In plain language
Pain around an accessory bone beside the medial navicular, its connection or the posterior tibial tendon; a symptomatic anatomical variant.
Clinical Significance & Management
Many accessory bones never need treatment. Confirm tenderness, arch mechanics and tendon function. Reduce shoe pressure and load first; selected patients need short immobilization. Persistent disability may prompt excision with tendon management.
Symptoms & Clinical Presentation
Tender medial prominence, redness or shoe irritation
Exercise aching, sometimes with a low arch
Etiology & Injury Mechanisms
- Footwear pressure, overload or sprain
- Irritation of the connection and posterior tibial tendon
Diagnostics & Imaging Guide
Standing alignment, gait, heel rise and tendon examination
Radiographs; selected MRI for persistent unexplained pain
Treatment Options
Load/shoe modification, appropriate arch support and selected immobilization
Surgery after unsuccessful conservative care; assess alignment too
Rehabilitation Milestones & Timeline
Rehabilitation depends on the diagnosis, procedure and associated injuries. Progression requires assessment of healing, symptoms and function; elapsed time or a single test cannot determine readiness for sport.
Settle
Reduce rubbing and impact, maintain comfortable activity
Rebuild
Restore foot-ankle strength, heel rises and balance
Return
Progress after walking/single-leg tolerance; protect tendon procedures
Evidence-Based Clarifications
A low arch alone is not a surgical indication. An accessory bone on X-ray may not explain all pain.
Sources & References
Accessory Navicular Syndrome
American College of Foot and Ankle Surgeons (ACFAS)
Accessory navicular
The Hospital for Sick Children (SickKids)
Educational clinical definitions synthesized from AAOS, Cleveland Clinic, Mayo Clinic, and HSS. Individual diagnosis and surgery require professional medical evaluation.
Publication date
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