Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
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What Is the Accessory Navicular?
The accessory navicular is an extra bone or piece of cartilage located on the inner (medial) side of the foot, adjacent to the navicular bone just above the arch. It is a normal anatomical variant — approximately 2 to 14 percent of people have one — but most people never experience symptoms. In some individuals, the accessory navicular becomes painful due to irritation from footwear, repetitive stress, or an acute injury, producing a condition known as accessory navicular syndrome.
At Balance Foot & Ankle, we diagnose and treat accessory navicular syndrome in adolescents and adults across Southeast Michigan, from young athletes whose symptoms emerge during growth to adults with long-standing arch pain.
Why the Accessory Navicular Causes Pain
There are three types of accessory navicular. Type I is a small sesamoid bone within the posterior tibial tendon — usually asymptomatic. Type II is the most clinically significant: a larger accessory bone connected to the navicular by a fibrocartilaginous synchondrosis (a joint-like connection). Stress across this synchondrosis causes inflammation and pain. Type III is a cornuate navicular — an accessory bone that has fused to the main navicular, creating an enlarged, prominent navicular projection that irritates overlying tissue and footwear.
The posterior tibial tendon inserts into or near the accessory navicular in Type II variants, and the mechanical stress of tendon pull across the unstable synchondrosis is a major driver of pain. Flatfoot deformity commonly accompanies accessory navicular syndrome because the abnormal tendon insertion reduces the arch-supporting mechanical advantage of the posterior tibial tendon.
Symptoms and Diagnosis
A bony prominence on the inner foot above the arch is often visible and palpable. Pain and tenderness directly over this prominence, worsened by footwear that presses on the area, are characteristic. Activity-related arch and instep pain that worsens with prolonged standing or athletic activity is common. Adolescents often first experience symptoms during rapid growth or when starting a new sport. X-rays confirm the accessory navicular type and exclude fracture. MRI evaluates synchondrosis edema, posterior tibial tendon integrity, and soft tissue involvement.
Conservative Treatment
Initial management focuses on reducing stress on the accessory navicular and controlling inflammation. Activity modification, anti-inflammatory medications, and footwear changes to avoid direct pressure over the prominence are first steps. Immobilization in a CAM boot for 4 to 6 weeks rests the synchondrosis and allows acute inflammation to resolve. Custom orthotics with medial arch support reduce stress on the posterior tibial tendon insertion and are particularly valuable in patients with concurrent flatfoot deformity.
Surgical Treatment: Kidner Procedure
When conservative management fails, surgical excision of the accessory navicular — the Kidner procedure — is highly effective. The accessory bone is removed and the posterior tibial tendon is reattached or advanced to optimize its mechanical position at the navicular. Recovery involves casting or boot immobilization for 4 to 6 weeks followed by physical therapy. Most patients achieve excellent pain relief and return to full activity within 3 to 4 months. Recurrence is rare after proper surgical excision.
If you have a prominent bony bump on the inner arch that causes pain with activity or footwear, contact Balance Foot & Ankle for evaluation. We serve patients throughout Southeast Michigan.
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Howell, MI 48843
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Dr. Tom on accessory navicular — extra bone arch pain, PTT-associated symptoms, Kidner procedure.
Accessory Navicular Relief Kit
Offloading + medial support often resolves symptoms. Dr. Tom’s kit:
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Medial arch support offloads accessory bone.
Stability during symptomatic phases.
Flare swelling control.
Medial arch topical relief.
Related: Flat Foot Guide · Custom Orthotics · Book Same-Week Appointment
Differential Diagnosis: What Else Could It Be?
Not every case of accessory navicular syndrome is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.
| Condition | How It Differs |
|---|---|
| Posterior tibial tendon dysfunction | Pain along the tendon course with progressive flatfoot; may coexist. |
| Medial midfoot sprain | Ligamentous tenderness without a prominent bony bump. |
| Navicular stress fracture | Dorsal midfoot pain with impact; confirmed on MRI, not an accessory bone. |
Red Flags — When to See a Podiatrist Now
Seek same-day evaluation at Balance Foot & Ankle if you notice any of the following:
- Visible bony bump on the medial midfoot with redness
- Collapsing arch in a child or adolescent
- Pain preventing participation in sport
- Failed 6 weeks of orthotic and activity modification
Call (810) 206-1402 or request an appointment. Our Howell and Bloomfield Hills offices reserve same-day slots for urgent foot and ankle issues.
In Our Clinic: What We See
Clinical perspective from Dr. Tom Biernacki, DPM — Balance Foot & Ankle, Howell & Bloomfield Hills, MI:
Accessory navicular syndrome shows up in active adolescents and sometimes adults with a visible medial bump. In our clinic the exam finding is tenderness directly over the ossicle and pain with resisted inversion. X-rays confirm the accessory bone; MRI shows whether the ossicle is inflamed. Most patients respond to custom orthotics, activity modification, and short-term boot immobilization over 6-12 weeks. When conservative care fails, a Kidner procedure — excising the ossicle and re-attaching the posterior tibial tendon — restores arch function. Dr. Biernacki counsels families to try orthotics for 6 weeks first; surgery when needed is predictable but usually preventable.
In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
Most Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
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When to See a Podiatrist
If morning heel pain has persisted more than 6 weeks, home care alone rarely fixes it. At Balance Foot & Ankle, we combine in-office ultrasound diagnostics, custom orthotics, and — when needed — shockwave or PRP to resolve plantar fasciitis that hasn’t responded to stretching and inserts. Most patients are walking pain-free within 4-8 weeks of starting a structured plan.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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