Over the years, I have had a number of patients who come in with complaints of pain in the inner center part of their arch. Typically, these patients tend to be athletic, however not all are. Oftentimes, these patients have a bump in this inner center arch area. What is this bump and why is it painful?

Accessory navicular

As infants and children, many of our bones start off as cartilage. These cartilage “bones” are difficult to see on x-ray until they become calcified. The calcification process occurs at a variety of different times in life depending on the bone.

An accessory navicular is an extra bone that is on the inner center arch of the foot. Up to 2.5% of individuals are born with the accessory navicular. Throughout early childhood, this condition is not noticed. However, in adolescence, when the accessory navicular begins to calcify, the bump on the inner aspect of the arch becomes noticed. For most, it is never symptomatic. However, for some, there is some type of injury, whether a twist, stumble, or fall, that makes the accessory navicular symptomatic.

There are three different types of accessory navicular. This extra cartilage, which is turned into bone, is found attached to the posterior tibial tendon, just medial (inside) the navicular bone. The accessory navicular can affect the insertion of the posterior tibial tendon. This tendon has a job of keeping your foot aligned and helping to maintain an arch. The accessory navicular can be associated with a normal foot posture and alignment, or sometime with a flat (pes planus) foot.

An initial assessment is an orthopaedic office begins with a thorough history and complete physical exam, including an assessment of the posterior tibial tendon and areas of tenderness. Associated misalignments of the ankle and foot should be noted. Finally, weight-bearing x-rays of the foot will help in making the diagnosis. Sometimes, an MRI may be needed to see if the posterior tibial tendon is involved with the symptoms or getting more clarity on the anatomy of the accessory navicular.

Initial treatment is conservative. With the first episode of symptoms, a medial heel wedge, anti-inflammatories, and physical therapy can be helpful. If very painful, a cast or boot may be needed for a short period time before the wedge and physical therapy can be initiated. Very rarely is a steroid injection warranted or recommended. As the pain improves, patients can resume activities. For a minority of patients, an arch support or custom orthotic can help to take some of the extra pressure off of the accessory navicular and the posterior tibial tendon.

For patients who have failed conservative care or who have had recurrent symptoms, surgery can be considered. Surgical intervention requires an excision of the accessory navicular and reattachment of the posterior tibial tendon to the navicular. Often times, this is the only procedure necessary. However, if there are other deformities such as a flat foot or forefoot that is abducted, other procedures may be required.

In summary, an accessory navicular is a fairly uncommon condition which is rarely symptomatic. Oftentimes non-surgical treatment is successful. In the minority of cases, surgical intervention is required. Patients typically do very well with conservative and surgical treatment. Athletic activities can usually be restarted once symptoms have improved or the patient has recovered from surgery.

www.seleneparekhmd.com

47 comments

  1. Rachel

    I have a ten year old daughter just diagnosed with accessory navicular. We are being referred to a podiatrist. In the meantime is there anything I can do to ease the discomfort?

    • Claire

      Hi Rachel, I had an operation on this last June because none of the options worked, but Sometimes icing it can help and Volatol? If she ever has to have the operation, I personally wouldn’t recommend it, after I was told I’d be back playing sport a couple of months later and I’m still in a walking boot not and on crutches

    • Bella

      I am dancer and I had this problem a few years ago in my left foot and I would stick my foot in an ice bath for 20 minutes every night of the week leading up to my dance competition and it really helped!

  2. selene parekh

    Rachel, thanks for your question. Each patient is different and really requires a thorough exam and work-up. You should see your orthopaedic foot and ankle specialist for a discussion regarding treatment options and outcomes. Good luck – / SGP

    • Rachel

      We did of course lol. As I had said we were waiting to be seen. I was hoping to aid her discomfort until then. Which has now past. But ty for all off your help.

  3. Kelley

    After 4 months from the surgery, the foot still has pain where the incision area is. Is this normal and what is the normal time of recovery after surgery? What may help? Daughter is very active at 12 years old and she has much discomfort and pain . Thank You

    • Jada

      Hi I had the surgical procedure the in August and it is now February and I still have horrible pain even though it has been six months. my doctor told me that physical activity would decrease the pain, but that didn’t work. what I do for temporary relief is , massage my foot with a lot of pressure, I do this whenever I’m just sitting down and, I do it for about 5-10 minutes. it might be a little sore at first but, it really relieves the pain. I hope this works for your daughter.

