Overview
Everyone has one navicular bone: one of the small bones of the foot. A small number of people have a second small navicular bone or piece of cartilage located on the inside of the foot just above the arch: both are simply called an "accessary navicular bone." It is located within the posterior tibial tendon which attaches in this area. It is easy to see as a "bump." Most that have it never have pain. If they get pain, we call it: "Accessary navicular bone syndrome."



Causes
Let us see the reasons why the tendon or the bone would get aggravated. Ankle or foot sprain, irritation of the bone caused by footwear, overusing the foot, quite common in athletes and dancers. People born with this extra bone are also known develop flat feet which also adds to the strain on the posterior tibial tendon and lead to the syndrome.

Symptoms
One obvious problem with the accessory navicular is that it may be large and stick out from the inside of the foot. This Can you lose weight by doing yoga? cause it to rub against shoes and so become quite painful. The fibrous connection between the accessory navicular and the navicualar, as well, is easy to injure, also leading to pain. This is kind of like a fracture, and such injuries cause the bone to move around too easily, leading to pain with activity. When the connection between the bones is injured in this way, the two bones do not always heal properly, so pain may continue unabated.

Diagnosis
The diagnosis begins with a complete history and physical examination by your surgeon. Usually the condition is suggested by the history and the tenderness over the area of the navicular. X-rays will usually be required to allow the surgeon see the accessory navicular. Generally no other tests are required.

Non Surgical Treatment
In order to strengthen your muscles to prevent further injury and to provide support to the foot, your podiatrist may also outline a physical therapy routine and prescribe orthotics. Orthotics will provide support to the arch of your foot, although they must be carefully crafted in order to make room for that pesky extra bone you?ve got poking about.



Surgical Treatment
After the anesthesia is administered you will be heavily sedated and placed on your stomach. Surgeons will place a tourniquet around your thigh and an incision will be made on the inside of the foot. The posterior tibial tendon will be moved as necessary and the accessory navicular will be removed. Surgeons will repair the posterior tibial tendon with sutures or suture anchors, and the wound will be closed. A splint will be placed on the foot for stabilization and immobilization. You will be permitted to leave the surgical center once you have been cleared by the anesthesiologist. Plan ahead to have a friend or family member take your prescription to a pharmacy to pick up your post-op medication. Use narcotic pain medications before bed or if numbness in your foot begins to dull. Schedule a post-op visit for 4 weeks after the procedure.

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Overview
An accessory navicular is an extra bone that is on the inner center arch of the foot. Up to 2.5% of individuals are born with the accessory navicular. Throughout early childhood, this condition is not noticed. However, in adolescence, when the accessory navicular begins to calcify, the bump on the inner aspect of the arch becomes noticed. For most, it is never symptomatic. However, for some, there is some type of injury, whether a twist, stumble, or fall, that makes the accessory navicular symptomatic.



Causes
This painful foot condition is caused by an extra bone in the foot called the accessory navicular. Only about 10% of people have this bone (4 to 21%), and not all of them will develop any symptoms. The navicular bone is one of the normal tarsal bones of the foot. It is located on the inside of the foot, at the arch.

Symptoms
One obvious problem with the accessory navicular is that it may be large and stick out from the inside of the foot. This can cause it to rub against shoes and so become quite painful. The fibrous connection between the accessory navicular and the navicualar, as well, is easy to injure, also leading to pain. This is kind of like a fracture, and such injuries cause the bone to move around too easily, leading to pain with activity. When the connection between the bones is injured in this way, the two bones How do you get a growth spurt? not always heal properly, so pain may continue unabated.

Diagnosis
Typically, accessory navicular syndrome isn?t hard to diagnose. Our podiatrists will examine the lower limb and check the hard prominence, as well as use X-rays to confirm the presence of extra bone tissue. Other diagnostic images may be able to identify inflammation and specific damage to the midfoot. Depending on the severity of your discomfort, conservative measures may be enough to resolve the condition.

Non Surgical Treatment
Although operative treatment, and removal of the accessory navicular is possible, this is not usually indicated at first. Conservative nonoperative treatment is best, the course depending on the severity of the symptoms. When the pain is very severe, which could indicate a fracture, a period of immobilization might be required. This is done by waring a fracture boot, or a cast, which can help the ossicle stay stable, aiding in healing. Immobilization usually lasts between 4 to 6 weeks. Afterwards, physical therapy exercise, or any appropriate home course, should be used to help strengthen the ankle and return the ankle and foot to full range of motion, and have no pain on movement. Sometimes crutches are used when weight bearing is too painful, but it is best to try to bear weight when possible.



