Pain After Accessory Navicular Surgery

Overview

The navicular bone of the foot is one of the small bones on the mid-foot. The bone is located at the instep, the arch at the middle of the foot. One of the larger tendons of the foot, called the posterior tibial tendon, attaches to the navicular before continuing under the foot and into the forefoot. This tendon is a tough band of tissue that helps hold up the arch of the foot. If there is an accessory navicular, it is located in the instep where the posterior tibial tendon attaches to the real navicular bone.

Accessory Navicular

Causes

An injury to the fibrous tissue connecting the two bones can cause something similar to a fracture. The injury allows movement to occur between the navicular and the accessory bone and is thought to be the cause of pain. The fibrous tissue is prone to poor healing and may continue to cause pain. Because the posterior tibial tendon attaches to the accessory navicular, it constantly pulls on the bone, creating even more motion between the fragments with each step.

Symptoms

If you develop accessory navicular syndrome, you may experience a throbbing sensation or other types of pain in your midfoot or arch (especially while or right after you use the foot heavily, such as during exercise), and you may notice a bony prominence on the interior of your foot above the arch. This prominence may become inflamed, which means it will likely feel warm to the touch, look red and swollen, and will probably hurt.

Diagnosis

To diagnose accessory navicular syndrome, medical staff ask about the patient?s activities and symptoms. They will examine the foot for irritation or swelling. Medical staff evaluate the bone structure, muscle, joint motion, and the patient?s gait. X-rays can usually confirm the diagnosis. MRI or other imaging tests may be used to determine any irritation or damage to soft-tissue structures such as tendons or ligaments. Because navicular accessory bone irritation can lead to bunions, heel spurs and plantar fasciitis, it?s important to seek treatment.

Non Surgical Treatment

Most cases of accessory navicular syndrome may be treated conservatively with some sort of immobilization. This should allow the fibrous tissue between the two bones to heal. If a patient is extremely flat footed (pronated) then I lean more towards an orthotic than a boot as my main goal is to keep the patient's foot from flattening out too much and thus reduce the strain on the two bones. Supplementation with ice, oral anti-inflammatory medication. If the patient is athletic sometimes we can keep them active with an orthotic, but other times they have to give up their sport for a period of time to allow the condition to heal.

Accessory Navicular Syndrome

Surgical Treatment

If non-surgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area, and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function.

Exercises For Accessory Navicular Syndrome

Overview

This syndrome is also referred to as os tibial naviculare or os tibial externum. As stated above, this condition quite often does not cause any pain. But if the posterior tibial tendon (the extra bone attaches to this tendon in the foot) or the accessory navicular bone itself were to get aggravated, then there would be pain.

Accessory Navicular Syndrome

Causes

Let us see the reasons why the tendon or the bone would get aggravated. Ankle or foot sprain, irritation of the bone caused by footwear, overusing the foot, quite common in athletes and dancers. People born with this extra bone are also known develop flat feet which also adds to the strain on the posterior tibial tendon and lead to the syndrome.

Symptoms

One obvious problem with the accessory navicular is that it may be large and stick out from the inside of the foot. This can cause it to rub against shoes and so become quite painful. The fibrous connection between the accessory navicular and the navicualar, as well, is easy to injure, also leading to pain. This is kind of like a fracture, and such injuries cause the bone to move around too easily, leading to pain with activity. When the connection between the bones is injured in this way, the two bones do not always heal properly, so pain may continue unabated.

Diagnosis

During your clinical exam, you may note erythema to the navicular prominence area and a foot that collapses in stance. While it?s common to see flat feet with these patients, this may not always be the case. You will note a significant difference in the off-weightbearing arch compared to the foot in stance, which is lower. These patients will always have pain to the navicular bone, especially at the major insertion of the posterior tibial tendon just proximal and also inferior to the navicular bone. You may also find they have pain on resisted adduction.

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 Syndrome

Surgical Treatment

In my experience, the Modified Kidner procedure is one of the most reliable operations for reducing arch pain associated with an accessory navicular bone (a.k.a. os tibial externum). You can also use this procedure to treat a prominence at the inner aspect of the arch, which has been caused by an enlarged navicular bone. The most common patients to visit our office with these problems are between the ages of 8 and 15 and are involved in activities like ice skating, ballet and soccer.

Pain After Accessory Navicular Surgery

Overview

The accessory navicular is a congenital anomaly, meaning that you are born with the extra bone. As the skeleton completely matures, the navicular and the accessory navicular never completely grow, or fuse, into one solid bone. The two bones are joined by fibrous tissue or cartilage. Girls seem to be more likely to have an accessory navicular than boys.

Accessory Navicular

Causes

Let us see the reasons why the tendon or the bone would get aggravated. Ankle or foot sprain, irritation of the bone caused by footwear, overusing the foot, quite common in athletes and dancers. People born with this extra bone are also known develop flat feet which also adds to the strain on the posterior tibial tendon and lead to the syndrome.

Symptoms

One obvious problem with the accessory navicular is that it may be large and stick out from the inside of the foot. This can cause it to rub against shoes and so become quite painful. The fibrous connection between the accessory navicular and the navicualar, as well, is easy to injure, also leading to pain. This is kind of like a fracture, and such injuries cause the bone to move around too easily, leading to pain with activity. When the connection between the bones is injured in this way, the two bones do not always heal properly, so pain may continue unabated.