  4. lynn

    Hello – I sprained my ankle 9 months ago and it never got better. I had some physical therapy and that helped to a point but I was till in a lot of pain. The pain was inconsistent… some days not bad and other days I could barely walk. I saw a podiatrist this summer and he diagnosed through MRI the accessory navicular. I have been wearing a boot for four weeks (will wear it for 8 total). After I am done with the boot, we will reassess and determine next steps. At this point I am still having some pain when I don’t have the boot on (going to the bathroom at night, showering, etc.) so I am not feeling optimistic that immobilzation will work. So I am wondering about the recovery time from the surgery – how long in bed, how long non-weight bearing, how long immobilized, etc. BTW, I am 50 and it seems like it takes forever for things to heal these days.

    • Dr. Selene Parekh

      Every surgeon has a different protocol. Typically these surgeries are done as an outpatient surgery. The extra bone, accessory navicular, is removed. The posterior tibial tendon is then advanced and attached back onto the navicular bone. Typically patients are non weight bearing in a cast for 2 to upwards of six weeks. After that, typically they are in a boot for another 4 weeks. During the time of the boot, weight bearing is allowed, physical therapy started. Hope this helps. – / SGP

    • Nicole

      Hey Lynn, I know this was awhile ago but I hope it still helps. I had the same immobilization and it didn’t help. I have gone through braces, ortho inserts, medication, fleet or patches, casts and crutches. Not only did none of those options really help but they are very expensive. I am planning on having the surgery in the next weeks. That’s what I would advise as nothing else has helped.

      • Marianne

        Hi Nicole. Did you have the surgery done?

    • Rich

      Hi Lynn,

      I had a fall from the stairs and my foot has been in pain for one year! I’ve done everything from physical therapy to chiropractors to splinting. Nothing has worked.

      May I know how you are a year later?

  5. Natalie

    is there any other non surgical treatments other than ice and pain medicine?

  6. stofono

    hi i have a lumpon my chest and it feels like an extra bone is it???? it REALY hurts

  7. Hailey

    Hi- I’m 13 and am about to have my second surgery. I’m not sure if I should do It I’m stilling having from 5 months later in my other foot.

  8. Kara

    Hi all, when I was 17 I noticed a ‘bump’ on the side of my foot which caused a great deal of pain if I was on my feet for an extended period of time. I went in to see a foot doctor and he did an Xray and diagnosed me with Accessory Navicular. He gave me insoles to wear in my shoes that would support my arch making that tendon not stretch so far over the extra bone. Now I’m 25, still dealing with the problem, I work on my feet for 8 hours a day which my foot has gotten used to, but i noticed that it appears to stick out more? Is it possible this bone can keep growing or maybe my foot got skinnier.. I have considered the surgery but being out of work for more than a month isn’t an option for me right now.

  9. June

    Hi I had this same problem yet I was misdiagnosed and they thought I had ligament weakness. However, an MRI was done and the bone showed up to be marginally inflamed. My orthopaedic specialist told me that it would be temporary pain and he said that we would not need to see him again unless I was in extreme discomfort. However, today I tripped down the stairs and I thought I may had sprained my ankle as the pain was so unbearable, yet my extra bone was swollen and red. What should I do?

  10. Ashley

    I broke my ankle 7 weeks ago and found through x-rays I have an accessory navicular. My ankle is healing nicely and isn’t giving me much trouble, but the inside of my foot (where the extra navicular is) gives me problems frequently. I went to the doctor this week and he told me he could remove the accessory navicular, but he would also recommend heel realignment surgery for me. Has anyone had heel realignment surgery with the navicular removal? I’m trying to decide if this is something I should go through with or not. Thanks!