Surgical Treatment
Surgical treatment of the accessory navicular syndrome with simple excision has the advantages of less invasive to the posterior tibial tenden and the medial longitudinal arch of the foot, shorter time of immobilization of the foot and stay in hospital, small incision and good clinical results. This procedure is one of the best selective treatments for the accessory navicular syndrome, especially for the patients without flatfoot deformity and old sprain injury.

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Overview
Some people, possibly beginning in early adolescents, but perhaps later, How can you heal an Achilles tendonitis fast? develop a painful bump on the side of their foot. The pain may be worse after athletic activity or just normal walking, and walking itself may become painful. This pain may become constant, but it will tend to improve with continued rest. Depending on the size of the bump, it may rub against shoes, or cause pain if the bump is hit by something. Over time, the arch of the foot may be lost and a flat food will develop.



Causes
Just having an accessory navicular bone is not necessarily a bad thing. Not all people with these accessory bones have symptoms. Symptoms arise when the accessory navicular is overly large or when an injury disrupts the fibrous tissue between the navicular and the accessory navicular. A very large accessory navicular can cause a bump on the instep that rubs on your shoe causing pain.

Symptoms
The majority of people with an accessory navicular experience no symptoms, since, for the most part, the little extra bone simply isn?t large enough to cause problems. Unfortunately, some people lose on ?accessory navicular roulette,? and the bone begins to mess things up with the foot. These problems usually show up sometime in adolescence, when bones and cartilage in the body are settling into their final shapes (although occasionally people make it all the way through childhood, only to start experiencing discomfort and pain in adulthood).

Diagnosis
Diagnosis starts by speaking with the patient about symptoms. The physician will look at the foot and examine it for signs of an accessory navicular. By putting pressure on the area, the doctor may determine its presence simply by the presence of pain. The muscle, joint, and the overall structure of the foot may be considered, as well as the way in which the patient walks. If a diagnosis of accessory navicular syndrome is made, an X-ray or MRI may be ordered to confirm diagnosis.

Non Surgical Treatment
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. 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 may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. 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.



Surgical Treatment
If your pain and discomfort don’t go away with treatments like these, then it may be time to consider surgery. If you decide to go through with it, your surgeon will probably remove the accessory navicular once and for all, and will tighten up the posterior tibial tendon in order to make it better able to support your arch. You’ll probably have to wear a cast for a several weeks, and a brace for some months after that, but with patience, you may be able to say goodbye to your symptoms.

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Overview
Achilles tendonitis is a relatively common condition characterized by tissue damage and pain in the Achilles tendon. The muscle group at the back of the lower leg is commonly called the calf. The calf comprises of 2 major muscles, one of which originates from above the knee joint (gastrocnemius), the other of which originates from below the knee joint (soleus). Both of these muscles insert into the heel bone via the Achilles tendon. During contraction of the calf, tension is placed through the Achilles tendon. When this tension is excessive due to too much repetition or high force, damage to the tendon occurs. Achilles tendonitis is a condition whereby there is damage to the tendon with subsequent degeneration and inflammation. This may occur traumatically due to a high force going through the tendon beyond what it can withstand or, more commonly, due to gradual wear and tear associated with overuse.

Causes
There are two large muscles in the calf. These muscles are important for walking. They create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel. Heel pain is most often due to overuse of the foot. Rarely it is caused by an injury. Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes. Achilles tendinitis may be more likely to occur if you Suddenly increase the amount or intensity of an activity. Your calf muscles are very tight (not stretched out). You run on hard surfaces such as concrete. You run too often, you jump a lot (such as when playing basketball), you do not have shoes with proper support, your foot suddenly turns in or out. Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

Symptoms
People with achilles tendinitis experience mild aching on the back of the leg close to the heel after increased activity. Stiffness in the back of the ankle when you first wake up in the morning, which subsides after mild activity. In some cases, the area may have swelling, thickening or be warm to the touch. Tenderness to touch along the tendon in the back of the ankle. Pain when the tendon is stretched (i.e. when you lift your foot/toes up).

Diagnosis
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an Achilles injury such as Achilles tendonitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.

Nonsurgical Treatment
Treatment will focus on relieving the pain and preventing further injury. Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time. (Often, a couple of weeks are needed for the tendon to heal.) Medication can help too. Your podiatrist may recommend or prescribe oral medication.



Surgical Treatment
The type of surgery you will have depends on the type of injury you are faced with. The longer you have waited to have surgery will also be a factor that determines What causes the heels of your feet to burn? type of surgery is needed. With acute (recent) tearing the separation in your Achilles tendon is likely to be very minimal. If you have an acute tear you may qualify for less invasive surgery (such as a mini-open procedure). Surgeons will always choose a shorter, less invasive procedure if it is possible to do so. Most surgeons know that a less complicated procedure will have less trauma to the tendon and a much quicker rate of recovery after the surgery.

Prevention
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles, because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom orthotics.