When should I see a podiatrist?

You should see a podiatrist for any persistent foot or ankle pain lasting more than a few days, difficulty walking, numbness or tingling, wounds that won't heal, changes in skin color or temperature, or structural deformities. Dr. Tom Biernacki, DPM is a board-certified podiatrist serving SE Michigan with same-day appointments available. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major insurance plans including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, Medicare, and many others. Contact our office at 810-206-1402 to verify your specific coverage. We also offer affordable self-pay options.

What should I expect at my first podiatry appointment?

Your first visit includes a comprehensive evaluation with Dr. Biernacki including medical history review, physical examination, biomechanical assessment, and any necessary diagnostic imaging (X-rays are available in-office). You'll receive a diagnosis, treatment plan, and same-day treatment when possible. Most initial visits take approximately 30-45 minutes.

What is an accessory navicular bone?

An accessory navicular is an extra bone on the inner side of the foot near the arch, present from birth in about 10% of people. It can become painful due to shoe pressure, injury, or irritation of the posterior tibial tendon attachment.

Does an accessory navicular need to be removed?

Not always. Many cases respond to orthotics, padding, shoe modifications, and physical therapy. Surgical removal (Kidner procedure) is considered when conservative treatments fail to relieve persistent pain and dysfunction.

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.

Accessory Navicular Bone: Extra Bone in the Arch — When Does It Hurt?

Name: Accessory Navicular Bone: Arch Pain Treatment | Podiatrist
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-23T08:42:42-04:00

About 10% of the population is born with an extra bone in their foot — the accessory navicular. Most people go their entire lives without knowing it’s there. But for some, this extra bone becomes a source of significant arch and inner ankle pain — particularly after injuries, during growth spurts in adolescence, or with increased activity. Understanding when this normal variant becomes a problem (and what to do about it) is essential for appropriate management.

What Is the Accessory Navicular?

The navicular is a small, boat-shaped bone on the inner (medial) midfoot that forms the apex of the arch. An accessory navicular is an extra ossification center — a secondary bone — located adjacent to the navicular on its posteromedial surface, near the insertion of the posterior tibial tendon.

There are three types:

Type I: Small sesamoid bone within the posterior tibial tendon substance — usually not symptomatic
Type II: Larger accessory bone connected to the main navicular by a fibrocartilaginous synchondrosis (fibrous joint). This type causes most symptoms — the synchondrosis is the painful area.
Type III: Fused accessory navicular — has united with the main navicular, creating a “cornuate navicular” with a prominent bump. Often asymptomatic or mildly symptomatic.

Why Does It Cause Pain?

The accessory navicular is the insertion point for the posterior tibial tendon — one of the most important arch-supporting tendons in the foot. When the accessory navicular is present:

The bony prominence on the inner arch is vulnerable to direct shoe pressure and irritation
The synchondrosis (the cartilaginous junction in Type II) is biomechanically stressed with every step and can become inflamed or partially disrupted
Overpronation (common with accessory navicular and associated flat feet) increases stress on the structure
Direct trauma (ankle sprains) can disrupt the synchondrosis

Who Gets Symptoms?

Symptoms most commonly first appear during adolescence — the active growth years (10–15 years old) — often triggered by sports, increased activity, or ankle injury. Adults may develop symptoms for the first time after an ankle sprain, change in footwear, or increase in activity level. Patients with flat feet (which is anatomically associated with accessory navicular) are at higher risk for developing symptoms.

Symptoms

Prominent, sometimes reddened bony bump on the inner arch/ankle
Pain and tenderness directly over the prominence
Pain with shoe wearing, particularly shoes with stiff medial counters
Pain that worsens with standing, walking, and physical activity
Arch fatigue and aching after prolonged activity
Occasionally, swelling and warmth over the prominence

Diagnosis

X-ray (weight-bearing, including oblique view) identifies the accessory navicular and classifies its type. MRI can assess the synchondrosis integrity and posterior tibial tendon involvement in complex or refractory cases.

Conservative Treatment

Activity Modification and Rest

During acute symptomatic flares, reducing high-impact activity allows the synchondrosis inflammation to subside. Complete immobilization in a walking boot for 4–6 weeks is sometimes necessary for severe acute presentations.

Custom Orthotics

The most important long-term intervention. Custom orthotics with a medial arch support reduce posterior tibial tendon stress and control the overpronation that perpetuates symptoms. A cutout or relief area over the accessory navicular prevents direct pressure on the prominence. Most symptomatic patients respond well to orthotics combined with activity modification.

Footwear Modification

Shoes with soft, accommodating medial counters and adequate arch support prevent the shoe from pressing directly on the prominence. Avoiding hard leather dress shoes during symptomatic periods is important.

Physical Therapy

Posterior tibial tendon strengthening and calf stretching reduce the forces transmitted to the accessory navicular. Physical therapy is particularly important in adolescent athletes returning to sport.

Surgical Treatment

When conservative care (at least 3–6 months) fails to resolve symptoms, surgery is highly effective:

Kidner procedure: The classic operation — the accessory navicular is excised and the posterior tibial tendon is advanced and reattached to the native navicular in a more plantar position. Excellent outcomes in appropriately selected patients. Recovery: 6–8 weeks non-weight-bearing, then progressive return to activity over 3–4 months.
Simple excision: In some cases, excision of the accessory bone alone (without tendon advancement) is appropriate, particularly for Type I or Type III presentations.

Surgical outcomes are generally excellent — 80–90% satisfaction rates, with most patients returning to full sport and activity within 4–6 months.

Related Conditions

Ready to Get Relief? Book an Appointment Today.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Treatment for Accessory Navicular Pain

An accessory navicular bone can cause chronic inner arch pain and difficulty with shoes. Our podiatrists offer conservative care and surgical options when needed.

Explore Our Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

Kiter E, et al. The accessory navicular: diagnosis and treatment. Foot Ankle Clin. 2019;24(4):657-671.
Choi YS, et al. Accessory navicular syndrome: etiology, pathogenesis, and treatment. Foot Ankle Int. 2014;35(6):626-633.
Jasiewicz B, et al. Results of simple excision for symptomatic accessory navicular. Foot Ankle Spec. 2008;1(1):27-31.

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.