  11. Alex

    hello, I had my foot kicked playing soccer and at first i assumed it was just a normal sprained ankle. About a month later the injury was still present. I eventually went to a podiatrist and had some MRI scans showing i have a small accessory navicular. I was given some custom made orthotics to try and offload the weight onto a different part of the foot. I’ve been wearing these orthotics for nearly about three weeks now and i still have pain in the accessory navicular region. I’m desperately trying to get this problem sorted by the start of football season which is in 8 weeks and I’m wandering what my options are. If i opt for surgery ill miss most of the season with no guarantee i can play properly afterwards. If i keep on going how i am i doubt it will fully heal and when i go to start training it will become worse almost instantaneously. The annoying thing about this is the pain is so inconsistent, sometimes it feels as good as new then sometimes its quite painful. Should i just go on crutches for a few weeks to ensure I’m not using my post tibial tendon at all? or is there any other options i have?

  12. Amelia

    hi,
    I was diagnosed with the accessory navicular awhile ago. Nothing has bothered it, until about 7 weeks ago when I rolled my ankle in a fluky injury. Nothing has seemed to help it I’ve been on crutches, I tried the air cast for 2 weeks, cast for a week(took it off so I could ice it), another type of boot, an inversion cast for 2 weeks, which I just got off and now I feel like I’m still at stage 1 with the air cast again. I have tried pain meds(motrin,tylenol 3) and ice it quite a bit. I’m going to physiotherapy today, to try to get some bloodflow and release tension throughout the area. Do you think this is the correct route to go in, with a possibility of it not working? Because I am a competitive hockey player and runner wondering if getting the surgery sooner will be beneficial for now and in the future. I was also wondering if waiting this injury out with the risk of it not getting better, or rushing to the surgery after almost 8 weeks? I’m just looking for the best soloution so I can get back to sports as soon as possible!!

  13. Jessica J

    I was diagnosed with fallen arches, an accessory nivicular, and Kolher’s disease in my right foot at age nine.
    I experience extreme foot pain, sometimes even inability to walk. I also get hip and back pain. It has only been two years from my diagnosis, so in class I seem to be the odd one out, a child with back pain! It is sort of funny. I wore a boot for several months last year, and still do occasionally. I had an MRI scan done, and several other x-rays and visits to the orthopedic.
    If you have any questions, feel free to ask

  14. Selene

    Hi- My story is exactly the same as above. It has been 1.5 yrs since injury. I have tried PT, acupunture, walking boot and the pain keeps coming back. I recently had a baby and took 5 months off, during this time my foot didn’t hurt at all. Once I started work and exercise the pain came back and I have it every day. My work consists of stocking (carrying up to 50 lbs and pulling pallets with merchandise). My question is if I agree to surgery can I go back to doing my current job after recovery? If so, after how long? My Doctor has recommended switching jobs but its not that easy to do when I need benefits for my family. I hope surgery works because it is so stressful having pain every day and not being able to be on my feet for long periods of time.

    • Rich

      Hi Selene,

      I am on the same boat. May I know what has happened since? Did you proceed withe surgery?

  15. Former athlete

    I had an accessory navicular in both feet that were involved in fractures after a sports injury. I went through their “conservative” treatment first which ended up being two years of casts before they decided it wasn’t helping and actually fixed it. That being said, I would still advocate for conservative treatment first. Whenever you open a joint, it’s never the same again and I actually need surgery again to do maintenance on what was fixed. I’m only 24 years old. This issue also caused other problems due to my body compensating for the damage.

    Moral of the story: know your body. Know what is normal for you and don’t second guess what you know about your own body. You’ve had it your whole life. Also, treat surgery as a last resort. Don’t go looking for it.

  16. Amy

    I had both feet done last year. Right foot in Sept and left foot exactly 3 months later so I could get it in before insurance deductibles reset.

    I still have pretty intense pain in both feet. Dr said it will take about a year to fully heal. Well, I limp around terribly sometimes and others walk just fine. Lately it’s been mostly painful as I’ve increased activity. I had to buy Vionic flip flops and they help immensely.

    They both still swell up but the left is much worse and will turn sort of red/purple when it swells. What an annoying situation. I really hope they eventually heal. The pain before was pretty bad and getting more frequent. It would also cause me to have to turn my feet and walk on the outer sides of them. I hope the surgery was a “cure” and not just a waste of time, pain, and money.

  17. Loren

    I am so frustrated with my problem and not sure what to do. I am a full time mother of two kids. I did therapy a year ago and that didn’t work. My doctor said I really do need surgery. I have this unbearable pain on both feet and it’s taking a toll with my daily life. I can’t do all the things I want with my kids because the pain is horrible. I love to be active and that’s become a challenge. Not sure if surgery will fix the problem make it worse.

