Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Accessory Navicular Syndrome: Inner Foot Pain in Active Adol relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
An accessory navicular is an extra bone — an ossicle present in approximately 4–21% of the population — located on the inner side of the foot just above the arch, adjacent to the navicular bone. In most people, the accessory navicular is asymptomatic and discovered incidentally on X-ray. In a subset of patients, particularly active adolescents and young adults, it becomes a source of persistent medial foot pain that significantly limits sport and physical activity. Understanding the anatomy and pathology helps explain why this condition is often misdiagnosed as a flat foot problem or medial ankle sprain.
The Three Types of Accessory Navicular
Radiographic classification guides both prognosis and treatment:
- Type I (Os tibiale externum): A small, completely separate rounded ossicle within the posterior tibial tendon — rarely symptomatic
- Type II: A larger triangular ossicle connected to the navicular by a fibrocartilaginous synchondrosis (cartilage joint) — the most clinically significant type, responsible for most symptomatic cases
- Type III: A prominent cornuate navicular — the accessory ossicle has completely fused with the navicular, creating a large medial navicular prominence
Type II accessory navicular is the most symptomatic because the posterior tibial tendon inserts partly into the accessory navicular rather than (or in addition to) the main navicular — creating a suboptimal mechanical arrangement and a cartilaginous joint (the synchondrosis) that can become inflamed and painful under load.
Who Gets Symptomatic Accessory Navicular?
Symptoms typically emerge in adolescence (ages 10–16) during growth spurts, coinciding with increased activity demands and a period of relative Achilles tendon tightness. The condition disproportionately affects:
- Female athletes (2:1 female to male ratio)
- Children and adolescents with flat feet (pes planus) — overpronation increases traction stress on the posterior tibial tendon and accessory navicular attachment
- Athletes in sports with running, jumping, or lateral cutting
- Patients after acute inversion ankle injuries — the accessory navicular can be acutely avulsed or its synchondrosis disrupted
Symptoms
The hallmark is a painful, prominent bony bump on the inner side of the foot — visible and palpable — with direct tenderness over the accessory navicular. Activities involving push-off, running, and prolonged standing worsen symptoms. The prominence may cause shoe irritation and a visible redness from pressure. In active cases, the inner arch aches with any prolonged weight bearing.
Treatment
The majority of symptomatic accessory navicular cases resolve with conservative management during adolescence:
- Activity modification: Temporary reduction in high-impact sport to allow synchondrosis inflammation to settle
- Custom orthotics: Medial arch support that reduces traction stress on the posterior tibial tendon attachment at the accessory navicular — the most important conservative intervention
- Immobilization: Short-leg cast or walking boot for 4–6 weeks during acute flares with significant synchondrosis tenderness
- Cortisone injection: Ultrasound-guided injection at the synchondrosis for persistent inflammation
Surgical treatment — the Kidner procedure (excision of the accessory navicular with posterior tibial tendon advancement to the main navicular) — is reserved for patients with persistent symptoms after 6+ months of conservative care. Outcomes are excellent, with most patients returning to full sport within 4–6 months of surgery.
Inner Foot Pain in an Active Adolescent? Get an Accurate Diagnosis.
Dr. Biernacki evaluates and treats accessory navicular syndrome at Balance Foot & Ankle — Bloomfield Hills and Howell, MI.
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3980 E Grand River Ave, Suite 140
Howell, MI 48843
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43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
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.
Watch: Dr. Tom explains
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☎ (810) 206-1402Book Online →Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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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