song, Zhongwen Tang, Jie Wen & Sheng Xiao
Journal of Orthopaedic Surgery and Research volume 18, Article number: 912 (2023)

Background
The surgical treatment of accessory navicular (AN) is divided into simple resection of AN and Kidner surgery used to reconstruct posterior tibial tendon (PTT) after AN resection. However, both of these procedures have certain disadvantages. Herein, we proposed a modified method to reconstruct PTT and compared the short-term clinical effect of our method with the modified Kidner procedure.

Methods
We collected data from 23 adolescent children with painful type II AN treated in our department between January 2015 and June 2020. The American Orthopedic Foot and Ankle Society Ankle-Hind foot (AOFAS-AH) Scores, the Meary Angle, and Pitch Angle of the lateral weight-bearing plain radiographs status were recorded before and after the operation to evaluate the treatment outcomes.

Results
In the modified Kidner surgery (MK) group, the median AOFAS-AH increased from 61 (59–68) to 87 (83–91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 13.0 (8–18) to 17.4 (14–22), and the Meary angle decreased from 18.3 (14–24) to 14.2 (8–20) (P < 0.05). In the PTT preservation folded suture (FS) group, the median AOFAS-AH increased from 61 (59–68) to 87 (85–91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 12.3 (7–18) to 18.4 (15–26), and the Meary angle decreased from 17.8 (13–23) to 5.7 (3–8) (P < 0.05). There was no significant difference in AOFAS-AH postoperative scores between the FS group and MK group; however, the improvement on Pitch and Meary angle of the lateral weight-bearing plain radiographs was significantly better in the FS group than in MK group (P < 0.05).

Conclusions
For painful type II AN in juvenile patients, the insertion-preserving folding suture procedure had similar short-term results on AOFAS-AH scores but greater improvement in the Meary angle and the Pitch Angle than the modified Kidner method.
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NewsBot · Dec 28, 2023

Radiologic foot alignment and clinical outcome after percutaneous drilling for symptomatic accessory navicular in skeletally immature children
So Minokawa et al
Medicine (Baltimore). 2023 Dec 22;102(51)

Various surgical treatments are available for a symptomatic AN, including percutaneous drilling (PD). PD is reportedly effective for ANs in skeletally immature children. However, no reports have described the foot alignment after PD in skeletally immature children. This study was performed to compare the radiographic parameters between the preoperative period and the final follow-up after PD for symptomatic ANs in skeletally immature children. From October 2013 to December 2020, PD was performed on 13 feet in 10 skeletally immature children. The patients comprised 5 boys and 5 girls with a mean age at surgery of 11.9 years. The mean follow-up period was 14.8 months. We measured 5 radiographic findings preoperatively and at the final follow-up: calcaneal pitch angle (CPA), talocalcaneal angle (TCA), talonavicular coverage angle (TNCA), anteroposterior talo-first metatarsal angle (ATMA), and lateral talo-first metatarsal angle (LTMA). Ten feet were assessed as excellent, 1 as fair, and 2 as poor. Ten unions (76.9%) were achieved among the 13 feet. The mean CPA improved from 16.4 ± 4.1 degrees preoperatively to 18.2 ± 3.4 degrees at the final follow-up, the TCA improved from 43.0 ± 3.7 to 45.2 ± 4.4 degrees, and the TNCA improved from 19.9 ± 4.4 to 15.4 ± 5.0 degrees (P < .05). The ATMA and LTMA were not significantly different between the preoperative period and final follow-up. We found that PD for symptomatic ANs in skeletally immature children was effective treatment, and some radiographic parameters showed significant differences between the preoperative period and final follow-up.
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NewsBot · Dec 28, 2023

Accessory navicular in children
Feng Xiang et al
World J Clin Cases. 2023 Dec 16;11(35):8256-8262

Accessory navicular (AN) is a developmental variation of the secondary ossification center of the navicular tuberosity. Ten percent of patients with AN will have pain symptoms that affect walking and life. As the AN changes the position of the posterior tibial tendon insertion, children with AN often have posterior tibial tendon function insufficiency and flexible flat foot. Surgical treatment is often required after failure of conservative treatment. This article reviewed the etiology, clinical manifestations, complications, and treatment methods of AN.
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NewsBot · Jan 4, 2024

Plantar Pressure Characteristics and Prevention of Painful Accessory Navicular in Military Recruits
Xiaopeng Pu et al
J Musculoskelet Neuronal Interact. 2023 Dec 1;23(4):436-477.