    • Colleen

      Hi Loren –

      I had this in both of my feet but at the time of my surgery only one was bothering me. I did the surgery and the recovery was very painful and it took awhile for my foot to get back to normal. However, I am better than ever now. I do not have anymore pain in that foot. Now my other foot is beginning to bother me so unfortunately I am going to have to get surgery on that. While the recovery sucks, it is worth it.

      • Kim

        I just saw the doc today and he recommended the surgery along with heel realignment. I had the same symptoms 6 years ago and this time, it isn’t getting an better. I’ve been in a walking boot now for 6 weeks. How long did it take for you to feel normal again? I’ve heard it’s a painful and long recovery. I teach 1st grade and have no idea when or how I’m going to do this. Thanks for any advice! Good luck with your other one.

      • Monica

        Can I ask how old you are? My 10 year old has this and we are debating the surgery.

      • Vicki

        Hi, May I ask the name of your surgeon and the city? You are the only success story I’ve seen with this surgery and I need to get it done. I live in Texas but will travel wherever the best surgeon is because I believe that is key. Thank you, Vicki

  18. Nicole

    I have one in each foot. It has really made my life a mess! I want to be more active and run more, but it hurts so much. It has also interfered with my sports. I have had custom insoles for my shoes made (600 dollars!) but they do little to help my flat feet (my feet are extremely flat due to the extra bones). It has also messed up my legs and knees. I had physical therapy due to extreme knee pain a few years back. And I am only 16. I am not sure if I want to get the surgery since it takes so long to heal and I would need BOTH removed – immobilizing me further. Also I have heard it doesn’t always help, even making things worse. I really want to make a decision before I go off to college as I would want it to be fully healed for then (I would be doing a LOT of walking while in college).

  19. Tonya

    I have the extra bone in my ankle also. When I was young I would scream in pain when my legs and feet would hurt was also taken to hospital and told it was growing pains. The around 13 I would hit it on my pedal riding my bike and it hurt always finally found the reason when referred to Podiatrist. I had orthotics made but lost them eventually and it doesn’t cause many issues unless I walk a lot. I need to get something done I would like them removed. I have spent 2 days at Disneyland and can barely stand my feet feel broken and it feels like the bone is being stabbed. Excruciating pain need to stop.

  20. Janey

    How long was recovery after the surgery and would you say you’ve benefited from it?
    I’ve been diagnosed of having an accessory navicular and tendinitis in my tibial tendon. It’s been described to me as an extra bone in my foot with a tendon thats structure is like a pen without the outer casing.
    Apparently born with the accessory navicular, however the pain only occurred after a dreadful inner twist of the ankle during a game of basketball nearly 12 months ago.
    I’m constantly in pain, I’ve been seeing the podiatrist, had my orthotics made and modified numerous times, I were in a moonboot for 3 weeks to take the pressure off. The specialist has tried shock wave therapy and that just caused agony. I’ve also been to physio to try and strengthen my foot as I am unable to even stand on my toes anymore and are putting alot of pressure on my ‘good foot’.
    I’m currently booked in to have an injection, however I’m not confident that it’s going to resolve anything. I’ve been told surgery isn’t all that common and theyre trying to avoid commencing such a procedure with the state that my tendon is in. It’s currently stressing me out and it has taken a toll on my career and my health. I just want to go back to living an ordinary life without pain or worry.
    I’m 25 years young and wish to live out my life with two feet in healthy working order!
    I’m constantly icing and have tried massaging, creams and been on anti inflammatories.. with very little relief.
    Any advice or related experience would be greatly appreciated!

    • Meg Ackerly

      Janey- see my reply left above. Get the surgery to remove the accessory navicular. I started having foot surgery in my 20’s but it was not until I had the foot reconstruction with accessory navicular removed, and heel repositioned that my life was improved. The first night after surgery is not too bad due to a nerve block, but 2nd and 3rd nights are very tough. After that, the pain gets much better, and I was done with pain meds after a week.

