The accessory navicular surgery is a procedure that is useful for people who experience pain along the inner center of their arch. You might even feel a bump in this area where the discomfort is at its highest levels. Athletes are usually the first to report an issue in this foot location, but it is a condition that can impact anyone.
Many of our bones actually began as cartilage. They are difficult to see on x-ray images until the calcification process occurs. This process can complete at different times in life depending on the bones in question. The accessory navicular is an extra bone that forms along the inner arch of the foot. About 2.5% of the general population experiences this condition with symptoms that may qualify for surgery. Most children do not notice this issue because the bone has yet to calcify.
About 14% of the general population has this condition, with most people never experiencing any symptoms because of it.
It can often go unnoticed without symptoms throughout a person’s life. This condition is usually discovered after someone experiences an injury to the foot. A stumble, fall, or twist can quickly make this extra bone become symptomatic.
There are three different types of the accessory navicular to consider. Each one offers unique challenges that an orthopedic surgeon must consider before recommending this procedure.
If you are struggling with pain along the inner arch, then these are the pros and cons of an accessory navicular surgery to consider.
List of the Pros of the Accessory Navicular Surgery
1. The accessory navicular surgery can relieve the pain from tendonitis.
When you have an accessory navicular in your foot, then there is an excellent chance that some of the discomfort you feel is due to the extra bone rubbing against one of the tendons in your foot. This condition causes that area to inflame as it tries to cope with the injury. It is a condition that can lead to severe swelling at times that can be extremely painful. You may even experience extensive fluid build-up around the tendon. The surgery will help to relieve these conditions, helping you to become pain-free once again.
2. It can provide immediate relief for some patients.
Some people experience discomfort along their inner arch because the extra bone is there and for no other reason beyond that. When this situation occurs, a simple excision can be enough to remove the discomfort. Although you will content with the recovery period after the surgery, you will notice an increase in comfort levels as soon as you can begin placing weight on the area once again.
3. The recovery process for the accessory navicular surgery is straightforward.
You will likely be kept in a short leg cast for the first month after your procedure with instructions not to bear any weight on the foot. There is a need to keep the full range of motion for your hip and knee, so bending and straightening the joints each day is encouraged. You may be instructed to wiggle your toes or perform straight leg raises too.
Once you can start to walk on the foot, you should do so as the pain levels permit. Use crutches until you can no longer walk with a limp. By the time you reach the second month post-surgery, you should be in an ankle brace for your exercises and working harder at your physical therapy. By the third month, you’ll begin to walk normally once again.
4. The accessory navicular surgery can help to reshape the foot.
You do not need this extra bone for normal foot function, which is why it qualifies for a surgical removal in the first place. When you receive this procedure, there is an opportunity for the orthopedic surgeon to reshape the food to improve the function of your tendons. This process can help to relieve the symptoms you experience.
5. It restores the functionality of the foot.
The typical non-surgical approaches to treating the accessory navicular involve the typical RICE model: Rest, Ice, Compression, and Elevation. You may have your foot placed in a cast to immobilize it as this can help to start the healing process. Some doctors will request orthotic devices that fit into the shoe to ensure the arch is supported, which can stop future symptoms. When this approach does not work, the surgery can help to restore functionality to the foot once again.
6. There may be discounts available for the surgery cost.
Some hospitals and orthopedic surgeons in the United States offer discounts to individuals if they are paying cash or do not have enough insurance coverage to limit their financial liabilities for the procedure. There is a 35% discount available for patients in California who may need this surgery. Some clinics in Chicago offer free services on specific days that you can schedule to find relief. There are also federally-funded health centers in the United States where fees are charged on a sliding scale to provide services. If your clinic does not provide this type of care, then be sure to ask for a referral.
List of the Cons of the Accessory Navicular Surgery
1. The initial treatment of the condition is very conservative.
Most doctors will not immediately jump to the need for the accessory navicular surgery if you experience discomfort in the foot related to this extra bone. It is common to take a conservative approach to deal with the pain and discomfort first. The first symptoms are given a medial heel wedge, NSAIDs or other anti-inflammatory medication, and then physical therapy to reduce symptoms. Some people may receive a boot or cast if the condition is extremely painful before these low-risk interventions are tried first.
When the pain improves, you can then resume normal activities. A steroid injection may be useful in specific cases. Even arch supports can take pressure off the bone. If none of these options work, only then will the surgery be deemed necessary. It can take between 6-12 months to go through the conservative phase.
2. It can take up to a year to recover from the surgery.
Most people can be back to their usual routine after their accessory navicular surgery in 6-9 months. If you hit the physical therapy centers soon after the procedure and take care of your body, then it may be possible to reduce your recovery time to 4-5 months instead. Some people take longer to heal than others, so it may be up to a year before you’re ready to return to the regular routine.
Younger patients typically recover faster and better than older ones, even though there can be hesitance to perform it on anyone younger than 18. Make sure that you work with a surgeon who is familiar with this procedure to minimize the potential disadvantages that you may face.
3. Some people are not good candidates for this procedure.
Many doctors are hesitant to perform the accessory navicular surgery on adolescents because of the potential complications involved with the process. Even if the condition is extremely painful, the conservative approach may be the recommendation to follow at all costs. Until you reach your 20s or 30s, the surgery is considered the treatment option of last resort. Then you will have the extra bone removed, followed by a reattachment of the posterior tibial tendon. If you have other deformities or your forefoot is abducted, then additional procedures become necessary as well.
4. The surgery may not fully remove the discomfort.
There are times when the accessory navicular surgery will successfully treat your condition, only to have the symptoms sometimes reoccur. If this happens, then non-surgical approaches are almost always recommended. Even when the bone is excised from the foot, the tendonitis and nerve damage that it causes could produce chronic symptoms that are challenging to treat. Some people may experience burning or tingling sensations in their foot that never go away after the procedure.
5. Some people have the bone grow back even if it is excised.
One of the most common ways to have the accessory navicular procedure is through a process called the Kidner procedure. It was developed in the 1930s as a way to remove the pain from a foot when the extra bone is present. Some people must have this surgery multiple times because the cartilage in their foot calcifies into another bone that may need to be removed.
6. Some people may be asked to stop playing sports.
The advantage of the accessory navicular procedure is that it can decrease the pain in your foot so that you can participate in your favorite sports once again. The disadvantage here is that some doctors may recommend that you avoid surgery if you want to continue pursuing athletics. There are doctors who may warn you not to participate in high-impact sports after recovery from the surgery to prevent your bother symptoms from recurring. If you receive this recommendation, then it might be helpful to seek out a second opinion on the matter.
7. There is a cost consideration to consider with this procedure.
The cost of the Kidner procedure or another surgical intervention for the accessory navicular can cost up to $17,000 (and sometimes more) depending on the region where you live and the severity of the condition. Depending on your insurance situation, you may be required to meet a deductible requirement before receiving any monetary benefits for the cost. If a family has a high-deductible plan, they may be responsible for most, if not all, of the entire surgery cost. That’s another reason why the conservative treatment options are tried first. They can provide relief at a fraction of the cost that the surgery and post-operative care demands require.
The pros and cons of the accessory navicular surgery show that it may be necessary in some instances, but it is usually the final choice that doctors recommend when other treatment options fail. Because there is a hesitance to perform this surgery, some patients may experience prolonged discomfort as they attempt the available conservative treatment options. Every surgery offers specific risks that you should discuss with your doctor to determine if this procedure is your best option.