Symptomatic Accessory Navicular Bone Research Articles

Four-Year Treatment Effect of Custom-Made Foot Orthosis on Pediatric Symptomatic Accessory Navicular Bone Combined with Flexible Flatfoot

Four-Year Treatment Effect of Custom-Made Foot Orthosis on Pediatric Symptomatic Accessory Navicular Bone Combined with Flexible Flatfoot

Symptomatic accessory navicular bone: A case report

Symptomatic accessory navicular bone is a rare condition. The authors report the case of a 30-year-old nurse who had chronic pain in the medial face of her right foot that was resisting to medical treatment. The Radiography revealed the presence of a large accessory navicular bone. Since the treatment was inefficacy, though well conducted, a surgical treatment was administered to the patient which allowed the complete regression of her symptoms. In this case, we will report the diagnostic elements and the different surgical modalities.

Effectiveness of Non-operative Treatment of Symptomatic Accessory Navicular in Pediatric Patients

Category: Midfoot/Forefoot Introduction/Purpose: Initial management of symptomatic accessory naviculae in pediatric patients is nonoperative. Common first line treatments include casting, shoe wear modification, limiting strenuous activities, and nonsteroidal anti-inflammatories. When nonoperative treatments fail to mitigate symptoms, surgery is indicated. Surgical treatment of symptomatic accessory navicular bones has been extensively studied. However, the efficacy of nonoperative treatment for alleviating pain or preventing surgery in effected patients has not been established. We believe that nonoperative treatment is frequently unsuccessful or does not give lasting pain relief, thus questioning whether surgery could be offered as first line treatment. Our study retrospectively reviews outcomes of adolescents treated non-operatively for symptomatic accessory naviculae in an effort to provide clinicians success rates for their discussion of treatment options with patients and their families. Methods: This is an IRB approved, retrospective study of adolescent patients diagnosed and treated non-operatively for symptomatic accessory navicular bones at Cincinnati Children’s Hospital Medical Center between the dates 8/1/2006 and 8/24/2016. Medical records were used to identify demographic information, type, duration, and total trials of conservative treatment, additional foot comorbidities, response to conservative management, and surgery if non-operative management failed. Included patients were under 18 years of age with medial sided foot pain, radiographic evidence of an accessory navicular, and had undergone at least 1 course of non-operative treatment. Patients with previously operated on accessory naviculars or other diagnosed painful foot conditions were excluded. Outcome measures consisted of pain relief, no surgical intervention, or need for surgical intervention. Available radiographic imaging for each patient was also used to identify type of accessory navicular and determine pes planus incidence. Statistical analysis using measures of central tendency was then performed. Results: 169 patients were included, with 226 symptomatic accessory naviculae. Average age at diagnosis was 11.8 years, with 78.2% females, and 22% males. 53 (32%) were left symptomatic accessory naviculae, 56 (33%) right, and 60 (36%) bilateral. Type II accessory naviculae were most frequent (72.7%), with Type I and Type III in 9.7% and 17.4%, respectively. 56% were chronic in nature, with 31% due to acute injury. Average number of non-operative trials was 2.08, with 28% experiencing complete pain relief, 30% requiring surgical intervention, and 41% that did not require surgical intervention, but were without documented pain relief. Of those that achieved complete pain relief, average length of non-operative treatment was 8.03 months. Conclusion: Results of this study can be used by clinicians to frame discussions surrounding treatment options for symptomatic accessory navicular bones with both patients and their families. Further research is warranted to determine the necessary duration and type of non-operative treatment, among those most commonly used, that is most successful in providing pain relief.

Symptomatic accessory navicular bone: A case series

IntroductionAccessory navicular bone (ANB) is present in 4–20% of the general population. It can cause of midfoot pain and consequently may lead to flat foot. The patient usually presents with pain and swelling on the medial aspect of the foot with difficulty on walking. Diagnosis is often delayed. Case reportsWe report the clinical presentation and outcome of five cases from Pakistan with symptomatic ANB comprised of four males and one female (23–45years) that were diagnosed after a significant delay. The mean duration of symptoms was one year before final diagnosis. Three cases involved the left foot while 2 were on the right side. Flat foot (pes planus) was present in one case while 2 others had a depressed medial longitudinal arch. Overuse activities including prolonged standing and excessive walking typically precipitated onset of symptoms while the female case was also overweight. Diagnosis was clinically suspected and confirmed by radiological investigations. Three patients were diagnosed with type II ANB and two with type III. Conservative management included RICE (Rest, Ice, Compression and Elevation), non-steroidal anti-inflammatory drugs (NSAIDs), foot orthotics, activity modification, patient education, and foot care. One of the patients further used a POP boot. All cases had a good recovery and were pain free at six months follow up. ConclusionsConservative treatment is sufficient for most patients while surgical treatment is usually reserved for those with chronic persistent pain and complications. Early diagnosis and management can halt the progression of ANB to chronic pain and foot deformities.

