The accessory navicular bone is a small bone located near the foot and is part of the medial (inner) side of the foot. It develops in about 10 to 30% of the population, according to Alsager et al. (2022). Although many individuals may have this bone without pain, in some cases this can lead to what is known as ancillary navicular syndrome. This condition occurs when there is irritation or inflammation of the accessory navicular bone and surrounding tissues, usually resulting in pain and discomfort during physical activities. Patients usually report symptoms such as swelling, tenderness and pain along the inner arch of the foot, especially during weight supporting activities, such as walking, running or standing, which can significantly interrupt their daily activities and quality of life.
The impact of ancillary navicular syndrome extends beyond physical discomfort. Many patients are limited in their social interactions and exercise routines as they avoid activities that exacerbate their symptoms. Mulkerin et al. (2019) point out that this condition can sometimes be a significant cause of foot pain, especially during rehabilitation after injuries or surgeries that affect the foot and ankle. This pain can lead to compensatory movement patterns or to avoid using the affected foot, leading to additional complications.
The prevalence and classification of accessory navicular syndrome is essential to fully understanding the condition. Alsager et al. (2022) categorizes it in two types: the primary type, which is a fibrous connection with the posterior tibial tendon and the secondary type, where a fully developed accessory bone occurs due to varied anatomical factors. Such classifications help to accurately diagnose the condition and determine the most effective treatment options.
Initial treatment approaches to painful accessory navicular syndrome usually include conservative measures such as rest, ice application, non-steroid anti-inflammatory drugs (NSAIDs) and physiotherapy. These methods aim to reduce inflammation and manage pain, allowing the affected area time to heal. In addition, personalized orthoses or support shoes may be recommended to relieve pressure on the accessory navicular bone during daily activities.
However, it is important to recognize that not all patients respond positively to conservative treatment. For those who continue to feel significant pain, surgical interventions can become necessary. Understand the symptoms, prevalence and initial approaches to treatment of accessory navicular syndrome creates a basis for evaluating various treatment options and its effectiveness in improving patient results., The conservative treatment options for navigation syndrome painful accessory concentrate on non -surgical strategies that help managing pain and improving function. These treatments include drugs, vegetable devices and physical therapy. Wynn et al. (2019) provide evidence that non -operative treatment can be particularly effective in the pediatric populations that experience this condition. They suggest that simple measures, such as bench painkillers such as ibuprofen or paracetamol, can help reduce inflammation and pain, allowing young patients to participate in daily activities and sport without significant discomfort.
Orthotic devices play a fundamental role in the conservative management of accessory navicular syndrome. Personalized orthoses are designed to adapt to individual forms of the foot and can help to redistribute stress through the foot. Pu et al. (2025) discuss how these orthotic devices can positively influence the morphology of the feet and the distribution of pressure. By supporting the arch and limiting the excess movement of the foot, the Ortese can alleviate the pain associated with the accessory navicular and provide long -term relief for patients. The study highlights the importance of using specific and tailor -made vegetable devices to meet the unique needs of each patient, leading to better results.
Physical therapy is another non -surgical treatment option that can benefit from individuals with accessory navicular syndrome. The goal of therapy is to strengthen the surrounding muscles, improve flexibility and promote adequate biomechanics during activities. Stretching exercises for the rear tibial tendon and the reinforcement exercises for the arch can be incorporated into a structured plan of physical therapy. This approach not only helps to manage symptoms, but also improves the general function of the foot, reducing the probability of future damage.
When comparing the conservative treatment approaches with surgical interventions, Jegal et al. (2016) provide insights on the effectiveness of both methods. They show that non -surgical strategies can be successful both in athletes and in the general population, with many patients who have significant relief from symptoms. The authors note that while some athletes can ultimately request surgery due to persistent pain or dysfunction, many individuals respond positively only to conservative measures. This strengthens the idea that, for a considerable number of patients, non -operating treatments are a practicable first -line option.
In light of these results, it becomes clear that non -surgical strategies, in particular in younger patients, can offer significant relief from the symptoms of accessory navicular syndrome. Drugs, vegetable devices and physical therapy provide an all -round approach to the treatment that effectively faces pain and functional limits. Both the research conducted by Wynn et al. (2019) and Pu et al. (2025) underlines the importance of individualized care that take into account the specific needs of each patient. In addition, Jegal et al. (2016) highlights the potential benefits of the conservative treatment options before considering surgical solutions, further emphasizing the value of the exploration of non -surgical paths for effective management of this condition., Surgical options for painful accessory navicular syndrome are often considered when conservative treatments do not provide sufficient relief. The most common surgical procedure implies the excision of the navicular accessory bone. Vaughan and Singh (2014) point out that if this surgery can cause significant relief of pain, it also involves the risk of continuous discomfort and potential deformation. It is crucial to understand these risks because they can have an impact on a patient’s decision to carry out surgery.
Some factors may predict if a patient may need surgery. Knapik et al. (2019) have identified characteristics such as the severity of symptoms, the extent of functional disorders and the overall quality of life as indicators who can lead a doctor to recommend surgery. Patients with significant pain that prevent them from participating in daily activities are more likely to pursue surgical options. In addition, Park et al. (2022) underline the importance of preoperative evaluations to determine the probability of successful results after surgery. This includes the evaluation of the patient’s age, overall health and specific needs linked to their foot function.