  21. Thomas

    Hi, 2 months ago I felt an extreme pain in my right foot, so I went to the doctor and he told me I have accessory navicular syndrome, he put me in a walking boot, 1 month after seeing him I went back and it felt as if the boot had done nothing to help, no decrease in pain, as of today I have been in a boot for a little more than 2 months and yesterday I went to the foot and Ankle guys at the hospital, I had set this appointment us the previous week. He told me to get an MRI which I am doing in a few days. He also told me that I should get surgery. He told me that in 30+ years of being a doctor he had never seen anyone in so much pain with this problem. The thing is it hurts really bad when walking and standing on it for a while and most of the time sitting down. I don’t want to get surgery if I don’t need to and I’m no expert on this so help me out. Plus if I get surgery I will miss the entire basketball season and I missed the entire football season with the problem. PS: I am a 14 male. Also Any recommendations on a surgeon? I can travel.

  22. Cool guest

    I am 13 now but when I was 8 I was diagnosed with os naviculare syndrome (accessory navicular). In both feet. Also if I am barefoot it used to not hurt now it hurt even barefoot. My feet hurt badly through out the day even off then and at night when sleeping. I roll my ankles a lot at least 5 times a day. And sprain 1 a week. I want to have the surgery done but I can’t tell my parents that. So do any of you guys have anything that I could do to relive some of the pain. Or a way to tell my parents.

    • Elizabeth

      Hi Cool guest,
      It’s been about 3 months since your post, I hope you read this reply.
      I saw in your post that you were asking about how to tell your parents about how much pain you are in and that you’d like to have the surgery.
      Please, just straight up tell them! I was ashamed and embarrassed as a kid (I’m 28 now) that it hurt me to wear my roller blades, new shoes my mom just bought me, etc. I was scared they’d be angry. I never told them, and now as adult the problem has gotten much worse, to the point where I can’t even stand or walk to the next room without being in terrible pain. My arches have fallen, the whole structure is messed up.
      My parents now regret that it didn’t tell them, they feel guilty that my problems could have been taken care of years ago.
      Please, just tell your folks. There is nothing to hide- you have a medical condition that is not your fault.
      Get it taken care of while your young or it will get worse.
      I hope you read this, cool guest.
      Keep me posted.

  23. Dana

    I was diagnosed in 2014 (at 26) with accessory navicular in both feet. One day I felt a pinching in my right foot, and within a few days I was completely immobilized, with my entire leg and foot swollen to twice its normal size. The weight of my bed sheet at night was so intense. It was definitely one of the most painful things I have ever gone through and I’ve had two children and gallstones lol. My podiatrist immediately recognized it and gave me a cortisone shot in the right foot; the left is also painful but on a tenth of the scale of the right. Three months later I got another cortisone shot in the right foot. It has been two years and it is just now becoming painful again. Orthotics are not really much of an option for me as I have to have special shoes at my work that the orthotics do not fit in (steel toe, electrostatic dissipating). I also have a 3 and 1 year old to chase around. My podiatrist told me I would eventually need the surgery, but I can’t imagine what the recovery will be like with two small children at home. I also would normally commute an hour in either direction to go to work, so I would be out of work for quite a while. Just looking for some recovery feedback from the surgery – particularly those who have small children or have had to return to work shortly after surgery and how that worked our for you. Thanks!

    PS. the cortisone shots are definitely a short term solution and is really just a temporary bandaid, but I cannot tell you how much better it feels just a few days afterward.

    • Elizabeth

      Hi Dana,
      Unfortunately I don’t have surgery feedback as I haven’t gotten it yet (insurance issues). But I am relieved to read that someone else has experienced the bed sheet thing! No one gets it when I talk about it, but I see you’ve felt it too! It’s painful to have the heel press into the bed or feel the blanket on top of the foot, I can’t even lay down without being in terrible pain.
      I’m glad cortisone worked for you- I had a medrol dose pack (6 day steroid regimen) which worked great the first time, but the second it did nothing except make me feel crazy, steroid psychosis I think. Be careful with steroids, they really are just temporary.
      Best wishes.

