What Is Accessory Navicular Syndrome?

The accessory navicular is an extra bone or piece of cartilage, also known as an accessory bone, located on the inner part of the foot near the arch. Accessory navicular is a congenital condition, meaning you’re born with an additional bone or piece of cartilage in the foot. The accessory navicular begins as an additional bone or cartilage growth near the navicular bone, often forming during adolescence. However, symptoms don’t always appear right away. Some people only develop pain or discomfort later in life, often due to overuse, injury, or increased activity. Typical accessory navicular symptoms include pain, swelling, and redness, which often relate to the affected part of the foot.

The accessory navicular is considered a normal anatomical variation, though it can sometimes lead to a condition known as accessory navicular syndrome. The accessory bone is not essential for normal foot function. This occurs when the extra bone becomes inflamed or puts pressure on nearby tendons and nerves. It is more common in people who are active in sports or have jobs that involve prolonged standing or physical activity.

Understanding the Anatomy of the Foot

The human foot is a remarkable structure made up of 26 bones, numerous tendons, and strong ligaments that work together to provide both stability and flexibility. At the heart of the foot’s arch is the navicular bone, a small, flat bone located on the inner side of the foot. This bone plays a crucial role in maintaining the arch and supporting normal foot function.

One of the most important structures supporting the arch is the posterior tibial tendon. This tendon connects the calf muscle to the navicular bone, helping to hold up the arch and allowing for smooth movement during walking and running. When the posterior tibial tendon is healthy, it keeps the arch stable and prevents the foot from rolling inward excessively.

In some people, an extra bone called the accessory navicular develops on the inner side of the foot, just above the navicular bone. While this accessory navicular bone is often a normal variant and may not cause any issues, it can sometimes lead to a painful condition known as accessory navicular syndrome. This happens when the extra bone causes chronic irritation, direct pressure, or inflammation, especially if it is connected to the navicular bone by cartilage or fibrous tissue.

Accessory navicular syndrome can develop when the posterior tibial tendon becomes irritated or inflamed due to the presence of the extra bone. This can result in pain, swelling, and tenderness along the inner side of the foot, particularly during activities that put stress on the arch. In some cases, the accessory navicular bone acts like a sesamoid bone— a small bone embedded within a tendon that helps reduce friction and improve mechanical function— and can become a bony enlargement that presses on the tendon, causing discomfort.

Diagnosing accessory navicular syndrome typically involves a thorough physical exam, a review of your medical history, and imaging tests such as imaging tests such as X-rays or MRI scans. Foot and ankle surgeons are specially trained to diagnose accessory navicular syndrome and can recommend the most effective treatment options. Nonsurgical treatments often include Physical therapy to strengthen the muscles around the foot and ankle, custom orthotic devices or arch support to relieve pressure, and pain relief medications. In some cases, injected steroid medications can help reduce swelling and relieve symptoms. A removable walking boot or cast may be used for a short period to immobilize the foot and allow inflammation to subside.

If nonsurgical treatments do not provide enough relief, surgical intervention may be considered. Surgical treatment usually involves removing the accessory navicular bone and, if necessary, repairing the posterior tibial tendon to restore normal function. The goal of any treatment—whether nonsurgical or surgical management—is to relieve symptoms, reduce pain and swelling, and help you return to your normal activities.

It’s important to seek treatment for accessory navicular syndrome, as chronic irritation and pain can lead to further complications such as flat feet (pes planus) or fallen arches. Early childhood and adolescence are critical periods for foot development, and any abnormalities, such as an accessory navicular bone, can become more pronounced as the foot grows. Activity modification, such as avoiding weight-bearing activities, can help reduce pain, and physical therapy can improve strength and range of motion in the affected area.

If you’re experiencing persistent foot pain, swelling, or a bony prominence on the inner side of your foot, consulting a foot and ankle surgeon or orthopedic surgeon is the best way to diagnose accessory navicular syndrome and determine the right treatment plan for you. With the right care, most patients can achieve lasting relief and restore normal foot function.

When Accessory Navicular Bone Syndrome Becomes a Daily Problem

Accessory navicular bone syndrome can become a source of chronic pain and discomfort that interferes with daily life. The development of pain often depends on factors like foot structure, activity level, and footwear. Recognizing the signs early can help guide appropriate care before the condition worsens. When there is a real injury to the accessory navicular bone, it can become a source of constant pain and discomfort. This is especially true if the bone becomes irritated due to increased activity or repeated pressure. Symptoms often include:

• Pain on the inner side of the foot

• Discomfort when standing, walking, or engaging in physical activities

• Swelling around the inner arch of the foot

• Tenderness to touch on the medial side of the foot

• Limited range of motion in the foot or ankle due to pain

• Difficulty wearing certain shoes due to irritation or pressure

• Bony prominence or a noticeable bump on the inner side of the foot

If your pain from an accessory navicular is becoming a daily concern, it’s important to manage it early. Early evaluation can help prevent long-term complications and ensure you receive the most effective treatment.

