What causes pain behind the heel?

Large Accessory Navicular Bone


Overview
Some people have more bones in their feet than others. Actually, it?s not all that uncommon to have extra bones in the feet. These extra bones area called accessory bones. The navicular bone, one of the small bones located at the instep or arch of the middle of the foot, is an example of an extra bone people are born with. It?s called the accessory navicular bone. During the maturation process, the navicular and the accessory navicular never fuse into one solid bone, but remain connected by fibrous tissue or cartilage. It is estimated that 4-14% of the population are born with an accessory navicular bone.

Accessory Navicular

Causes
People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following. Trauma, as in a foot or ankle sprain. Chronic irritation from shoes or other footwear rubbing against the extra bone. Excessive activity or overuse.

Symptoms
It?s common for any symptoms to present during adolescence, when bones are maturing, though problems may not occur until adulthood. You may notice a bony prominence on the inner side of the midfoot. There may or may not be redness and swelling around this bump, especially if it rubs against footwear. You may be prone to blisters or sores in the area. Pain generally involves a vague ache or throbbing in the midfoot and arch as well, especially when you?re active. Many people with this syndrome develop flat feet, too, which can create additional strain in the foot.

Diagnosis
An initial assessment What is the Ilizarov method? an orthopaedic office begins with a thorough history and complete physical exam, including an assessment of the posterior tibial tendon and areas of tenderness. Associated misalignments of the ankle and foot should be noted. Finally, weight-bearing x-rays of the foot will help in making the diagnosis. Sometimes, an MRI may be needed to see if the posterior tibial tendon is involved with the symptoms or getting more clarity on the anatomy of the accessory navicular.

Non Surgical Treatment
Rest is the most important factor in relieving your pain. You may need to immobilize your foot to allow the affected tissues to rest enough that they can heal. Icing the area will help decrease any inflammation and swelling. Our staff may recommend anti-inflammatory medications as well. Most likely you will need to change your footwear-and possibly add orthotics-to accommodate your bony prominence and relieve strain in the midfoot. Sometimes physical therapy may be able to help strengthen tissues and prevent additional injuries.

Accessory Navicular

Surgical Treatment
For patients who have failed conservative care or who have had recurrent symptoms, surgery can be considered. Surgical intervention requires an excision of the accessory navicular and reattachment of the posterior tibial tendon to the navicular. Often times, this is the only procedure necessary. However, if there are other deformities such as a flat foot or forefoot that is abducted, other procedures may be required.

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Foot Pain Accessory Navicular Bone


Overview
Everyone has one navicular bone: one of the small bones of the foot. A small number of people have a second small navicular bone or piece of cartilage located on the inside of the foot just above the arch: both are simply called an "accessary navicular bone." It is located within the posterior tibial tendon which attaches in this area. It is easy to see as a "bump." Most that have it never have pain. If they get pain, we call it: "Accessary navicular bone syndrome."

Accessory Navicular

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
Perhaps the most common of the extra bones in the foot, the accessory navicular bone is estimated to be present in 7 to 19 percent of the population. Zadek and Gold maintained that the bone persisted as a distinct, separate bone in 2 percent of the population. Also be aware that the accessory bone normally fuses completely or incompletely to the navicular. It is this incomplete fusion which allows for micromotion, which, in turn, may cause degenerative changes that How can I increase my height after 18? also contribute to the pain.

Diagnosis
The foot and ankle are prone to bony ?accessories? which usually have no accompanying symptoms. Accessory navicular syndrome is often diagnosed when an adolescent complains of pain in the foot. Girls are more susceptible than boys, and the condition is usually bilateral, occurring in both feet. Navicular accessory syndrome may be diagnosed when a trauma (foot or ankle sprain) aggravates the bone or tibial tendon, or when there is chronic irritation from footwear or overuse.

Non Surgical Treatment
The treatment for a symptomatic accessory navicular can be divided into nonsurgical treatment and surgical treatment. In the vast majority of cases, treatment usually begins with nonsurgical measures such as orthotics, strappings or bracing. Surgery usually is only considered when all nonsurgical measures have failed to control your problem and the pain becomes intolerable.

Accessory Navicular Syndrome

Surgical Treatment
Fusion of the accessory navicular to the navicular with screws is required when there is a large accessory navicular bone and removal of this bone would reduce the articular surface of the Navicular to the talus (coxa pedis). Fusion will relieve pain without disrupting the tibialis posterior tendon insertion nor narrowing talar head support. In most instances, a patient’s recovery will be as follows. 0-6 weeks: Immobilization (in case or cast boot) non-weight-bearing or touch weight-bearing. 6-10 weeks: Increasing activity in a cast boot. Physical therapy to work on strength and balance. Full recovery after 9 weeks-2 months. In some patients (where the posterior tibial tendon is still intact and functioning) the treating surgeon may allow weight-bearing as tolerated in a cast boot immediately after surgery.

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