Accessory Navicular Os Naviculare 2026 | DPM

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An accessory navicular, also called os naviculare or os tibiale externum, is an extra bone or cartilage development located on the inner side of the midfoot near the navicular bone. This anatomical variant is present in approximately 10-15% of the population, but causes pain in only a small percentage of cases. At Balance Foot & Ankle PLLC, Dr. Tom Biernacki specializes in diagnosing and treating symptomatic accessory navicular conditions that limit your activities and quality of life.

The accessory navicular typically develops during late childhood or early adolescence as ossification occurs. When it becomes symptomatic, it’s usually due to inflammation of the tibialis posterior tendon that inserts nearby, repetitive stress from activities, or mechanical irritation from shoe pressure. Patients often present with a bony prominence on the inner arch that’s tender to touch, along with pain during walking or athletic activities. The condition can develop gradually or emerge suddenly after a change in activity level.

Conservative treatment should always be attempted first and successfully resolves symptoms in approximately 80-90% of cases. This includes activity modification to reduce stress on the area, custom orthotic devices that redistribute pressure and support the arch, anti-inflammatory medications, and physical therapy to address any biomechanical imbalances. Proper footwear selection is crucial—avoiding shoes that press directly on the inner arch prominence can provide immediate relief. Icing after activity and rest periods are also important components of the healing process.

For patients whose symptoms persist despite 6-12 months of conservative management, surgical removal of the accessory navicular may be recommended. Dr. Biernacki performs this procedure with meticulous attention to protecting nearby nerves and blood vessels, and reinforcing the tibialis posterior tendon insertion. Recovery typically takes 4-6 weeks with proper rehabilitation, and most patients experience complete pain relief and return to normal activities including sports. The key to successful outcomes is early recognition and appropriate treatment tailored to each patient’s activity level and functional goals.

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In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your accessory navicular os naviculare, our podiatry team at Balance Foot & Ankle can help with expert evaluations and advanced in-office care.