Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
The most important clinical decision with Accessory Navicular Os Naviculare 2026 | DPM isn’t which treatment to choose — it’s identifying which subtype you have first. Our podiatrists see patients treated for the wrong subtype for months before the correct diagnosis leads to full resolution. Call (810) 206-1402 — expert podiatric care across Michigan.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
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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✅ Pros / Benefits
- Conservative treatment is effective in 80-90% of cases without surgery
- Custom orthotics and proper footwear often provide rapid pain relief
- Condition is highly responsive to activity modification and rest
- Surgical removal is a straightforward, low-risk procedure when needed
❌ Cons / Risks
- Some cases require 6-12 months of conservative care before improvement
- Surgical recovery requires several weeks of activity restriction
Dr. Tom Biernacki’s Recommendation
Accessory navicular is one of the more straightforward foot conditions to treat because conservative measures work so well for most patients. The key is recognizing it early and addressing biomechanical issues. When surgery is needed, it’s a reliable procedure with excellent outcomes. I focus on understanding each patient’s activity goals to guide treatment decisions.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
What is the difference between an accessory navicular and a normal navicular bone?
The navicular is a normal bone in the midfoot arch. An accessory navicular is an extra bone or cartilaginous structure that some people develop, typically located just above and behind the inner ankle bone. Most people with accessory naviculars have no symptoms, but when the tibialis posterior tendon becomes inflamed or when pressure accumulates, pain develops.
Can an accessory navicular go away on its own?
No, the accessory navicular bone itself is permanent and won’t disappear. However, the pain associated with it can resolve completely through conservative treatment like orthotics and activity modification. If conservative measures fail after adequate time, surgical removal is the only way to eliminate the problem permanently.
How is accessory navicular different from posterior tibial tendon dysfunction?
While these conditions often occur together, they’re distinct. Accessory navicular is an anatomical variant (extra bone structure), while PTTD is inflammation of the tibialis posterior tendon itself. Both can cause inner foot pain, but accessory navicular has a visible bone prominence, and treatment may differ. Dr. Biernacki evaluates both structures to determine the primary cause of your symptoms.
What activities should I avoid with an accessory navicular?
Avoid high-impact activities that stress the inner arch, such as running, jumping, and activities requiring quick directional changes. Walking, swimming, and cycling are usually tolerated well. As symptoms improve with conservative treatment, activities can gradually be resumed with appropriate support and footwear.
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When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
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 same-day evaluations and advanced in-office care.
OrthoInfo – AAOS: Accessory Navicular Syndrome
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.