Clinical Meaning of Hot Uptake on Bone Scan in Symptomatic Accessory Navicular Bones.

We analyzed clinical factors related to uptake on a Tc-99m HDP bone scan of the accessory navicular (AN). We retrospectively reviewed patients who had been examined by an orthopedic surgeon and underwent bone scan due to suspected symptomatic AN. A three-point grading system was used to evaluate uptake on bone scan. Relationships between grade, symptoms, age, gender, symptom duration, and bone size were analyzed. In total, 73 ANs (30 asymptomatic, 43 symptomatic) were enrolled. The majority of asymptomatic ANs had no uptake but some had grade 1 (n = 8) or 2 (n = 2) uptake. All asymptomatic ANs with uptake remained asymptomatic during follow-up. For the asymptomatic ANs, larger bones showed a higher grade. With a cut-off value of size ≤6.8mm, there is no chance of uptake. All symptomatic ANs showed uptake on bone scan. For symptomatic ANs, larger size and shorter pain duration were related to a higher grade. Age, gender, and left-/right-sideness were not related to grade. Multiple regressions revealed that only uptake grade, not size or symptom duration, was the significant risk factor for a symptomatic AN. With a cut-off value of grade <1, a symptomatic AN could be ruled out with a negative predictive value of 100%. Bone scanning is useful for symptomatic ANs with a high negative predictive value. Higher grade is related to larger size and shorter pain duration. For asymptomatic ANs, grade was related to size but did not predict symptom development.

The patellofemoral joint alignment in patients with symptomatic accessory navicular bone

Quadriceps angle (Q angle) provides useful information about the alignment of the patellofemoral joint. The aim of the present study was to assess a possible link between malalignment of the patellofemoral joint and symptomatic accessory navicular (AN) bone as an underlying cause in early adolescence using Q angle measurements. This study was performed on patients presenting to the Foot and Ankle Clinic at the Jordanian Royal Medical Services because of pain on the medial side of the foot that worsened with activities or shoe wearing, with no history of knee pain, between September 2013 and April 2015. The Q angle was measured using a goniometer in 27 early adolescents aged 10-18 years diagnosed clinically and radiologically with symptomatic AN bone, only seven patients had associated pes planus deformity; the data were compared with age appropriate normal arched feet without AN. Navicular drop test (NDT) was used to assess the amount of foot pronation. The mean Q angle value among male and female patients with symptomatic AN with/without pes planus was significantly higher than in controls with normal arched feet without AN (p<0.05). Symptomatic AN feet were also associated with higher NDT values (p<0.001). The present findings suggest an early change in patellofemoral joint alignment in patients with symptomatic AN bone with/without arch collapse. Therefore, it is recommended that Q angle assessment should be an essential component of the examination in patients with symptomatic AN bone.

Symptomatic accessory navicular bone: A case series

Symptomatic accessory navicular bone: A case series

Incremental value of single photon emission tomography/computed tomography in 3-phase bone scintigraphy of an accessory navicular bone.

Accessory navicular bone is one of the supernumerary ossicles in the foot. Radiography is non diagnostic in symptomatic cases. Accessory navicular has been reported as a cause of foot pain and is usually associated with flat foot. Increased radio tracer uptake on bone scan is found to be more sensitive. We report a case highlighting the significance of single photon emission tomography/computed tomography in methylene diphosphonate bone scan in the evaluation of symptomatic accessory navicular bone where three phase bone scan is equivocal.

Accessory navicular bone incidence in Chinese patients: a retrospective analysis of X-rays following trauma or progressive pain onset

Optimal treatment of symptomatic accessory navicular bones, generally asymptomatic 'extra' ossicles in the front interior ankle, remains debated. Incidence and type of accessory navicular bones in Chinese patients were examined as a basis for improving diagnostic and treatment standards. Accessory navicular bones were retrospectively examined in 1,625 (790 men and 835 women) patients with trauma-induced or progressive symptomatic ankle pain grouped by gender and age from August 2011 to May 2012. Anterior-posterior/oblique X-ray images; presence; type; affected side; modified Coughlin's classification types 1, 2A, 2B, and 3; and subgroups a-c were recorded. Accessory navicular bones were found in 329 (20.2%) patients (143 men and 186 women; mean age, 47.24 ± 18.34, ranging 14-96 years). Patients aged 51-60 exhibited most accessory navicular bones (29.7%), with risk slightly higher in women and generally increasing from minimal 10.9% at ages 11-20 to age 51 and thereafter declining to 0.4% by age 90. The incidence was 41.6% for Type 1 (Type 1a: 9.1%, Type 1b: 15.5%, and Type 1c: 19.4%), 36.8% for Type 2 (Type 2Aa: 2.1%, Type 2Ab: 13.7%, Type 2Ac: 5.1%, Type 2Ba: 2.1%, 2Bb: 2.1%, and 2Bc: 11.6%), and 21.6% for Type 3 (Type 3a: 4.5%, Type 3b: 14%, and Type 3c: 3.0%). Approximately one-fifth (20.3%) of ankle pain patients exhibited accessory navicular bones, with Type 2 most common and middle-aged patients most commonly affected. Thus, accessory navicular bones may be less rare than previously thought, underlying treatable symptomatic conditions of foot pain and deformity.

Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones

Accessory navicular bones might cause not only cosmetic problems but also be a reason of discomfort and pain. In case of inefficient conservative treatment symptomatic accessory naviculars are treated surgically. Presentation of results of simple excision of symptomatic accessory navicular. Material consists of 22 patients (34 feet), 17 women and 5 men, treated surgically between 1992 and 2006. Mean age at surgery was 14.1 years (9-22 years). Accessory navicular type I was present in 5 feet (14.7%), type II in 17 (50%) and type III-in 12 (35.3%). Main symptom was localized pain on the medial arch of the foot, in the height of navicular bone. Surgery consisted of simple accessory navicular excision and if needed partial resection of navicular bone. The mean follow-up period was 5.6 years (1-13 years). We analyzed: intensity of pain (VAS score system), daily and sport activity. Subjective results were analyzed using a questionnaire. The questionnaire was returned from 21 patients: 9 patients had total pain relief, 11 considerable and one patient had persistent pain. Mean VAS results before surgery was 5.9 and 1.7 after surgery. Only one patient required analgesics occasionally. Complications were present in two patients (6.1%). All active patients returned to their sport activities. Surgical treatment of symptomatic accessory navicular by simple excision technique gives satisfying results, surgery is minimally traumatic and risk of complications low.

The symptomatic accessory navicular bone: A report and discussion of the clinical presentation

An accessory navicular bone is a congenital anomaly caused by aberrant ossification. Usually asymptomatic, they are relatively common in our population. They can present in several different locations, which can have an impact on the clinical presentation and the degree of dysfunction. Occasionally, these can become symptomatic, which can manifest as chronic or acute on chronic foot pain. Diagnosis of this condition relies on radiographic evaluation. The 45-degree eversion oblique view of the foot is the most important view for identifying this condition, although several different imaging techniques can be used. Treatment of this condition includes both surgical and nonsurgical options. Ultimately, surgery yields the best outcome for young patients, though conservative management has relevance for less active patients. The following case demonstrates the presence of a symptomatic accessory navicular bone in a young athlete.

Symptomatic and Asymptomatic Accessory Navicular Bones: Findings of Tc-99m MDP Bone Scintigraphy

AIM: The accuracy of bone scintigraphy in diagnosing symptomatic accessory navicular bones has not been well studied. We conducted a retrospective study to explore the results and use of scintigraphy in symptomatic and asymptomatic accessory navicular bones.MATERIALS AND METHODS: Thirteen patients with a total of 13 symptomatic and 10 asymptomatic accessory navicular bones were included in the study. We used a scoring system to grade the scintigraphic abnormalities. The patients’ symptoms and scintigraphic findings were recorded.RESULTS: Though focally increased radiopharmaceutical uptake was observed in all symptomatic accessory naviculars, half of the asymptomatic accessory navicular bones had the same manifestations. The scoring system was of no value in differentiating symptomatic from asymptomatic accessory navicular bones.CONCLUSION: Bone scintigraphy is a sensitive but not a specific tool for diagnosing a symptomatic accessory navicular.Chiu, N.-T. (2000). Clinical Radiology55, 353–355.

The symptomatic accessory tarsal navicular bone: assessment with MR imaging.

To determine if a symptomatic accessory navicular bone, a normal variant, displays a pattern of altered signal intensity on magnetic resonance (MR) images indicative of an abnormality that could account for the patient's foot pain. Both feet were imaged in seven patients with an accessory navicular bone on radiographs and unilateral foot pain. Five patients had focal medial foot pain, and two had vague, diffuse pain. T1-weighted spin-echo and T2-weighted fat-suppressed sequences were used. A bone marrow edema pattern (BMEP) was noted in the accessory navicular bones of the five patients with focal pain and in the adjacent navicular tuberosities of three of them. The two patients with vague pain showed no osseous or soft-tissue abnormalities. Two patients with positive MR images underwent surgical excision of the accessory navicular bone, and histologic examination revealed osteonecrosis in one patient. The BMEP in a symptomatic accessory navicular bone is indicative of chronic stress and/or osteonecrosis. This information can furnish an objective basis for surgical or conservative management.