  24. Steven

    I believe this bone is of ancient dna and is uncommon my gf has it and some of my friends do as well actually a majority do i think we banded together in some unconscious tribal way. I believe arch support negatively affects people with this bone more than without it i wear flat footed shoes and have amazingly strong and very balanced feet i believe its doing a diservice to put feet like this in a cast aka shoe all day long i believe its there for support and strength and putting it in a shoe only atrophies the muscles and tendons that may or may not connect to this bone rendering it truly useless im not really sure of the mechanics of the bone but i do believe it plays a role in balance

  25. kim

    Yesterday morning I noticed a bruise and bump forming right on the inside of my arch. It is still bruise and it is definitely inside of my skin and not on the outside. It’s swollen and hurts when I press on it. I’ve been working out more lately…I wonder if I stressed something? I also had a double bunionectomy about 12 years ago. I have a screw in each foot. It almost feels like the screw. (It isn’t. The screws have not moved.) Super weird! Help!

  26. Sapna

    I was diagnosed with accessory navicular when I was 11 years old. I used orthotic shoes that did not really help. As I got older, I wore running shoes with arch “cookies” in them, and they helped a lot. My pain is also inconsistent and my bone also turns red when it is hurting. I recently rolled my ankle in a fitness class and it has been hurting a lot since then. But I haven’t stopped going to class. I think exercise and running strengthens the muscles that support the bone. I have debated getting the surgery, but I recently met a runner who had the surgery on both feet. He is a world-class athlete, competes in races, and really knows his body – strengths and weaknesses. He told me that he regrets getting the surgery. He has not been able to run in 6 months, even though the doctor told him the recovery would only be 6 weeks.

  27. Nicole

    I think I’ve finally figured out that I have accessory navicular syndrome. The pain started when I was a teen, and it was often very tender and sore right below my inner ankles. It has plagued me for years, and my feet look like they have extra inner ankle bones. They were often very tender by the end of the day, and then sore and stiff when I woke up in the morning, and it always seemed like I had to break them in after getting up. I had mentioned it to a doctor, and told her that I thought I had extra ankle bones, but I don’t think she was familiar with anything like this. I was referred to a rheumatologist who ruled out rheumatoid arthritis, but the ankle/feet problem was never diagnosed. After doing online research, I am certain that this is what has plagued me all these years.

    If this happens to be a congenital defect due to some defective gene, I wonder if we all inherited this from a common ancestor?

  28. Gelsey

    I am a 12 year old girl. I got surgery to remove my extra bone 3 weeks ago. Just to let you know, the surgery isn’t scary at all. I just remember a mask over my mouth and the nurses telling me jokes and I couldn’t stop laughing. I start laughing slower and the world is slower. Then I woke up like took a 3 second nap. I am still in a cast and crutches. I started noticing the pain at 10 years old. It effected me ALOT. It was one of the worst pains ever. The first time I can remember me feeling the pain was at a 5th grade track day(I probably felt it a little bit before too). I’ve been dancing for 9-10 years. As a dancer who dances 5 times a week, I would say some stuff and people didn’t think it was serious. I would dance through the pain(not a good idea) because I didn’t want to stop dancing. Two months ago, I tried out for a performing arts school. We knew I had a extra bone by then but I danced through the pain. I find out if I make it at the end of this month. We wanted to get the surgery done so I would be able to dance at my new school if I made it. And because I am still growing and that is a good time to get it over with.( I am so sorry if my sentences don’t make sense or my grammar is terrible.) my foot will forever be less boney.?

  29. Gelsey

    Yesterday I left a comment saying “I hope I get into Lincoln Park I will find out at the end of this month.” Well I find out literally last night and I got in?Now I don’t have to worry about the problem cause I got surgery

  30. Darrell

    Sapna, my experience was like that of your running acquaintance. I wasn’t world class, but I did run cross country in high school. I got the surgery on one foot around age 22, which was back in 1980 or so. Like your friend, I was told it would I would be able to run in a couple months. But, also like your friend, it was not runnable even after 6 months. In fact it took full year to recover. It did wind up being somewhat better than before, eventually. But it was such an annoying experience that I never did get the other foot done. I did check with a surgeon a few years ago, and he said surgery now would be pretty much the same as back in the day.

  31. Eliza

    Soo I’m an equestrian, (ride horses) they’re my life, heard somewhere that if you have to get surgery then recovery time is about 6 months??!! Is this true??!

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