Causes Of Os Trigonum Syndrome
Os trigonum sometimes become painful this is called os trigonum syndrome. In most cases os trigonum syndrome occurs following an injury such as an ankle sprain. This can also occur due to repeated downward pointing of the toes such as occurs during ballet.
A particular type of os trigonum injury is called the nutcracker injury. This refers both to the fact the the os trigonum is crushed like a nut between the ankle bone and the heel bone, and to the Nutcracker ballet.
Get Your Symptoms Checked By A Professional
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If you or your adolescent suffer from these symptoms, make an appointment at American Foot for a checkup:
- A visible bony prominence on the inside of the midfoot just above the arch
- Redness and swelling of the bony prominence
- Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity
How Bone Spurs Are Diagnosed
See a doctor for foot pain that worsens or doesnt improve. A doctor will physically examine your foot and joints to determine the location of pain and to assess your range of motion.
Your doctors will use an imaging test to diagnose a bone spur. Options include an X-ray, CT scan, or MRI.
You dont need treatment for a bone spur that doesnt cause symptoms. Since a bone spur will not go away on its own, options to relieve bothersome pain include:
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Extra Bones And Accessory Bones Of The Foot
There are 26 bones in the normal human foot but some people have extra bones. These extra bones usually do not cause any problems and you may not even know that you have one.
Sometimes, however, they do lead to pain in the foot or ankle. If think you might have an accessory bone in your foot and it is causing pain, contact us today to schedule an appointment in our Seattle clinic. Even when they cause a lot of pain we can usually treat them conservatively. Surgery is almost never necessary and it is always our last resort, but in rare occasions the extra bone must be removed to relieve pain.
What Is Accessory Navicular Syndrome

Accessory navicular syndrome is when an extra bone in the foot causes pain and other symptoms. The accessory navicularalso known as the os naviculare or os tibiale externumis a small bone that extends from the navicular bone, one of the tarsal bones near the instep. About 14 percent of the population has an accessory navicular, and about half of the people with the extra bone have it in both feet.
Often, an accessory navicular causes no symptoms. When it does, howeverthe most common symptom being painit is known as accessory navicular syndrome. The posterior tibial tendon attaches near the navicular bone and accessory navicular, so tendon irritation is a common source of pain in accessory navicular syndrome.
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Do You Have Bone Growth On Top Of Your Foot
Most guys especially say they dont need it for the pain or that it doesnt even help that much, but this is to help your tissues heal faster, not so much for the pain relief.
What to do if you have extra bone in your foot?
In rare cases surgery might be necessary. The standard surgery for this condition is called a Kidner procedure. This involves separating the tibialis posterior tendon from the navicular and removing the extra bone. The tendon is then reattached and the wound is sutured.
The Dawning Of Distress
The redness, irritation, and soreness often appear in patients between ages 8 and 15 when the bones are maturing and the cartilage is developing. Athletics and activities become more strenuous, the feet suffer, and the top of the foot where the bone is protruding hurts. The condition can be aggravated in patients with flat feet. The pain can also manifest in adulthood.
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Why Do I Have An Extra Ankle Bone
What Is the Os Trigonum Bone? An os trigonum bone is a congenital malformation that develops before birth when one area of the tallus doesnt fuse with the rest of the bone during growth. When the bone doesnt fuse properly, theres an extra small bone in the ankle.
How do you get rid of an extra bone in your foot?
The most common procedure used to treat the symptomatic accessory navicular is the Kidner procedure. To perform this procedure, a small incision is made in the instep of the foot over the accessory navicular. The accessory navicular is then detached from the posterior tibial tendon and removed from the foot.
What Causes Accessory Navicular Syndrome
While the exact reason for the development of the accessory navicular bone itself is unknown, there is thought to be a genetic factor involved for some people.
Accessory navicular syndrome is caused by irritation or damage to the area of the navicular and the surrounding soft tissues. This may occur from:
- Abnormal foot biomechanics, particularly a flatter foot type
- Impact trauma to the inside of the foot
- An injury such as ankle sprains
- Tight footwear that rubs against the accessory navicular
- Overuse of the posterior tibial tendon and surrounding soft tissues
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Home Treatment For Accessory Navicular
Below are our recommended home treatments for accessory navicular syndrome. You can try them for a few weeks but if you are still not better then see a foot and ankle specialist in your area. If your pain worsens see someone right away. The products below are the ones we recommend to our patients and they are also affiliate links so we may receive a small commission at no additional cost to you if your order from the link.
View Related Problems + Treatments
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Dr. Dominic Carreira is a leading arthroscopic surgeon focused on hip preservation, foot and ankle surgery, and sports medicine. His practice is with Peachtree Orthopedics.
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Dr. Carreira considered top arthroscopic surgeon by leading physical therapist.
