This young woman presented following an ankle sprain injury. She reports ‘twisting’ her ankle during a football game (but the exact mechanism was unclear). She was unable to continue and had been unable to walk without pain since. She complained of highly localised pain and swelling around the medial ankle and midfoot. She was found to have loacalised tenderness over the medial mid-foot in the region of the navicular tuberosity. She also had pain and weakness with resisted ankle inversion.
An x-ray showed a type 2 accessory navicular. An MRI subsequently confirmed increased signal about the navicular synchondrosis.
This player was initially managed with a medially posted orthotic and six weeks in a below knee walking boot. She the spent a further six weeks wearing a supportive sports shoe (with the orthotic) and refrained from running or other pain-provoking activities. Unfortunately the patients symptoms failed to resolve. As a result she then had a surgical excision of the accessory ossicle. She was able to retun to football five months following this proceedure.
In most cases an accessory navicular is an incidental finding (as many as 30% of adults have some form of supernumerary foot bone). They can be unilateral of bilateral. In some situtations the accessory bone can become symptomatic. A disrupted navicular synchondrosis should be suspected when a patient presents with highly locaised medial foot pain and tenderness. This often occurs after an innoculous ankle ‘sprain’. The pain is often provoked by resisted ankle inversion (as fibres of the tibailis posterior tendon attach to the ossicle). The ossicle can generally be easily seen on a x-ray while the synchondrosis can be defined on MRI. In many cases the injury will heal with time and protected weight bearing however surgical excision may be required.
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