Quick answer: Accessory Navicular Syndrome Medial Foot Pain Adolescents Michigan has multiple potential causes including mechanical, neurological, vascular, and inflammatory. The patterns we see most often are overuse, poorly-fitted shoes, and biomechanical imbalance. Red flags requiring urgent evaluation: warmth/redness (infection), inability to bear weight (fracture), and unilateral swelling without injury (DVT). Book online, or call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Accessory Navicular Syndrome — Medial Arch Pain in Ado relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Appointments in Howell + Bloomfield Township: (810) 206-1402.
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What Is an Accessory Navicular?
An accessory navicular is an extra bone (os naviculare) located on the inner side of the foot, adjacent to the navicular bone at the medial arch. It is present in approximately 4–14% of the population as a normal anatomical variant — most people with an accessory navicular have no symptoms throughout their life. However, in approximately 1 in 3 carriers, the accessory navicular becomes symptomatic during adolescence (typically age 8–15, coinciding with growth plate activity) or in adulthood after trauma or repeated stress. Symptomatic accessory navicular syndrome is one of the most common causes of medial arch pain and flatfoot in adolescents. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, Dr. Tom Biernacki, DPM evaluates and treats accessory navicular syndrome. Call (810) 206-1402.
Why the Accessory Navicular Becomes Painful
The accessory navicular is the attachment site of the posterior tibial tendon — the primary arch-supporting tendon of the foot. The posterior tibial tendon transmits significant tensile force through the accessory navicular with every step. Three accessory navicular subtypes exist with different symptom patterns: Type I — a small sesamoid bone in the posterior tibial tendon, rarely symptomatic; Type II — connected to the navicular by a cartilaginous synchondrosis (fibrocartilage bridge) — the most common symptomatic type, where repetitive stress creates micromotion and inflammation at the fibrocartilage junction; Type III — fully fused to the navicular (cornuate navicular), typically asymptomatic. Type II accessory navicular produces pain because the fibrocartilage synchondrosis acts like a stress fracture site under repetitive posterior tibial tendon loading — inflaming and developing stress edema visible on MRI.
Symptoms and Diagnosis
Accessory navicular syndrome presents with: a visible bony prominence on the inner side of the foot at the medial navicular area; tenderness directly over the bony prominence with direct pressure (shoe pressure); pain with standing, walking, or running activities; and frequently, a flatfoot deformity on the same side (the accessory navicular alters the posterior tibial tendon’s mechanical advantage). X-ray confirms the presence and type of the accessory navicular on oblique foot views. MRI is the most sensitive diagnostic tool — it shows bone marrow edema at the synchondrosis junction, confirming the Type II accessory navicular is actively stress-loaded and symptomatic rather than incidental.
Conservative Management
Conservative treatment of accessory navicular syndrome succeeds in 70–89% of patients when implemented consistently: short-leg cast or cam boot immobilization for 4–6 weeks to rest the synchondrosis and reduce bone marrow edema; custom orthotics with a medial arch post and navicular pad that offloads direct pressure on the prominence while providing arch support; activity modification — reducing high-impact loading during growth plate activity; and anti-inflammatory management. The critical element: orthotics must be worn in all footwear including athletic shoes, not just dress shoes. Custom medial arch support significantly reduces posterior tibial tendon pull on the accessory navicular during ambulation.
Surgical Management — Kidner Procedure
When conservative management fails after 3–6 months, surgical excision of the accessory navicular (modified Kidner procedure) provides reliable pain relief: the accessory navicular is excised through a medial incision; the posterior tibial tendon is reattached or advanced to the native navicular in a more plantar position to improve its arch-supporting mechanical advantage; recovery 6–8 weeks non-weight-bearing, 3–4 months to full activity. Success rates exceed 85% in adolescents and 75% in adults. In patients with concurrent significant flatfoot, a flatfoot reconstruction (calcaneal osteotomy, posterior tibial tendon advancement) may be combined with the Kidner procedure for comprehensive correction.
Accessory Navicular Management in Howell & Bloomfield Township Michigan
Dr. Tom Biernacki, DPM evaluates accessory navicular syndrome with clinical examination, weight-bearing X-rays, and MRI coordination at Balance Foot & Ankle. Custom medial arch orthotics are fabricated in-office. Surgical consultation is available when conservative management is insufficient. Serving Howell, Brighton, Bloomfield Township, Troy, Auburn Hills, and all Southeast Michigan. Book your evaluation or call (810) 206-1402.
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Ready to Get Expert Foot Care?
Dr. Biernacki and our team at Balance Foot & Ankle are accepting new patients in Howell and Bloomfield Township, MI. Most insurances accepted.
or call (810) 206-1402
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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 online booking 24/7 at our Howell and Bloomfield Township 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 Township
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 expert 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. For an urgent foot or ankle problem, call (810) 206-1402 and we’ll find the soonest opening.
In Our Clinic: What We See
Clinical perspective from Dr. Tom Biernacki, DPM — Balance Foot & Ankle, Howell & Bloomfield Township, 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.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Book online 24/7
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
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Ready to Get Back on Your Feet?
Appointments in Howell + Bloomfield Township. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Call Now: (810) 206-1402
When to See a Podiatrist for This Type of Pain
If your pain has lasted longer than 3-4 weeks despite home treatment, is interfering with daily activities, or includes redness, swelling, or warmth, it’s time to schedule an evaluation. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki and his team specialize in same-day diagnosis and conservative treatment plans tailored to your activity level and goals. Most patients are walking pain-free within 4-6 weeks of starting our protocol.
Red flags that warrant immediate care: sharp pain after a fall, inability to bear weight, visible deformity, numbness or tingling, fever with foot pain, or any open wound on a diabetic foot. Don’t wait — early treatment dramatically improves outcomes and prevents chronic complications.
Visit Balance Foot & Ankle — Online Booking 24/7
Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Township. If you’re dealing with heel pain, ingrown toenails, or a foot injury, you can book online 24/7.
Book online 24/7. (810) 206-1402
Frequently Asked Questions
When should I see a doctor?
See a podiatrist if pain persists past 2 weeks, prevents normal activity, or is accompanied by red-flag symptoms (warmth, swelling, numbness, inability to bear weight).
Can I treat this at home?
Mild cases respond to RICE protocol (rest, ice, compression, elevation), supportive shoes, and OTC anti-inflammatories. Persistent symptoms need professional evaluation.
How long does it take to heal?
Most soft tissue injuries resolve in 2-6 weeks with appropriate care. Bone injuries take 6-12 weeks. Chronic conditions need longer-term management.
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Appointments available in Howell and Bloomfield Township, Michigan.
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Or call: (810) 206-1402
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.