Beyond the decision-making process, the comparison between surgical interventions and conservative treatments also deserves attention. CIRRINCIONE et al. (2024) explored the profitability of various therapies for navicular accessory syndrome. Their research has revealed that if conservative measures are generally less expensive in advance, they do not always satisfy patients looking for significant pain relief. On the other hand, surgical interventions, although more expensive, tended to produce higher public health services, indicating a better quality of life after surgery for many people.
Patient results after surgery can vary considerably. For some, surgery has little or no pain and a significant improvement in the feet function. Others may still experience discomfort or complications, which can cause dissatisfaction with the surgical process. This variability highlights the need for preoperative discussion targeted between patients and health care providers concerning the expected results and rehabilitation processes.
The evaluation of long -term satisfaction of patients is essential to understand the success of treatment options. Research suggests that patients with surgical excision often report substantial improvements in their symptoms, provided that their expectations are managed effectively. However, more studies are necessary to systematically assess the long -term results of surgical interventions in relation to conservative treatments, especially in various patient populations.
Future research should focus on identifying the optimal calendar for surgical intervention and to further explore the individualized characteristics of patients who could predict successful results. Increasing understanding in these fields can guide clinicians in enlightened treatment decisions and improving patient satisfaction in the management of navicular accessory syndrome.
Citations:
Jegal, H., Park, Y.U., Kim, J.S., Choo, H.S., Seo, Y.U. and Lee, K.T., 2016. Accessory navicular syndrome in athlete vs general population. Foot & Ankle International, 37(8), pp.862-867. https://journals.sagepub.com/doi/abs/10.1177/1071100716644791
Park, Y.H., Kim, W., Choi, J.W. and Kim, H.J., 2022. Risk factors for persistent pain requiring surgical treatment in adult symptomatic accessory navicular. Clinical Journal of Sport Medicine, 32(3), pp.e308-e312. https://journals.lww.com/cjsportsmed/fulltext/2022/05000/risk_factors_for_persistent_pain_requiring.28.aspx
Mansoor, S.N. and Rathore, F.A., 2017. Symptomatic accessory navicular bone: A case series. The Egyptian Rheumatologist, 39(4), pp.263-266. https://www.sciencedirect.com/science/article/pii/S1110116417300248
Campbell, J.T. and Jeng, C.L., 2020. Painful accessory navicular and spring ligament injuries in athletes. Clinics in Sports Medicine, 39(4), pp.859-876. https://www.sportsmed.theclinics.com/article/S0278-5919(20)30043-0/abstract
Vaughan, P. and Singh, D., 2014. Ongoing pain and deformity after an excision of the accessory navicular. Foot and Ankle Clinics, 19(3), pp.541-553. https://www.foot.theclinics.com/article/S1083-7515(14)00059-X/abstract
Wynn, M., Brady, C., Cola, K. and Rice-Denning, J., 2019. Effectiveness of nonoperative treatment of the symptomatic accessory navicular in pediatric patients. The Iowa Orthopaedic Journal, 39(1), p.45. https://pmc.ncbi.nlm.nih.gov/articles/PMC6604528/
Rammelt, S. and Sands, A.K., 2020. The accessory navicular and its association with flatfoot. Fuß & Sprunggelenk, 18(1), pp.60-71. https://www.sciencedirect.com/science/article/pii/S1619998720300118
Knapik, D.M., Archibald, H.D., Xie, K.K. and Liu, R.W., 2019. A retrospective study on factors predictive of operative intervention in symptomatic accessory navicular. Journal of Children’s Orthopaedics, 13(1), pp.107-113. https://journals.sagepub.com/doi/abs/10.1302/1863-2548.13.180168
Cirrincione, P.M., Bram, J.T., Nichols, E.T., Beber, S.A., Matsuzaki, Y., Fabricant, P.D. and Scher, D.M., 2024. Health State Utilities and Cost-Effectiveness Economic Evaluation for Treatment of a Symptomatic Accessory Navicular. Foot & Ankle International, 45(10), pp.1156-1167. https://journals.sagepub.com/doi/abs/10.1177/10711007241262794
Mulkerrin, P., McLoughlin, R. and O’Keeffe, S.T., 2019. Accessory navicular syndrome as a cause of foot pain during stroke rehabilitation. Age and ageing, 48(1), pp.159-161. https://academic.oup.com/ageing/article-abstract/48/1/159/5126785
Alsager, G.A., Alzahrani, K., Alshayhan, F., Alotaibi, R.A., Murrad, K. and Arafah, O., 2022. Prevalence and classification of accessory navicular bone: a medical record review. Annals of Saudi Medicine, 42(5), pp.327-333. https://www.annsaudimed.net/doi/abs/10.5144/0256-4947.2022.327
Pu, X., Xing, W., Cheng, Z., Wang, Y., Wang, Y., Zhang, Y., Jiang, L., Liu, B. and Kang, Q., 2025. Effects of customized orthoses on foot morphology and pressure in patients with accessory navicular syndrome. BMC Musculoskeletal Disorders, 26(1), p.491. https://link.springer.com/article/10.1186/s12891-025-08689-7
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