Accessory Navicular Syndrome What is the Accessory Navicular? The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people. What is Accessory Navicular Syndrome? People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following: Trauma, as in a foot or ankle sprain Chronic irritation from shoes or other footwear rubbing against the extra bone Excessive activity or overuse Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular. Signs and Symptoms of Accessory Navicular Syndrome Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include: A visible bony prominence on the midfoot (the inner side of the foot, just above the arch) Redness and swelling of the bony prominence Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity Diagnosis To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion, and the way the patient walks may also be evaluated. X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition. Treatment: Non-Surgical Approaches The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used: Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. Physical therapy. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeated. When Is Surgery Needed? 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. Achilles Tendon Rupture What is the Achilles Tendon? A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the "heel cord," the Achilles tendon facilitates walking by helping to raise the heel off the ground. What is an Achilles Tendon Rupture? An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in "weekend warriors" – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures. Signs and Symptoms A person with a ruptured Achilles tendon may experience one or more of the following: Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf – often subsiding into a dull ache A popping or snapping sensation Swelling on the back of the leg between the heel and the calf Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the "R.I.C.E." method should be used. This involves: Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage. Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin. Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling. Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level. Diagnosis In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests. Treatment Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on the severity of the rupture and the patient‘s health status and activity level. Non-Surgical Treatment Non-surgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal. Surgery Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient‘s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing. Complications such as incision-healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery. Physical Therapy Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle. Acute Inflammation What Is Acute Inflammation? Inflammation is the body‘s normal protective response to an injury, irritation, or surgery. This natural ―defense‖ process brings increased blood flow to the area, resulting in an accumulation of fluid. As the body mounts this protective response, the symptoms of inflammation develop. These include: Swelling Pain Increased warmth and redness of the skin Inflammation can be acute or chronic. When it is acute, it occurs as an immediate response to trauma (an injury or surgery), usually within two hours. When it is chronic, the inflammation reflects an ongoing response to a longer-term medical condition, such as arthritis. Although inflammation can be caused by an infection, they are not the same and are treated differently. Your foot and ankle surgeon can best determine the cause of your inflamed tissue. Treatment To reduce inflammation and the resulting swelling and pain, injured tissue needs to be properly treated. The earlier you start treatment, the better. Initial treatment for acute inflammation in the foot or ankle consists of RICE therapy: Rest: Stay off the foot or ankle. Walking may cause further injury. Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again. Compression: An elastic wrap should be used to control swelling. Elevation: The foot or ankle should be raised slightly above the level of your heart to reduce swelling. Elevate the Leg Properly In addition to the above measures, your foot and ankle surgeon may prescribe a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, or another type of medication. If Pain Persists or Becomes Worse The symptoms of inflammation typically improve within two or three days. If your pain and discomfort do not improve after three days, call your doctor or go to an emergency room to determine whether a more serious problem exists.