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

An accessory navicular is an extra bone or ossification center located on the medial side of the foot adjacent to the navicular tuberosity, present in approximately 10–14% of the population. While many individuals with an accessory navicular never experience symptoms, a subset develops medial midfoot pain — a condition known as accessory navicular syndrome — that can significantly limit activity and require intervention.

Anatomy and Classification

Three types of accessory navicular are recognized. Type I is a small sesamoid bone within the posterior tibial tendon, typically asymptomatic and an incidental radiographic finding. Type II — the most clinically significant — is a larger ossification center connected to the navicular by a fibrocartilaginous synchondrosis that is prone to repetitive microtrauma, inflammation, and painful disruption. Type III represents complete fusion of the accessory ossicle to the navicular, creating an elongated “cornuate” navicular that may cause shoe fitting difficulties but is less commonly symptomatic than Type II.

Clinical Presentation

Patients with accessory navicular syndrome typically present in adolescence or young adulthood with medial foot prominence and pain that is worsened by activity, prolonged standing, and tight shoe wear. The posterior tibial tendon inserts partially onto the accessory ossicle in Type II lesions, meaning that pronation forces transmitted through this insertion chronically stress the synchondrosis. Examination reveals a prominent, tender medial navicular, and flat foot deformity (pes planus) is frequently associated — whether causal or consequential remains debated.

Conservative Treatment

The majority of patients respond to conservative management. Rest and activity modification during acute flares, immobilization in a walking boot for 4–6 weeks for significant exacerbations, and custom orthotics with medial arch support and a navicular pad to offload the prominence form the cornerstone of non-surgical care. Physical therapy targeting posterior tibial tendon strengthening and foot intrinsic musculature is added once acute symptoms subside. Most adolescent patients achieve resolution with skeletal maturation as the synchondrosis matures.

Surgical Management

Surgical intervention is indicated for patients with persistent pain despite 3–6 months of appropriate conservative care. The Kidner procedure — simple excision of the accessory ossicle with advancement of the posterior tibial tendon to the remaining navicular — has historically been the standard approach and provides reliable relief. More recently, synchondrosis repair using internal fixation (screw or suture anchor) has shown favorable outcomes for Type II lesions with intact fibrocartilage, preserving the accessory ossicle while stabilizing the painful junction. Dr. Biernacki at Balance Foot & Ankle evaluates accessory navicular syndrome with on-site X-ray and MRI correlation, providing individualized management from orthotic fabrication to surgical correction. Call (810) 206-1402 for evaluation at our Bloomfield Hills or Howell office.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

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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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Accessory Navicular Treatment in Michigan

An accessory navicular bone can cause inner arch pain, especially in active adolescents and young adults. Our podiatrists provide both conservative and surgical solutions.

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Clinical References

1. Choi YS, Lee KT, Kang HS, Kim EK. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic findings. Korean J Radiol. 2004;5(4):274-279.
2. Malicky ES, Levine DS, Sangeorzan BJ. Modification of the Kidner procedure with fusion of the primary and accessory navicular bones. Foot Ankle Int. 1999;20(1):53-54.
3. Grogan DP, Gasser SI, Ogden JA. The painful accessory navicular: a clinical and histopathological study. Foot Ankle. 1989;10(3):164-169.