Is the Accessory Navicular Bone Dangerous?

While accessory navicular bone pain can be uncomfortable and disruptive, it is generally not considered dangerous. Most individuals with this condition can manage the pain with conservative treatments like rest, ice, and physical therapy. If left untreated, the pain may worsen or lead to more significant mobility issues.

In rare cases, if the pain becomes chronic or severe, it may lead to permanent damage or difficulty with movement. If you’re experiencing persistent discomfort, it’s essential to consult a healthcare provider for proper diagnosis and treatment options. Early intervention may help alleviate symptoms and restore proper function.

Managing Flare-Ups of Accessory Navicular Bone Pain

When the pain from accessory navicular syndrome flares up, there are ways to manage it. Some strategies include:

• Ice and elevation: Applying ice to the affected area can reduce inflammation, while elevating your foot helps improve blood flow and decrease swelling.

• Over-the-counter pain relievers: Medications like ibuprofen or acetaminophen can help control pain and reduce inflammation.

• Activity modification: Temporarily avoiding activities that exacerbate pain, like running or standing for long periods, can allow your foot to recover.

Reducing inflammation and preventing flare-ups starts with taking care of your overall well-being. Managing stress, getting restful sleep, and eating a nutrient-rich diet all play a vital role in how your body responds to pain and heals over time. Chronic stress and poor sleep can heighten pain sensitivity and slow recovery, while a balanced diet helps your body repair and stay resilient. By prioritizing these foundational habits, you can better manage your symptoms and reduce the likelihood of future flare-ups. (Add internal link here.)

Choosing the Right Footwear for Accessory Navicular Syndrome

Wearing the right shoes is key to managing accessory navicular pain. Shoes that press on the medial arch of the foot can irritate the bone and worsen symptoms. To reduce discomfort, it’s important to wear shoes with the following features:

• Wide toe box: Helps avoid pressure on the foot, particularly around the arch.

• Arch support: Provides even weight distribution across the foot, reducing strain on the accessory navicular.

• Cushioned soles: Absorb shock and relieve stress on the foot during walking or running.

For additional support, custom orthotics can be highly beneficial. These specially designed insoles provide extra arch support and help align the foot, reducing pain caused by the accessory navicular. If you’re interested, Resurgens offers podiatry evaluations and custom orthotics to help you find the best footwear solution.

Staying Active With Accessory Navicular

Although accessory navicular syndrome can limit certain activities, there are still plenty of low-impact exercises that can help you stay active without aggravating your condition. Some of the best options include cycling, swimming, and yoga. These exercises reduce stress on the foot while improving strength, flexibility, and circulation. Always consult your healthcare provider or physical therapist to ensure your exercise routine is safe and appropriate for your specific condition.

In addition to low-impact activities, physical therapy plays a critical role in strengthening the muscles and improving blood flow around the foot and ankle. A physical therapist can teach you exercises designed to prevent flare-ups and help you comfortably move toward a full recovery. Physical therapy and low-impact exercises are great ways to stay active and give your body the support it needs to heal properly.

When to Re-Evaluate Your Treatment Plan

If your pain persists or worsens despite conservative treatments, it may be time to revisit your treatment plan. Signs that you may need more advanced care include:

• Increased pain, especially if over-the-counter medications aren’t effective

• Limited mobility or difficulty walking and standing

• No relief from rest or activity modification

Accessory Navicular Treatment

There are both nonsurgical and surgical treatment options for accessory navicular syndrome. Your plan will depend on the severity of your condition.

Nonsurgical Treatment

Nonsurgical care focuses on relieving symptoms with simple, at-home methods such as:

• Ice

• Immobilization

• NSAIDs

• Physical therapy

• Orthotic insoles to support the arch

Surgical Treatment

If the condition does not improve with nonsurgical care, surgery may be necessary to remove the extra bone. Since the accessory navicular is not required for normal function, removing it often alleviates symptoms after recovery. In some cases, the bone is removed and the posterior tibial tendon reattached to the sole of the foot. Accessory navicular bone surgery is about 90% effective at relieving pain.

If you’re struggling with accessory navicular pain, schedule an appointment with a Resurgens Foot physician today and get moving again.