Accessory Navicular Syndrome Treatment 2026 | DPM

Type	Description	Prevalence	Symptoms	Treatment
Type 1 (Ossicle)	Small separate sesamoid bone within PTT; no cartilage connection	30% of accessory naviculars	Usually asymptomatic	Observation; orthotics if mild pain
Type 2 (Synchondrosis)	Triangular accessory bone connected to navicular by fibrocartilage; largest type	50-60%; most symptomatic	Medial foot prominence + pain; PTT insertion site pain	Orthotics 6-12 months; Kidner procedure if fails
Type 3 (Cornuate Navicular)	Fully fused accessory bone; enlarged navicular tuberosity	10-20%	Mild medial prominence; usually minimal pain	Padding; rarely surgical

Treatment	Indication	Success Rate	Recovery	Notes
Activity Modification	Initial management all types	30-50% resolve with rest	4-8 weeks	Reduce high-impact activity
Custom Orthotics (medial arch)	Type 2; symptomatic flatfoot	60-70% pain improvement	Immediate	Supports arch; reduces PTT stress
Walking Boot Immobilization	Acute flare; failure of insoles	70-80% resolve acute pain	4-8 weeks	Reduces fibrocartilage synchondrosis stress
Cortisone Injection	Adjunct; acute pain at synchondrosis	50-65% temporary relief	Immediate	Ultrasound-guided preferred; limit to 1-2 injections
Kidner Procedure (modified)	Type 2; failed 6-12 months conservative	75-90% good-excellent	6-8 weeks NWB; 3-4 months return to sport	Excises accessory bone + advances PTT insertion
Simple Excision (Geist)	Type 2; PTT insertion adequate; no flatfoot	70-85%	4-6 weeks	Less complex than Kidner; no tendon advancement

Quick answer: Treatment for accessory navicular syndrome causes treatment follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.

https://www.youtube.com/watch?v=8opvH3qxkW4

What Is an Accessory Navicular?

An accessory navicular is an extra bone or piece of cartilage located on the inner (medial) side of the foot, just above the arch — adjacent to the navicular bone. It is a congenital variant present in approximately 4-21% of the population, with the highest prevalence in females. The vast majority are asymptomatic and discovered incidentally on X-ray. However, when symptomatic, it produces the distinct clinical syndrome of accessory navicular syndrome.

Types of Accessory Navicular

Three types are recognized. Type I is a small, rounded ossicle within the tibialis posterior tendon — essentially a sesamoid bone. Type II (the most clinically significant) is connected to the navicular by a synchondrosis (cartilaginous joint) — it is into this type that the tibialis posterior tendon preferentially inserts, making it most susceptible to traction injury and instability. Type III is essentially a fused accessory navicular that has united with the navicular, forming a prominent “cornuate navicular.”

Why It Causes Pain

Pain in accessory navicular syndrome stems from two mechanisms: direct bony prominence that rubs against shoe upper material causing bursal irritation, and abnormal biomechanics due to the tibialis posterior tendon inserting into the accessory bone rather than the navicular proper — altering arch mechanics and contributing to progressive flatfoot deformity. Adolescent growth spurts trigger symptoms in many patients due to increased tensile demand across the synchondrosis.

Symptoms

Medial arch pain and a visible or palpable bony prominence on the inner foot are the hallmarks. Shoe irritation at the prominence causes callus and bursal swelling. Pain worsens with activity, tight footwear, and prolonged walking. The condition is common in adolescent athletes and frequently becomes symptomatic during growth spurts. Flatfoot deformity is commonly associated.

Conservative Treatment

Initial management is conservative — rest, activity modification, and offloading shoe modifications. Custom orthotics with a medial arch support and navicular pad relieve pressure from the prominence and improve arch mechanics. Immobilization in a walking boot for 4-6 weeks is appropriate for acute flares. Corticosteroid injection into the bursa overlying the prominence reduces inflammation in recalcitrant cases.

Surgical Treatment: The Kidner Procedure

When conservative management fails after 3-6 months, surgical excision is highly effective. The Kidner procedure involves excision of the accessory navicular and reattachment of the tibialis posterior tendon to the native navicular — restoring the normal arch-supporting function of the tendon. Success rates exceed 85% for pain relief. Recovery involves non-weight-bearing for 2-3 weeks followed by progressive rehabilitation over 3-4 months.

Dr. Tom's Product Recommendations

Recommended Products

In-Office Treatment at Balance Foot & Ankle

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