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Accessory Navicular Removal Surgical Process

December 3, 2012

Accessory Navicular

An accessory navicular is defined as an extra bone in the foot, and oftentimes it causes moderate to severe discomfort.  Depending on the severity, your doctor may recommend a non-surgical treatment to alleviate the pain, or surgery if treatment doesn’t decrease symptoms. Here is an explanation of the surgical process for Accessory Navicular Removal.

Pre-surgical Care

  • Follow patient-specific surgical center recommendations regarding how to prepare for surgery, anesthesia, etc.
  • Before surgery you will be given regional anesthesia and Novocain-like medication to provide complete pain relief.

Surgical Care

  • After the anesthesia is administered you will be heavily sedated and placed on your stomach.
  • Surgeons will place a tourniquet around your thigh and an incision will be made on the inside of the foot.
  • The posterior tibial tendon will be moved as necessary and the accessory navicular will be removed.
  • Surgeons will repair the posterior tibial tendon with sutures or suture anchors, and the wound will be closed.
  • A splint will be placed on the foot for stabilization and immobilization.

Post-surgical Care

  • You will be permitted to leave the surgical center once you have been cleared by the anesthesiologist.
  • Plan ahead to have a friend or family member take your prescription to a pharmacy to pick up your post-op medication.
  • Use narcotic pain medications before bed or if numbness in your foot begins to dull.
  • Schedule a post-op visit for 4 weeks after the procedure.

Post-surgical timeline for Accessory Navicular removal

(Consult your doctor for patient-specific post-op care as recommendations may vary.  The below timeline is a general guideline for routine accessory navicular removal)

First 3-5 days

  • Elevate leg for 23 hours a day for the first three days.  Elevation will help reduce swelling, which may last more than 4 months.
  • Move and flex your toes after the nerve block mitigates.  Motion will help decrease pain and swelling.
  • Use strong narcotics for pain management.  Begin to use a lesser pain control medication like Motrin or Tylenol after 3-5 days.

First 2 weeks

  • You can return to work after 10-14 days if your job is non-labor intense.  Check with your doctor to ensure it is safe to return to work.
  • Visit your clinic to have your original cast replaced after two weeks.  A secondary cast will be worn for an additional 4 weeks.

Beyond 2 weeks

  • Do not place weight on the foot for 6 weeks.  This will give the tendon ample time to heal.
  • Return to the surgical center after 6 weeks to have your secondary cast removed and a fracture boot placed on you foot.  This will assist in weight bearing.
  • You can return to labor-intensive work after 3 months, but speak with your doctor about your specific case and work requirements.

Further maintenance

  • Do not get cast wet.  Use a waterproof cast cover (such as a Drypro) to keep your cast dry during showers.
  • Patients who underwent a procedure on their left foot may operate an automatic transmission vehicle within a week, but consult your surgeon about operating a vehicle when taking specific pain-management medication.
  • Patients who had the procedure done on their right foot should wait until the foot has healed enough to bear weight and they feel safe operating a vehicle.
  • If you experience foot pain after 3 months, consult your doctor.
  1. nia permalink

    Sorry to be a pest! I know this is my second question today. I have psoriatic arthritis that attacked my peroneal tendons in both feet causing tears, an accessory navicular/tibial tendon pain, and peroneal subluxation. Another possible diagnosis that’s been considered was crps, but I had no sensitivity to touch, just prolonged pain and redness and swelling they thought was more likely due to the arthritis. I’ve been on methotrexate and enbrel and my joint pain is getting better but the tendons in my feet are still so painful I can barely walk. I had to quit school and work. I’m getting the peroneal subluxation fixed soon, but wondering if anyone knows if they can take out the accessory navicular at the same time? Does removing it help with posterior tibial tendonitis? I believe the plan right now is a groove deepening and debridement of the peroneal tendon and also getting rid of a low lying muscle belly. But I’m worried that I will have to have two surgeries on that foot because the accessory navicular/tibial tendon is so painful I can’t even wear shoes that rub against that bone! Not sure which problem to address first. I’m also not sure I should even tell my surgeon about the accessory navicular pain, because I’m worried if I do, he’ll get overwhelmed and won’t even want to help me with the subluxation…should I bring it up? I’m worried :/

    • anklefootmd permalink

      Always tell your surgeon about everything before surgery. Fix one set of problems at a time. Sometimes the primary problem is causing secondary problems. Once you fix the first one, the symptoms of the other go away. Its always easier and safer to do less. Sometimes more isn’t better. Less is often more.

  2. Niki H permalink

    I had modified kidner procedure about 11 weeks ago. I had very little pain until about a week ago when I was released from using my walking boot. Unfortunately, my posterior tibial tendon hurts again, especially when I push off of the big toe to walk. Is this normal since the tendon had to be re-attached or should I be concerned? I am still doing PT, so hoping that helps, but certainly frustrated that I have similar pain as I did pre-surgery (with the exception of the intense pain around the navicular bone).

    • anklefootmd permalink


      Kidner procedures sometimes do not heal and the pain continues, but you need to let the healing run its course. Some people are slow to heal and some don’t eventually heal. Tendon surgeries sometimes take longer to resolve, and we typically wait 4.5 to 6 months to see if things are improving or are not before discussing other options. Best of luck with your recovery.

      Dr. S

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