Dr. Dominic Carreira is a leading arthroscopic surgeon focused on hip preservation, foot and ankle surgery, and sports medicine. His practice is with Peachtree Orthopedics.
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How Is Accessory Navicular Syndrome Treated
Traditional medicine often falls short when it comes to treatment for this painful condition. As similar to other chronic pain conditions, the following regimen is usually recommended: RICE, immobilization, anti-inflammatory medications, cortisone injections, and/or innovative surgical options. Clients familiar with Prolotherapy often say no thanks to those choices, as they know these treatments will only continue to weaken the area in the foot. Instead, they choose Prolotherapy to strengthen the structures in the medial foot.
Signs And Symptoms Of Os Trigonum Syndrome

Os Trigonum syndrome causes pain to be felt at the back of the ankle joint. There may also be swelling in the area. The ankle joint may be sore to touch, but more often the pain is worse when the ankle is stretched in a downwards position as this pinches the bone between the calceaneus and the tibia . There will usually be restricted movement and tightness of the ankle compared to the non-affected foot.
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Discover How We Can Help You Find Relief From Accessory Navicular Syndrome
Accessory navicular syndrome is a condition involving some level of discomfort from an extra piece of cartilage or bone on the inner part of the foot above the arch. Present at birth , the additional posterior tibial tendon or bone may not be problematic at all if somebody with this abnormality has no foot pain because of it.
- If the extra bone is causing pain, there are several non-surgical treatments that can be tried before surgery is considered.
- In many cases, steps can be taken to minimize discomfort from accessory navicular syndrome.
What Is An Accessory Bone
When we are born, our bones are mostly cartilage. Over the first years of life this cartilage becomes bone. Most of the bones in the foot start to convert to bone in two areas and they eventually merge into one. Sometimes, however, they do not merge together and you are left with an extra bone. Accessory bones can occur in many bones in the foot, but they occur most commonly in three areas:
- Off of the navicular bone on the inside of the foot
- Off of the back of the ankle bone
- Off of the cuboid bone
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Causes Of Accessory Navicular Syndrome
The extra bone sometimes forms when the last of the seven tarsal bones develops. If this bone fails to unite during normal development in early childhood, an accessory navicular bone is the result. Its estimated that this abnormality is present in about 5-14 percent of all feet.
People with this extra bone may develop pain from it later from a foot injury or another condition that affects the foot in the same area. Sudden trauma from a sprained ankle or foot, for instance, may cause the extra bone or tissue to become painful. Additional causes and risks factors include:
- Overuse of the bones, tendons, ligaments, and muscles of the foot
- An underlying condition such as diabetes that affects feet
- Chronic irritation from shoes that dont fit properly rubbing against the extra bone
- Having flat feet
Evolution And Other Animals
The non-humanapes tend to walk on the lateral side of the foot, that is with an ‘inverted’ foot, which may reflect a basic adaptation to walking on branches. It is often held that their feet lack longitudinal arches, but footprints made by bipedally walking apes, which must directly or indirectly reflect the pressure they exert to support and propel themselves do suggest that they exert lower foot pressure under the medial part of their midfoot.
However, human feet, and the human medial longitudinal arch, differ in that the anterior part of the foot is medially twisted on the posterior part of the foot, so that all the toes may contact the ground at the same time, and the twisting is so marked that the most medial toe, the big toe or hallux, tends to exert the greatest propulsive force in walking and running. This gives the human foot an ‘everted’ or relatively outward-facing appearance compared to that of other apes. The strong twisting of the anterior part of the human foot on the posterior part tends to increase the height of the medial longitudinal arch. However, there is now considerable evidence that shoe-wearing also accentuates the height of the medial longitudinal arch and that the height of the medial longitudinal arch also differs very considerably between individuals and at different speeds.
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What Is An Ankle Sprain
An ankle sprain is an injury to the foot’s ligaments in the ankle. Ligaments are tough bands of elastic tissue that connect bones to each other. Ankle sprains may occur if the ankle rolls, turns, or twists beyond its normal range of motion. Ankle sprains may be caused by awkward foot placement, irregular surfaces, weak muscles, loose ligaments, or wearing shoes with spiked heels. The symptoms of a sprain will depend on how severely the ligaments are stretched or torn, but usually include swelling, pain, or bruising. Treatment will depend on the severity of the sprain, but may include:
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Resting the ankle
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Wrapping the ankle with elastic bandage or tape
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Ice pack application
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Elevating the ankle
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Nonsteroidal anti-inflammatory drugs, such as ibuprofen to help reduce the pain and inflammation
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Gradual return to walking and exercise
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Physical therapy
Ligaments are fibrous, elastic bands of tissue that connect and stabilize the bones. An ankle sprain is a common, painful injury that occurs when one or more of the ankle ligaments is stretched beyond the normal range of motion. Sprains can occur as a result of sudden twisting, turning or rolling movements.
