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Overview
Accessory navicular syndrome occurs when a type II accessory navicular (or "os tibiale externum") becomes painful due to movement across the pseudojoint between the ossicle and the navicular bone. The syndrome presents on MRI with bone marrow oedema signal (hypointense T1, hyperintense T2/STIR) in both the accessory ossicle and navicular. It can be inferred on musculoskeletal ultrasound if a patient's pain is located at a type II accessory navicular and the patient is tender to transducer pressure. Ultrasound can also be useful to compare with the contralateral side.

Accessory Navicular Syndrome

Causes
An accessory navicular develops as a result of a congenital anomaly and is found more often in women. If the bone is large, it may rub against a shoe, causing pain. Because of its location, the posterior tibial tendon may pull on the bone during walking or running, causing the fibrous tissue that connects the accessory navicular to the navicular to tear and become inflamed.

Symptoms
The symptoms of accessory navicular syndrome commonly arise during adolescence, when bones are maturing and cartilage fuses into bone. How does Achilles tendonitis occur? In other instances, symptoms do not appAccessory Navicularear until adulthood. The signs and symptoms include a visible bony prominence on the midfoot the inner side of the foot above the arch. Redness or swelling of the bony prominence. Indistinct pain or throbbing in the midfoot and arch during or after physical activity.

Diagnosis
Keep in mind there are two different types of accessory navicular bones, which you can distinguish by getting a weightbearing AP X-ray of the foot. Dwight has classified type I as a small, round and discreet accessory bone just proximal to the main navicular bone. Geist described the type II accessory bone, which is closely related to the body of the navicular but separated by an irregular plate of dense fibro-cartilage.

Non Surgical Treatment
Treatment options for a painful accessory navicular can include anti-inflammatory medications, rest, arch support structures in the shoe, or use of a cast or splint. Severe cases may require surgery.

Accessory Navicular

Surgical Treatment
The original procedure advocated by Kidner involved shelling out of the accessory navicular bone from within the insertional area of the posterior tibial tendon and rerouting this tendon under the navicular bone in hopes of restoring a normal pull of this tendon. When treating younger children, history has shown us that simply shelling out of the accessory navicular bone from within the tendon and remodeling the tuberosity of the navicular bone can give you satisfactory results.
In general, you want to reserve advancement of the posterior tibial tendon for adults or those who have a more significant flatfoot deformity. You may also use this approach after determining that quality custom orthotics are only resulting in a slight decrease of symptoms.

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:: برچسب ها : What do you do for Achilles tendonitis? , What makes you grow taller during puberty? , How do you get rid of Achilles tendonitis? ,
تاريخ : چهارشنبه 8 شهريور 1396 | 11:56 | نویسنده : Johnnie Quintero |