Accessory Navicular Removal Surgical Process

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.
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Lance Silverman, MD

Orthopaedic Surgeon and founder of Silverman Ankle & Foot. Treating Minnesotans with Ankle & Foot problems since 2004.

Comments

  1. nia says

    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 says

      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 says

    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 says

      Niki,

      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

  3. Bee says

    I had a kidner procedure six months ago along with some other surgeries to the foot. Right after the surgery my foot kept jerking and twitching really hard at night. I’ve never had anything like that happen before. Maybe it was caused by the nerve block? Anyways, long story short, it caused excruciating pain in the tibial is posterior tendon and as I started trying to weight bear it got worse and worse until now I can’t step down on that foot at all without excruciating pain. Discussed with doctor the possibility of opening it back up to check on the posterior tibial tendon since the MRI was hard to read this early on and with metal in the foot. I tried six weeks non weight bearing and no improvements. Every step causes intense sharp pain I that tendon. Attempts at tiny pt exercises make it throb. There’s definitely some swelling around the tendon. My question is, is tendonitis ever this severe? I’m curious as to whether we should wait to open it up a little while longer of just get surgery to see what’s going on. You wouldn’t think it could tear that easily, but I do have joint hyper mobility and have torn things before pretty easily. I have tenderness over the tendon when they push on it and same pain when I try to put weight on it. It’s swollen. The tendon feels thicker. Cortisone injection made it worse oddly after a couple weeks. I’m only 25. Is there a chance that I will be one of those weird cases of surgical complications that just never ever gets better? I’m scared that this pain will never go away :( like, really really scared! Do these things tend to get better with time and surgery? I have a really good doc with a really good reputation, but I guess there are always risks of complications with any procedure. Sorry this has gotten so long! My basic questionis-is there a good chance this will all resolve and I will walk pain free someday again? I’m worried :( thanks for this website and for taking the time to read these comments!

    • anklefootmd says

      Bee,

      Patients who hurt 3-4.5 months after a Kidner procedure may have failure of the tendon to heal back down to bone. Despite the best of intentions, this happens sometimes.
      In some circumstances, revision repair can be performed. In others excision of the bad Posterior tibial tendon can be performed and replacement with a new tendon (flexor digitorm longus). Hopefully your doctor can shed more light on your current status. Hoping for the best.

      Dr. Silverman

      • Bee says

        Thank you so much! Helps so much to know it what could be going on and that there’s a procedure to fix it!

      • Bee says

        Sorry to be a pest, I had one more question if you don’t mind answering… what happens if they transfer the FDL tendon to replace a bad tibial tendon and then the FDL tears? My doc seems to think that exploratory surgery is the next step with a possible FDL transfer, which has me scared because I seem to tear tendons so easily :/

      • anklefootmd says

        An FDL tendon used to replace a posterior tibial tendon when it fails for a series of reasons. When I see patients with FDL tendon problems after a posterior tibial tendon reconstruction, exploration of the tendon transfer is one of the least likely options for me to choose. Instead, patients with a failure of the tendon transfer in this circumstance often will need a fusion procedure in order to become pain free and improve function.

  4. Sue Andrews says

    Hi my daughter had the extra bone removed 13 months ago, yet the lump where it was is now twice the size and hurts her more, the consultant just said it will heal over time and 6 weeks ago discharged her, is it normal for the lump to still be there?? Thanks

  5. Keri Fisher says

    My daughter is 9 and a soccer player. She has had trouble walking with pain, so we took her to the Dr. She was diagnosed with accessory navicular. He gave us an over the counter orthotics, but it does not seem to be helping her. I am worried because she is so young and this foot pain is impacting her life. The Dr. said, the bone is growing and by age 15, it may not hurt her anymore. He also said only 30 percent get surgery. She needs to stay active and happy…should we go for a second opinion?

    • anklefootmd says

      Keri,

      Simple answer is yes. Get a second opinion. The treatment algorithm for a symptomatic accessory navicular that works best is to immobilize the pull on the bone by using a walking cast boot. If that doesn’t heal it then surgery is indicated. Age is not a factor. Making a patient wait until a certain age is not scientific, practical nor sympathetic.

      Dr. Silverman

  6. Bee says

    Thank you so much! Now I won’t have so much fear of my backup plan (surgery to transfer the tendon) failing next. I emailed my doctor this week and I have the feeling he’s gonna want to re-open the thing up. The tendon keeps making this bizarre popping sound with stabbing pain every time I try to do ROM. Don’t know what that means, but I have the feeling it’s not going to be good! Good to know there are solutions!

  7. Anynomous says

    Ok, so I had my accesory navicular removed on both feet, the tendon didn’t heal back to the bOne right so I had another surgery to get it fixed, my first question is, three months after the surgery My posterier tibial tendon keeps popping, eveytime it pops is very painful. Why is this? My other question is, since I had the surgery on both feet does this mean I will need to get it fixed on the other foot too? I have pain in the other foot but it is not as bad?

  8. Cathy says

    My daughter (13) has bilateral accessory navicular. Her orthopedist stated that he felt surgery was inevitable, however we are trying orthotics (she had congenital club foot and two Achilles tendon lengthening procedures one at infancy and one at age 5). If surgery is inevitable, does she have to be done growing before the procedure happens. She has overcome a lot with her feet, and she is an athlete, I would like to get this over with before she enters high school. and this summer between track and cross country/soccer season. We have an appt, scheduled just want to see if this is something we have to wait for her growth to finish

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