Diagnosis

Upon examining a foot with a symptomatic accessory navicular, there will often be a bony prominence on the inside of the foot, just below and in front of the inside ankle bone (medial malleolus). The size of this prominence will vary from small to quite large. Pressing over this area will often cause discomfort. There may be an associated flat foot deformity as this can occur in patients with an accessory navicular. Stressing the posterior tibial tendon by raising the heel up and down on one foot, or by forcing the foot to the inside against resistance, may aggravate the symptoms as these maneuvers stress the posterior tibial tendon which is attached on the inside of the accessory navicular bone. Patients may walk with a slight limp due to the pain.

Non Surgical Treatment

Non-surgical treatments are enough to cure the symptoms caused by the accessory navicular. The treatment options include Immobilization, a cast or a walking boot is usually used to immobilize the foot so that the inflammation and pain are alleviated quickly due to the rest that the foot gets. Apply ice bags or wrap the ice in a towel and apply it on the aching region to alleviate inflammation. Orthotic devices that can be fit into the shoes are prescribe to keep the symptoms from resurfacing. Exercises are helpful for strengthening the muscles, which would not only help alleviate inflammation but also keep the symptoms from appearing again. NSAIDs and steroids may be prescribed as per the need of the patient to ease the pain and inflammation.

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.

Are Shoe Lifts The Ideal Solution To Leg Length Difference

There are actually two different kinds of leg length discrepancies, congenital and acquired. Congenital implies that you are born with it. One leg is structurally shorter compared to the other. Through developmental phases of aging, the human brain senses the walking pattern and identifies some variation. The human body usually adapts by tilting one shoulder to the "short" side. A difference of less than a quarter inch isn't really abnormal, does not need Shoe Lifts to compensate and typically won't have a serious effect over a lifetime.

Leg Length Discrepancy Shoe Lift

Leg length inequality goes typically undiagnosed on a daily basis, yet this problem is very easily solved, and can eliminate quite a few instances of lower back pain.

Therapy for leg length inequality usually consists of Shoe Lifts. These are generally very inexpensive, generally costing under twenty dollars, compared to a custom orthotic of $200 or even more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Chronic back pain is easily the most widespread health problem impacting men and women today. Over 80 million people are afflicted by back pain at some stage in their life. It's a problem which costs employers huge amounts of money every year due to lost time and output. Fresh and better treatment solutions are continually sought after in the hope of reducing the economical influence this condition causes.

Leg Length Discrepancy Shoe Lifts

People from all corners of the earth suffer the pain of foot ache due to leg length discrepancy. In these situations Shoe Lifts are usually of beneficial. The lifts are capable of alleviating any pain and discomfort in the feet. Shoe Lifts are recommended by many certified orthopaedic doctors.

So as to support the human body in a balanced manner, feet have got a crucial part to play. Inspite of that, it is sometimes the most overlooked zone in the human body. Many people have flat-feet which means there may be unequal force placed on the feet. This causes other parts of the body like knees, ankles and backs to be impacted too. Shoe Lifts guarantee that ideal posture and balance are restored.
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What Are The Signs Or Symptoms Of Heel Spur

Heel Spur

Overview

Heel spurs are a bone growth that extends from the heel bone, particularly on the bottom front of the heel bone and sometimes slightly to the side. Usually, a heel spur forms where the plantar fascia ligament attaches to the bottom of the heel bone. Those who overuse, or put heavy stress on the plantar fascia, are at risk of developing heel spurs.

Causes

Heel spurs are common in patients who have a history of foot pain caused by plantar fasciitis. In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.

Heel Spur

Symptoms

Heel spurs are most noticeable in the morning when stepping out of bed. It can be described as sharp isolated pain directly below the heel. If left untreated heel spurs can grow and become problematic long-term.

Diagnosis

A heel spur is often seen on X-ray as a bony protrusion, which can vary in size. However, because a Heel Spur only indicates increased load on the plantar fascia, and not pain, an ultra sound may be required to assess other actual cause of the heel pain such and may include checking to see if the plantar fascia is inflamed or degenerated.

Non Surgical Treatment

Diathermy treatment uses an electrical current to produce heat that sedates the inflamed tissues. The ultrasound device sends sound waves into the heel and sets up a massaging action that stimulates blood circulation. Treatment with a whirlpool bath involves placing the foot directly into the jetting stream. Orthopedic molds and appliances, such as orthotics, are designed by foot specialists for use inside the shoe to eliminate irritation to the heel when the patient stands or walks. When those appliances are used, the spur (in effect) floats on air. At the same time, the body's weight is transferred forward from the tender spot.

Surgical Treatment

More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include release of the plantar fascia, removal of a spur. Pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

Prevention

There are heel spur prevention methods available in order to prevent the formation of a heel spur. First, proper footwear is imperative. Old shoes or those that do not fit properly fail to absorb pressure and provide the necessary support. Shoes should provide ample cushioning through the heel and the ball of the foot, while also supporting the arch. Wearing an orthotic shoe insert is one of the best ways to stretch the plantar fascia and prevent conditions such as heel spurs. Stretching the foot and calf is also helpful in preventing damage. Athletes in particular should make sure to stretch prior to any physical activity. Stretching helps prevent heel spurs by making tissue stronger as well as more flexible. In addition, easing into a new or increasingly difficult routine should be done to help avoid strain on the heel and surrounding tissue.
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