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What Is the Accessory Navicular?
The accessory navicular bone (i.e. Os Tibialis Externum) is one of the accessory bones located on the inside of the foot. It is located next to the navicular bone on the inner midfoot.
If the accessory navicular bone is causing pain, swelling, or discomfort in the foot, especially during physical activities such as running or jumping, then surgery may be needed.
What Causes Accessory Navicular Problems in the Foot?
In some people, the accessory navicular bone that is present during childhood may be large or shaped in a way that it presses on the surrounding soft tissues. This can cause pain in pediatric patients as well as adults.
Sports that cause repetitive stress to be placed on the inner foot can also cause discomfort along the navicular accessory bone.
Wearing improper shoes that press on the extra bone can cause tenderness as well.
The symptoms of a painful accessory navicular bone include pain and tenderness in the midfoot area, specifically on the inside of the foot. The pain is worsened with physical activity, especially those that involve running or jumping.
In some cases, swelling and redness may also be present. Individuals may experience difficulty walking or wearing shoes, especially those that are tight or place pressure on the affected area.
Accessory Navicular Surgery- What Does It Entail?
Accessory navicular surgery, also known as a “Kidner procedure” is a surgical intervention aimed at removing an accessory navicular bone located on the inner side of the foot.
The surgery is typically performed as an outpatient procedure, which means that patients can go home the same day.
Before the surgery, the patient will receive general anesthesia to ensure that they are asleep and do not feel any pain during the procedure. The surgery itself typically takes between one and two hours to complete.
During the surgery, the surgeon will make an incision on the inside portion of the midfoot. The incision is made in such a way as to minimize scarring and to provide easy access to the accessory navicular bone.
Once the bone is exposed, the surgeon will carefully cut it away using specialized tools. In some cases, the posterior tibial tendon, which attaches to the navicular bone, may need to be detached to remove the extra bone.
After the bone is removed, the surgeon will reattach the posterior tibial tendon using strong anchors. These anchors will remain inside the bone and usually do not need to be removed.
The incision will then be closed using sutures, which are strong threads that help hold the tissue and skin together.
To aid in healing and to ensure that the foot remains stable during recovery, a cast or posterior splint will be applied to the leg.
Accessory Navicular Surgery Recovery
After undergoing accessory navicular surgery, it is crucial to follow proper post-operative care to ensure a successful recovery.
Immediately after the procedure, it is recommended to ice and elevate the affected leg to reduce swelling. Elevating the leg on two pillows will help promote blood flow and reduce inflammation.
It is also important to keep the dressing dry while showering, which can be achieved by using a cast protector.
You will need to remain non-weight bearing on the foot for 6-8 weeks after surgery.
Crutches or a knee scooter can be used to avoid placing weight on the foot. After this initial period, patients can slowly begin weight-bearing in an athletic shoe, as suggested by their physician. However, it is important to avoid strenuous physical activity until fully healed.
Physical therapy is typically recommended 3 times a week for a month to help improve the strength of the posterior tibial tendon and enhance overall balance.
Full recovery after accessory navicular surgery can take up to 3 months.
During this time, it is recommended to wear orthotics, which can help relieve pressure on the posterior tibial tendon and support the arch of the foot.
Custom orthotics are ideal since they are custom-made for each individual’s feet, ensuring a proper fit. Patients can ask their Podiatrist for a prescription for custom orthotics.
While custom orthotics may be costly, they can last anywhere from 5-10 years, making them a worthwhile investment in foot health.
Possible Surgical Complications of the Navicular Bone
- Infection: Infection can occur at the surgical site. If you notice redness, warmth, swelling, and pain at the incision site, you may have an infection. Notify your doctor immediately because you may need antibiotics. If the infection is severe, your doctor may even recommend IV antibiotics.
- Nerve injury: Nerve damage can occur after surgery. Nerve damage can be temporary or permanent. You may experience numbness, tingling, or burning pain at the surgical site. Your doctor will prescribe pain medications to reduce the pain.
- Scar tissue formation: Scarring is also a possible complication of accessory navicular surgery. Scarring can cause the area to appear bumpy and can make it difficult for the foot to move in certain directions.
- Failure of suture anchors: Occasionally, suture anchors that are used in surgery can fail. This can happen due to inadequate bone quality, improper tensioning of the anchors, and anchor fatigue. If the suture anchor has failed, your doctor will remove the anchor in surgery and insert a stronger one.
How Successful Is the Procedure?
Accessory navicular surgery is generally successful in relieving pain and restoring normal foot function. The success rate of the procedure is reported to range from 80-93% (1). This, of course, depends on the patient and the severity of the deformity.
When Can You Drive After Navicular Surgery?
The recommended duration of time to wait before driving after foot surgery varies depending on which foot was operated on.
For those who underwent surgery on their right foot, it is advised to wait for six to eight weeks before driving. Do not attempt to drive while wearing a cast. Only when you are comfortable walking and able to move your ankle up and down should you consider driving.
On the other hand, those who had surgery on their left foot should wait for two to three weeks before driving. It is suggested to keep the foot elevated for most of the day during the first few weeks after surgery.
Also, it is important not to take any narcotics before driving as this can be hazardous. Always follow your doctor’s instructions and ask for their advice before resuming any driving activities.
How Long Should You Take Off Work After Navicular Surgery?
Navicular problems can make it difficult to work. The amount of time needed off work after accessory navicular surgery varies based on the job and the individual’s health.
If the job requires sitting, it is suggested that you take one to two weeks off to allow your foot to recover and reduce the possibility of complications.
During this time, keep the foot elevated and avoid placing too much weight on it.
Returning to a more physically demanding job may take weeks or even months.
Is an Accessory Navicular Bone Dangerous?
While an accessory navicular bone is not inherently dangerous, it can lead to pain and discomfort due to its location and tendency to impinge on nearby soft tissue structures.
Conclusion
In conclusion, accessory navicular syndrome is a common condition that can cause discomfort and pain in the foot. While many cases can be managed with conservative treatments and pain medicine, some patients may require surgery to alleviate their symptoms.
If you are experiencing pain or discomfort in your foot, it is important to schedule an appointment with a Podiatrist or an MD Orthopedic specialist to receive an accurate diagnosis and appropriate treatment.
With proper care, patients with accessory navicular conditions can find relief and improve their quality of life.
Related article: Accessory Navicular: Causes, Symptoms & Treatment for Navicular Pain
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References
- Wariach S, Karim K, Sarraj M, Gaber K, Singh A, Kishta W. Assessing the Outcomes Associated with Accessory Navicular Bone Surgery-a Systematic Review. Curr Rev Musculoskelet Med. 2022 Oct;15(5):377-384.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463416/
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