Painful Accessory Navicular Treated With Fusion of the Synchondrosis

Painful type II accessory navicular

Failure of conservative care

The hallmark of the examination is focal pain over the accessory navicular.

Posterior tibial tendon function may be compromised by pain at the accessory navicular, although unassisted toe rise is still possible.

A flatfoot deformity, with increased heel valgus, may develop in advanced cases.

Standing anteroposterior ( Fig. 29.1A ), lateral ( Fig. 29.1B ), and oblique ( Fig. 29.1C ) views of the foot should be obtained.

A computed tomography scan through the navicular helps determine if the accessory piece is of sufficient size to accept a screw.

Magnetic resonance imaging is helpful if concomitant posterior tibial tendinopathy is present, which is unusual.

Orthotics may be helpful for mild symptoms.

A walking cast for 4–6 weeks should be tried prior to operative intervention.

Physical therapy may be beneficial in select cases.

There are three types of accessory navicular ( Fig. 29.2A ).

This procedure is used for type II accessory navicular ( Fig. 29.2B ).

The patient is placed supine.

A bump under the contralateral hip will help externally rotate the leg.

An ankle tourniquet may be used, but a thigh tourniquet is preferable as it places no tension on the posterior tibial muscle or tendon during the repair.