Accessory Navicular Bone: Difference between revisions
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== Physical Therapy Management <br> == | == Physical Therapy Management <br> == | ||
If the accessory navicular bone becomes problematic physical therapy may be prescribed. This will include exercises and treatments to strengthen the intrinsic foot muscles and lateral thigh rotators muscles and decrease inflammation. Often is the accessory navicular bone linked to Posterior tibial dysfunction to a pes planus. <sup>[3]</sup> To adjust the arch of the foot orthotic devices are required. The physician can analyze the gait of the person to see where the adjustments need to be made. Activity modification, such as limiting or stopping any strenuous activities that cause the Accessory Navicular bone to become symptomatic can be used for initial treatment. Casting can be used to prevent repetitive micro trauma either directly or from pull of the posterior tibial tendon. When the cast is being removed it the physician can start building up the ROM from the patient and counter atrophy. <sup>[8]</sup><br> | |||
== Key Research == | == Key Research == | ||
Revision as of 11:29, 28 May 2011
Original Editors - Carlos De Coster
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
PubMed (http://www.ncbi.nlm.nih.gov/pubmed)
MeSH terms:
• Complications
• Diagnosis
• Drug therapy
• Epidemiology
• Etiology
• Pathology
• Rehabilitation
• Surgery
• Therapy
Medline Plus
Used keyword:
• Accesory navicular bone
• Os tibiale externum
Definition/Descrition[edit | edit source]
The accessory navicular bone or os tibiale externum is often erroneously considered as a normal anatomic and roentgenographic.
It is the most common ossicle in the foot. [1] Most commonly it occurs bilateral.[2]
We can distinct three types of accessory navicular bone:
1) A small round separate ossicle imbedded within the posterior tibial tendon.
2) A larger, triangular ossification centre adjacent to the navicular tuberosity and connected by a synchondrosis.
3) An enlarged medial horn of the navicular itself, called a cornuate navicular.
These three types have a collective incidence of 4 to 21% [3] The type 2 and 3 variants have been associated with pathologic conditions such as posterior tibial tendon tear and accessory navicular bone [3]
Clinically Relevant Anatomy[edit | edit source]
The navicular bone is one of the tarsal bones found in the foot. It is located on the medial side of the foot, and articulates proximally with the talus. Distally it articulates with the three cuneiform bones. In some cases it articulates laterally with the cuboid. The tibialis posterior inserts to the os naviculare. [4] The tibialis posterior muscle also contracts to produce inversion of the foot and assists in the plantar flexion of the foot at the ankle. Tibialis posterior also has a major role in supporting the medial arch of
the foot and therefore dysfunction can lead to flat feet in adults. [5]
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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- Kidner operation: in which the main insertion of the tibialis posterior is re-routed. The main portion of the tendon was also rerouted under the navicular onto the medial side, with the intention of restoring the normal line of pull of the tendon. [5]
- Excision: hereby the ossicle is been cut away. However when doing this operation it is essential that the medial surface of the main navicular bone was contoured to prevent any residuel prominence.
- Occasionally, a limited fusion of the cuneiform metatarsal or talonavicular joints also was recommended. The rationale and efficacy of this operation have been questioned.
- Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation.
- 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. [6]
- Corticosteroid injections can be used as a treatment modality. However, this modality should be used with caution as it may weaken the posterior tibial tendon and lead to subsequent rupture. [7]
Physical Therapy Management
[edit | edit source]
If the accessory navicular bone becomes problematic physical therapy may be prescribed. This will include exercises and treatments to strengthen the intrinsic foot muscles and lateral thigh rotators muscles and decrease inflammation. Often is the accessory navicular bone linked to Posterior tibial dysfunction to a pes planus. [3] To adjust the arch of the foot orthotic devices are required. The physician can analyze the gait of the person to see where the adjustments need to be made. Activity modification, such as limiting or stopping any strenuous activities that cause the Accessory Navicular bone to become symptomatic can be used for initial treatment. Casting can be used to prevent repetitive micro trauma either directly or from pull of the posterior tibial tendon. When the cast is being removed it the physician can start building up the ROM from the patient and counter atrophy. [8]
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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