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What Is Accessory Navicular Syndrome

Overview


Accessory navicular syndrome occurs when a type II accessory navicular (or "os tibiale externum") becomes painful due to movement across the pseudojoint between the ossicle and the navicular bone. The syndrome presents on MRI with bone marrow oedema signal (hypointense T1, hyperintense T2/STIR) in both the accessory ossicle and navicular. It can be inferred on musculoskeletal ultrasound if a patient's pain is located at a type II accessory navicular and the patient is tender to transducer pressure. Ultrasound can also be useful to compare with the contralateral side.


Accessory Navicular


Causes


Most of the time, this condition is asymptomatic and people may live their whole lives unaware that they even have this extra bone. The main reason the accessory navicular bone becomes problematic is when pain occurs. There is no need for intervention if there is no pain. The accessory navicular bone is easily felt in the medial arch because it forms a bony prominence there. Pain may occur if the accessory bone is overly large causing this bump on the instep to rub against footwear.


Symptoms


The symptoms of accessory navicular syndrome commonly arise during adolescence, when bones are maturing and cartilage fuses into bone. In other instances, symptoms do not appAccessory Navicularear until adulthood. The signs and symptoms include a visible bony prominence on the midfoot the inner side of the foot above the arch. Redness or swelling of the bony prominence. Indistinct pain or throbbing in the midfoot and arch during or after physical activity.


Diagnosis


Usually, you will only need an X-ray to determine the size or type of the accessory navicular bone or the amount of medial navicular tuberosity hypertrophy. Be cognizant of stress fractures which may be duplicated as a hairline fracture or increased calcification. When treating children, always look for avascular necrosis of the navicular (Kohler?s disease). An X-ray of this condition will reveal a flattening of the navicular along with increased bone density.


Non Surgical Treatment


If symptoms have been aggravated by an increase in activity level, backing off on activities in the short term can be helpful. The foot is subject to a lot of repetitive loading during walking, and therefore minimizing this force will often help symptoms to settle. After symptoms have settled, the activity level can then be gradually increased.


Accessory Navicular


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.
06 Mayo 2017
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Accessory Ossicle Navicular Pain

Overview


The human body is rarely the same from person to person. Some things stay the same, like the function of the internal organs. Even when structures are similar, however, little variations, like extra bone tissue, can make a significant difference in the body. Having small, extra bones is not as uncommon as you might think. Sometimes, though, these additional tissues can cause painful problems, as with accessory navicular syndrome.


Accessory Navicular Syndrome


Causes


Accessory navicular syndrome as it is called can result from a number of causes, excess or overuse syndrome as seen in an athlete. Trauma to the foot as in an ankle sprain or direct trauma to the navicular bone. chronic irritation from shoes rubbing against the extra bone, over time, may cause pain. Excessive pronation which strains the attachment of tibialis posterior muscles into the navicular bone. Keep in mind, the larger the actual accessory bone, the greater the chance of it becoming an issue.


Symptoms


Not everyone who has an accessory navicular will develop these problems. When problems do occur, they may begin in early adolescence. The obvious indication is a painful bump on the inside of the foot, which hurts to touch, and causes problems that gradually become worse, and which are aggravated by activity, walking, etc., leading to all the problems discussed here. Pain may be worse towards the end of the day, and continue into the night. Among adults, symptomatic accessory navicular is more common in women than in men, with onset typical at 40 years of age or greater. Among symptomatic children, the mean age of onset for maels is 6 years, and for females, 4.5 years. In general, symptoms may occur between 2 and 9 years of age.


Diagnosis


The foot and ankle are prone to bony ?accessories? which usually have no accompanying symptoms. Accessory navicular syndrome is often diagnosed when an adolescent complains of pain in the foot. Girls are more susceptible than boys, and the condition is usually bilateral, occurring in both feet. Navicular accessory syndrome may be diagnosed when a trauma (foot or ankle sprain) aggravates the bone or tibial tendon, or when there is chronic irritation from footwear or overuse.


Non Surgical Treatment


Treatment of the accessory navicular begins with rest, which may include activity modification or temporary immobilization in a boot or a brace. Once the inflammation subsides the foot needs to be supported. The support consists of a specially designed orthotic arch support. Occasionally, the orthotic will dig into the edge of the accessory navicular bone under the arch of the foot. This is very uncomfortable. For this reason the orthotic support needs to be carefully made. The orthotic support will help control (but not cure) the flat foot and will often decrease the inflammation on the navicular.


Accessory Navicular


Surgical Treatment


Surgery may be an option if non-surgical treatment does not decrease the symptoms of accessory navicular syndrome. Since this bone is not needed for the foot to function normally, Your surgeon may remove the accessory navicular, reshape the area, and repair the posterior tibial tendon for improved function.
06 Mayo 2017
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Contracted Toe Tendon Surgery

HammertoeOverview


A hammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery. People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.


Causes


Ill-fitting shoes or a muscle imbalance are the most common causes of Hammer Toe. If there is an issue with a muscle in the second, third or fourth toes preventing them from straightening, Hammer Toe can result. If one of these toes is bent long enough Hammer toe in one position, the muscles tighten and cannot stretch out. Left untreated, surgery may be required. Women are especially prone to developing Hammer Toe because of their shoes. Hammer Toe results from shoes that don?t fit properly. Shoes that narrow toward the toe, pushing smaller toes into a bend position for extended periods of time. High heels that force the foot down into a narrow space, forcing the toes against the shoe, increasing the bend in the toe.


HammertoeSymptoms


People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.


Diagnosis


Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.


Non Surgical Treatment


If the problem is caught in the early stages you can avoid hammer toe surgery. One of the easiest methods of treatment is to manipulate the toe out of a bent position then splint and buddy wrap it alongside it?s larger neighbour. This method of hammer toe taping will help the problem to fix itself. Make sure the toe isn?t resuming its bent shape during the recovery. To alleviate some of the painful symptoms of hammer toe avoid wearing high heels or shoes that cramp or stifle your feet. Choosing a pair of minimalist shoes can be an excellent choice for both foot and postural health. Wearing shoes that give the toes plenty of space and are comfortable lined is also a smart choice. Hammer toe recovery starts be treating the toe respectfully. Soft insoles or protection for the corn can also provide additional assistance.


Surgical Treatment


For the surgical correction of a rigid hammertoe, the surgical procedure consists of removing the damaged skin where the corn is located. Then a small section of bone is removed at the level of the rigid joint. The sutures remain in place for approximately ten days. During this period of time it is important to keep the area dry. Most surgeons prefer to leave the bandage in place until the patient's follow-up visit, so there is no need for the patient to change the bandages at home. The patient is returned to a stiff-soled walking shoe in about two weeks. It is important to try and stay off the foot as much as possible during this time. Excessive swelling of the toe is the most common patient complaint. In severe cases of hammertoe deformity a pin may be required to hold the toe in place and the surgeon may elect to fuse the bones in the toe. This requires several weeks of recovery.


Hammer ToePrevention


In some cases foot problems may present at birth, many foot problems such as hammer toes can be prevented. Hammer toe prevention can be a simple process, such as, checking your feet regularly and wearing the right shoes for your feet. Good circulation is also an essential part of foot health and hammer toe prevention. Taking a warm foot bath or giving yourself a foot massage are great ways of keeping your feet healthy.
14 Agos 2015
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