What is Accessory Navicular Removal?
An accessory navicular is an extra bone or piece of cartilage located on the inner side of the foot, just above the arch. While this condition can occur from birth, it can become symptomatic due to various factors, demanding surgical intervention in some cases. Accessory navicular removal is a surgical procedure performed to alleviate pain and discomfort associated with this condition.
Anatomy and Pathophysiology
The navicular bone is a key structure in the medial longitudinal arch of the foot. An accessory navicular is a congenital anomaly found in approximately 10-12% of the population. This extra bone can be classified into three types:
- Type I: A sesamoid bone embedded within the posterior tibial tendon.
- Type II: A larger, triangular bone connected to the navicular by a cartilaginous or fibrous bridge.
- Type III: A fused, prominent navicular bone resulting from the ossification of the accessory bone.
Symptoms of Accessory Navicular Removal
Symptoms often arise due to irritation, inflammation, or degeneration of the posterior tibial tendon, leading to medial foot pain and discomfort, particularly during physical activities.
Indications for Accessory Navicular Removal Surgery
Surgical removal of an accessory navicular is typically considered after failure of conservative treatments. Indications for surgery include:
- Persistent pain despite non-surgical interventions such as orthotics, physical therapy, or anti-inflammatory medications.
- Recurrent inflammation or tendinitis of the posterior tibial tendon.
- Significant interference with daily activities or sports participation.
Preoperative Assessment of Accessory Navicular Removal
A thorough clinical evaluation will be done by your healthcare provider, including:
- Detailed medical history and physical examination focusing on the medial aspect of the foot.
- Imaging studies like X-rays, MRI, or CT scans to assess the type of accessory navicular and the condition of the surrounding soft tissues.
- It is advised to discontinue any nonsteroidal anti-inflammatory drugs (NSAIDs) for a minimum of seven days prior to the procedure.
Surgical Technique of Accessory Navicular Removal
The surgical approach depends on the type of accessory navicular and the extent of the symptoms. Common steps include:
- Excision of the Accessory Navicular: The extra bone is removed through an incision on the medial side of your foot. The posterior tibial tendon is also inspected and repaired if necessary.
- Reattachment of the Posterior Tibial Tendon: In addition to excision, the posterior tibial tendon is relocated and reattached to the navicular bone to improve foot function and relieve tension on the tendon.
Postoperative Care of Accessory Navicular Removal
Postoperative management includes:
- Immobilization: Your foot will be typically immobilized in a cast or boot for 2-4 weeks to allow for initial healing.
- Gradual Weight Bearing: You may gradually transition to weight-bearing activities based on pain and healing progress.
- Physical Therapy: Rehabilitation exercises are crucial for restoring strength, flexibility, and function of the foot.
Potential Complications of Accessory Navicular Removal
As with any surgical procedure, accessory navicular removal carries its risks, including:
- Infection
- Nerve damage
- Incomplete pain relief or recurrence of symptoms
- Delayed wound healing or scar formation
Outcomes of Accessory Navicular Removal
You may experience significant pain relief and improved foot function following accessory navicular removal. Long-term outcomes are generally favourable, with most individuals returning to their normal activities and sports participation within a few months post-surgery.
