Mortons Neuroma is a common painful condition involving compression of nerves between the long bones of the forefoot just before they enter the toes. Commonly this involves the 3rd and 4th toes, however may affect the 2nd and 3rd toes. Repeated trauma or compression of these nerves causes the nerves to swell and thicken causing a Morton's neuroma to develop.
The pain of Morton's neuroma occurs when the nerve connecting the toe bones (metatarsal bones) becomes irritated or compresse
For most people with an accessory navicular, the extra bone does not cause any problems and most are unaware of its presence. But certain activities or circumstances may cause the extra bone or the tibialis posterior tendon that contains it to grow irritated. This is called accessory navicular syndrome, and its possible causes include sprains, overuse, or wearing shoes that constantly rub against the bone. Individuals who have a collapsed arch (commonly known as flat feet) may be at greater risk of accessory navicular syndrome, assuming they have the extra bone, because of the added daily trauma placed on the tibialis posterior tendon.
People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following. Trauma, as in a foot or ankle sprain. Chronic irritation from shoes or other footwear rubbing against the extra bone. Excessive activity or overuse.
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 do not always heal properly, so pain may continue unabated.
Diagnosis is fairly simple based on an examination by your doctor. He or she will palpate the navicular bone, and based on the location of pain will suspect an accessory navicular. The doctor will also observe your gait to see if you are flatfooted. At this point an x-ray will make the definitive diagnosis. Other causes of pain in the same area of the foot would include a fracture of the navicular bone or possibly tendonitis or even a partial tear of the tibialis posterior tendon that inserts into the navicular. In these cases there is usually a history of trauma. People with a naturally "large" navicular bone may also develop a bursitis due to chronic shoe pressure.
Non Surgical Treatment
Traditional medicine often falls short when it comes to treatment for this painful condition. As similar to other chronic pain conditions, the following regimen is usually recommended: RICE, immobilization, anti-inflammatory medications, cortisone injections, and/or innovative surgical options. Clients familiar with Prolotherapy often say? no thanks? to those choices, as they know these treatments will only continue to weaken the area in the foot. Instead, they choose Prolotherapy to strengthen the structures in the medial foot.
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.
The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people. People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.
Like all painful conditions, ANS has a root cause. The cause could be the accessory navicular bone itself producing irritation from shoes or too much activity. Often, however, it is related to injury of one of the structures that attach to the navicular bone. Structures that attach to the navicular bone include abductor hallucis muscle, plantar calcaneonavicular ligament (spring ligament) parts of the deltoid ligament, posterior tibial tendon.
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).
Your doctor will diagnose an accessory navicular by examining your child?s foot. Your physician may also obtain x-rays to confirm the accessory navicular and to rule out other conditions.
Non Surgical Treatment
Initial treatment is conservative. With the first episode of symptoms, a medial heel wedge, anti-inflammatories, and physical therapy can be helpful. If very painful, a cast or boot may be needed for a short period time before the wedge and physical therapy can be initiated. Very rarely is a steroid injection warranted or recommended. As the pain improves, patients can resume activities. For a minority of patients, an arch support or custom orthotic can help to take some of the extra pressure off of the accessory navicular and the posterior tibial tendon.
Once the navicular inflammation has lessened it is not necessary to perform surgery unless the foot becomes progressively flatter or continues to be painful. For these children, surgery can completely correct the problem by removing the accessory navicular bone and tightening up the posterior tibial tendon that attaches to the navicular bone. The strength of this tendon is integral to the success of this surgery as well as the arch of the foot. Following surgery the child is able to begin walking on the foot (in a cast) at approximately two weeks. The cast is worn for an additional four weeks. A small soft ankle support brace is then put into the shoe and worn with activities and exercise for a further two months.