Objective: The objective of this study was to provide practical guidance for the prevention of painful accessory navicular among recruits by comparing and analyzing the plantar pressure parameters of individuals with normal foot, flat foot, and accessory navicular.

Methods: After training, a total of 90 military recruits were included in this study, comprising 30 with normal foot, 30 with flat foot, and 30 with painful accessory navicular. The plantar pressure distribution was measured for all participants.

Results: In individuals with flat feet, there was an increase in plantar pressure on the medial side of the forefoot, as well as a significant increase in pressure on the medial side of the heel and arch (P<0.05). Conversely, there was a significant decrease in pressure on the lateral side of the heel and arch (P<0.05). In patients with painful accessory navicular, the medial pressure on the foot arch showed a further increase (P<0.001), while the lateral pressure on the foot arch exhibited a further decrease (P<0.001), indicating highly significant differences.

Conclusion: Compared to participants with flat feet, participants with accessory navicular demonstrated faster and more impulsive impact on the ground within the same stress area, resulting in more noticeable pain caused by the injury to the accessory navicular.
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NewsBot · Apr 3, 2024

Treatment of Symptomatic Os Supranaviculare in Athletes
Kazuya Sugimoto et al
Foot Ankle Int. 2024 Mar 16:

Background: Although the incidence of os supranaviculare (OSSN) is generally low, symptomatic OSSN affects athletes. The aim of this study was to assess the variations of OSSN and the results of osteosynthesis between the OSSN and the navicular bone.

Methods: Eleven feet of 10 elite athletes with symptomatic OSSN were treated. There were 3 male and 7 female patients with an average age of 19 years. Eight feet exhibited navicular stress fracture (NSF). Operative treatment was performed in 9 feet of 8 patients and 2 conservatively. Seven OSSNs were fixed with 1 or 2 screw(s) according to their size, using an autologous bone graft. The accompanying NSF was also treated surgically in 4 feet. Foot condition was evaluated using the Japanese Society for Surgery of the Foot (JSSF) midfoot rating scale and sports activity score of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).

Results: The median OSSN was 12.7 mm in width, 5.6 mm in length, and 6.6 mm in height. The dorsal surface of the OSSN required at least 70 mm2 to be fixed using 2 screws. Seven OSSNs of 6 patients treated surgically successfully fused with the navicular. Two small OSSNs that were not stabilized with screws also fused after surgical treatment for NSF. However, one of the 2 OSSNs with NSF treated nonoperatively did not achieve fusion. The patients were followed up for 24-161 months. The median JSSF score improved from 87 to 97.7 postoperatively (P = .00312). The median postoperative SAFE-Q sports score was 84.8. All patients returned to their original activities.

Conclusion: Our results suggest that osteosynthesis with autologous bone graft was effective for symptomatic OSSNs. Even when the OSSN was small and not suitable for internal fixation, treatment of NSF was effective for union of OSSNs. The OSSN possibly belongs to a part or subtype of NSF.
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Accessory navicular

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Should I get my accessory navicular removed?

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Accessory navicular

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Possible Accessory Navicular Fracture?

Accessory Navicular surgery

Accessory Navicular Surgery Poor Outcome

Accessory Navicular Bone

Accessory Navicular Removal Surgery Post Op Recovery Timeline

PTTD, Accessory Navicular Syndrome

Should I get my accessory navicular removed?

Share This Page

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