The painful accessory navicular


The accessory navicular is usually considered a normal anatomic and roentgenographic variant. The term may refer to two distinct patterns. First, a sesamoid bone may be present within the posterior tibial tendon (Type 1); this is anatomically separate from the navicular. Second, an accessory ossification center may be medial to the navicular (Type 2). During postnatal development this is within a cartilaginous mass that is continuous with the cartilage of the navicular. At skeletal maturity the accessory center usually fuses with the navicular to form a curvilinear bone The Type 2 pattern may be associated with a painful foot, particularly in the athletic adolescent, and should not be arbitrarily dismissed as a roentgenologic variant in the symptomatic patient.

The clinical, radiologic, pathologic, and surgical findings in ten cases are reviewed. Roentgenographically the ossicle is triangular or heartshaped. 99mTc MDP imaging may be of value when the significance of the ossicle is uncertain. Even when the roentgenographic variant is bilateral, increased radionuclide activity occurs only on the symptomatic side. Histologic examination of surgically excised specimens reveals inflammatory chondro-osseous changes in the navicular-accessory nacicular synchondrosis compatible with chronic trauma and stress fracture. Nonsurgical treatment with orthotics or cast immobilization produces variable results and resection of the accessory navicular may be the treatment of choice.

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  1. 1.

    Basmajian JB, Stecko G (1963) The role of muscles in arch support of the foot. J Bone Joint Surg [Am] 45:1184

    Google Scholar 

  2. 2.

    Dale GC, Harris WR (1958) Prognosis in epiphyseal separation: An experimental study. J Bone Joint Surg [Br] 40:116

    Google Scholar 

  3. 3.

    DuVries HL (1978) Surgery of the foot, 4th edn, Mann RA (ed) Mosby, St Louis, p 105

    Google Scholar 

  4. 4.

    Francillon MR (1932) Untersuchungen zur anatomischen und klinischen Bedeutung des Os tibiale externum. Z Orthop Chir 56:61

    Google Scholar 

  5. 5.

    Geist ES (1914) Supernumerary bones of the foot: A roentgen study of the feet of 100 normal individuals. Am J Orthop Surg 12:403

    Google Scholar 

  6. 6.

    Geist ES (1925) The accessory scaphoid bone. J Bone Joint Surg [Am] 7:570

    Google Scholar 

  7. 7.

    Giannestras NJ (1973) Foot disorders, medical and surgical management, 2nd edn. Lea and Febiger, Philadelphia, p 583

    Google Scholar 

  8. 8.

    Guntz E (1933) Os tibiale und Unfall (Abriss des Os tibiale) Arch Orthop Unfallchir 34:320

    Google Scholar 

  9. 9.

    Haglund P (1906) Über Fraktur des Tuberculum ossis navicularis in den Jugendjahren und ihre Bedeutung als Ursache einer typischen Form von Pes valgus. Z Orthop Chir 16:347

    Google Scholar 

  10. 10.

    Harris RI, Beath T (1947) Army foot survey, Vol 1. National Research Council of Canada, Ottawa, p 52

    Google Scholar 

  11. 11.

    Jones RL (1941) The human foot. An experimental study of its mechanics and the role of its muscles and ligaments in the support of the arch. Am J Anat 68:1

    Google Scholar 

  12. 12.

    Kidner FC (1929) The prehallux (accessory scaphoid) in its relation to flat-foot. J Bone Joint Surg [Am] 11:831

    Google Scholar 

  13. 13.

    Latten W (1927) Histologische Beziehungen zwischen Os tibiale und Kahnbein nach Untersuchungen an einem operierten Falle. Dtsch Z Chir 205:320

    Google Scholar 

  14. 14.

    Monahan JJ (1920) The human pre-hallux. Am J Med Sci 160:708

    Google Scholar 

  15. 15.

    Mygind HB (1953) The accessory tarsal scaphoid. Acta Orthop Scand 23: 142

    Google Scholar 

  16. 16.

    Ogden JA (1982) Skeletal injury in the child. Lea and Febiger. Philadelphia

    Google Scholar 

  17. 17.

    Ogden JA, McCarthy SM, Jokl P (1982) The painful bipartite patella. J Pediatr Orthop 2:263

    Google Scholar 

  18. 18.

    Ray S, Goldberg VM (1983) Surgical treatment of the accessory navicular. Clin Orthop 177:61

    Google Scholar 

  19. 19.

    Salter RB, Harris WR (1963) Injuries involving the epiphyseal plate. J Bone Joint Surg [Am] 45:587

    Google Scholar 

  20. 20.

    Smith AD, Carter JR, Marcus RE (1984) The os vesalianum: An unusual cause of lateral foot pain. Orthopedics 7:86

    Google Scholar 

  21. 21.

    Strayhorn G, Puhl J (1982) The symptomatic accessory navicular bone. J Fam Pract 15:59

    Google Scholar 

  22. 22.

    Sullivan JA, Miller WA (1979) The relationship of the accessory navicular to the development of the flat foot. Clin Orthop 144:233

    Google Scholar 

  23. 23.

    Swenson PC, Wilner D (1949) Unfused ossification centers associated with pain in the adult. AJR 61:341

    Google Scholar 

  24. 24.

    Veitch JM (1978) Evaluation of the Kidner procedure in treatment of symptomatic accessory tarsal scaphoid. Clin Orthop 131:210

    Google Scholar 

  25. 25.

    Zadek I (1926) The significance of the accessory tarsal scaphoid. J Bone Joint Surg 8:618

    Google Scholar 

  26. 26.

    Zadek I, Gold AM (1948) The accessory tarsal scaphoid. J Bone Joint Surg [Am] 30:957

    Google Scholar 

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Correspondence to J. P. Lawson M.B., F.R.C.R..

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Lawson, J.P., Ogden, J.A., Sella, E. et al. The painful accessory navicular. Skeletal Radiol 12, 250–262 (1984).

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Key words

  • Foot, tarsus, navicular
  • Normal variants, accessory navicular, os tibiale externum, prehallux