This condition has been observed in multiple family members and has propensity to occur slightly more in females than males. For most individuals this condition is a non-issue and most people who have them never have a problem with them. Over the years when x-raying patients for other problems I will point out that they have an extra bone in their foot and the usual response from the patient is nothing more than a yawn.
It is commonly believed that the posterior tibial tendon loses its vector of pull to heighten the arch. As the posterior muscle contracts, the tendon is no longer pulling straight up on the navicular but must course around the prominence of bone and first pull medially before pulling upward. In addition, the enlarged bones may irritate and damage the insertional area of the posterior tibial tendon, making it less functional. Therefore, the presence of the accessory navicular bone does contribute to posterior tibial dysfunction.
The main symptom of an aggravated accessory navicular is pain, particularly in the instep. Walking can sometimes be difficult, and tight shoes may worsen the condition.
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
Treatment options for a painful accessory navicular can include anti-inflammatory medications, rest, arch support structures in the shoe, or use of a cast or splint. Severe cases may require surgery.
Depending upon the severity the non operative or conservative treatment should be maintained for at least 4- 6 months before any surgical intervention. There are 2 surgeries that can be performed depending upon the condition and symptoms. First is simple surgical excision. In this generally the accessory navicular along with its prominence is removed. In this procedure, skin incision is made dorsally to the prominence of accessory navicular. Bone is removed to the point where the medial foot has no bony prominence over the navicular, between the head of the talus and first cuneiform. Symptoms are relieved in 90% of cases. Second is Kindler procedure. In this the ossicle and navicular prominence is excised as in simple excision but along with the posterior tibial tendon advancement. Posterior tibial tendon is split and advanced along the medial side of foot to provide support to longitudinal arch. After surgery 4 week short leg cast, well moulded into the arch with the foot plantigrade is applied. Partial weight bearing till the 8th week and later full weight bearing is allowed. When the cast is being removed How we can increase our height? start building up the ROM to counter atrophy and other physical therapy treatment which include stretching and strengthening exercises.
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