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What Causes Bone Spurs On The Foot
A bone spur on top of the foot is sometimes due to osteoarthritis, a type of arthritis. With this condition, cartilage between bones can deteriorate over time. To compensate for missing cartilage, the body produces extra growths of bones called bone spurs.
Osteoarthritis isnt the only thing that causes a bone spur on top of the foot. A number of other factors can cause deterioration of cartilage, resulting in the growth of a bone spur.
Activities that can contribute to bone spurs include dancing, running, and exercise. Other causes include:
- injury to the foot
- obesity or being overweight
- wearing tight shoes
Bone spurs commonly occur on the foot due to the amount of pressure placed on these bones.
If you have a bone spur on the foot, itll likely appear on top of the mid-foot. You may also develop a toe spur or a heel spur.
Although bone spurs are common on the foot, they can form on other parts of the body, including:
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What Is A Bunion
A bunion is a protrusion of bone or tissue around a joint. Bunions may occur at the base of the great toe or at the base of the little toe, and often occur when the joint is stressed over a period of time. Women get bunions more often than men do because they may wear tight, pointed, and confining shoes. Bunions can also be a result of arthritis, which often affects the big toe joint.
Treatment of bunions may vary depending on the pain and deformity. Treatment may include:
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Wearing comfortable, well-fitting shoes
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Applying pads to the affected area
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Medications, such as ibuprofen
A bunion, also known as hallux valgus, develops on the big toe joint when the bones of the big toe become misaligned. It looks like a large bump on the side of the toe. The big toe angles in toward the second toe, and, in severe cases, may overlap or tuck beneath the second toe. Bunions are more common in women than in men.
Surgery For Accessory Navicular Syndrome

Some patients reach a point where conservative treatments only provide temporary relief. If this is the case, surgery may be recommended to correct the deformity. Surgery typically involves removing the accessory bone, repairing the posterior tibial tendon, and restructuring the foot back to a normal appearance. The extra bone is not necessary for proper foot functioning.
Its not possible to prevent an abnormality like accessory navicular syndrome. However, it is possible to make smart decisions when it comes to how you care for your feet. Wearing comfortable shoes that provide sufficient support and seeking treatment for any sudden or worsening foot pain can increase your odds of responding well to treatment recommendations. Accessory navicular syndrome is an inherited condition. Yet every person will have a different experience with it.
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Change Shoes Or Wear Padding
Changing your footwear can also relieve symptoms of a bone spur, especially if you work on your feet.
Choose shoes that arent too tight or too loose, and ones that dont pinch your toes. Wear shoes with rounded or square toe for extra room. If you have a low arch, add extra padding to your shoes to relieve pressure.
Foot Bone Problems & Conditions: Your Complete Guide
Our bones are strong and durable, however, if they are not taken care of they can become weak and brittle.
Our feet hold over 25% of all the bones in our body. The bones in the feet work with the muscles, tendons and ligaments, which allows mobility, stabilization and balance. We may not realize it, but we rely heavily on the bones in our feet to live day to day.
Use this section to learn about problems and conditions that can affect the bones of the foot. Many times, there are preventive measures you can take to avoid problems altogether.
Youll find information like this, plus additional info such as symptoms and causes of various injuries that can occur to the bones. To get started, click on the title of the article that interests you below.
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Why Is Research Important For Rare Diseases
Research increases what we know about rare diseases so that people can get a diagnosis more quickly and can know what to expect. Research also helps doctors better understand how well a treatment works and can lead to new treatment discoveries. It may even help improve diagnosis and treatment of more common diseases.
Accessory Navicular Syndrome Treatment
Accessory navicular that do not cause pain need no treatment. Treatment for accessory navicular syndrome usually starts with conservative care, and the condition often requires nothing more.
Switching to softer shoes is usually the first-line treatment. If that doesnt work, a custom-made orthotic insert may help. Other conservative measures can include:
- Rest from physical activities that aggravate the area
- Nonsteroidal anti-inflammatory medication to control PTT
- Physical therapy
If surgery is necessary, the Kidner procedure is the most common. This is where a surgeon removes the accessory navicular and reattaches the posterior tibial tendon with a screw. It is a fairly simple surgeryit takes approximately 45 to 60 minutesthat usually produces a good outcome .
After the surgery a hard cast will usually be necessary to immobilize and protect the affected foot. For the first two weeks to a month after surgery, the patient will wear the cast and should not bear weight on the affected foot.
After approximately a month, the cast can be removed and replaced by a boot, and the patient will be able to begin to bear weight on the leg. About six weeks after surgery, the patient should be fully able to bear weight on the affected leg and can begin physical therapy. A full recovery may take up to six months, but patients can return to work or school far sooner.
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