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Having problem with Navicular tendon. Why would it need to have extra bone removed when is not flat footed?

Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
my daughter is having a problem with her Navicular tendon. I'm confused about the possible surgery. Why would she need to have her extra bone removed when she is not flat footed. Also, if it her tendon and the connective tissue is the problem and the bone is not, why can't we take care of the tendon and leave the bone alone. If she gets the bone removed its a 14 week recovery. If she gets only the tendon worked on than its 6 weeks.
Posted Tue, 20 Aug 2013 in Bones, Muscles and Joints
Answered by Dr. K. Naga Ravi Prasad 2 hours later
Hi, thanks for writing to XXXXXXX

Before I answer your query, I have to let you know a few points about accessory navicular bone.

Presence of Flat foot can be PHYSIOLOGICAL or PATHOLOGICAL. Presence of Accessory navicular bone is "associated" with Flat foot but not in all cases.

Accessory navicular bones are seen in roughly 12% of the population and are a NORMAL variant. Two patterns of accessory navicular bones are described -

(1) In this category, the accessory navicular bone is a sesamoid bone in the tendon of tibialis posterior, it is anatomically separate from the navicular bone and usually DOES NOT CAUSE SYMPTOMS.

(2) Here, the accessory navicular is in close association with the navicular bone causing a change in the shape of navicular bone. This type may be associated with PAIN, particularly DURING ADOLESCENCE.

Accessory navicular is NOT A CAUSE of hypermobile flatfoot, but because both conditions are common, they may present together.


If the patient is symptomatic with pain, then a course of conservative treatment with analgesic antiinflammatory medications, use of longitudinal arch supports, or an ocassional local injection of steroid will help.

When conservative measures fail to relieve the symptoms of a painful accessory navicular, SIMPLE EXCISION OF THE ACCESSORY NAVICULAR BONE and ANATOMIC REPAIR OF THE TIBIALIS POSTERIOR TENDON will yield successful results.

Having said all the details, to simplify - Mere excision of accessory navicular bone will not make the surgery complete but the tendon of tibialis posterior has to be repaired (because the accessory navicular is present within the tendon in most cases).

Hope I have addressed all your issues. Happy to help for any more clarifications.

Above answer was peer-reviewed by
Follow-up: Having problem with Navicular tendon. Why would it need to have extra bone removed when is not flat footed? 5 hours later
Let me give you more information about my daughter. She dances about 10-12 hours a week (ballet, tap, Jazz). My daughters problem started spontaneously while walking to class. The orginal orthopaedic that saw her said she may need to get her tendon removed which would result in a loss of activity for 6 weeks. The foot doctor said if surgery is necessary she would need the bone to be removed as well. I was told that this would be a 14 week recovery.

My daughter has normal looking feet with high arches. Per my research the navicular bone is usually removed when the person has flat feet as well as other symptoms.

Currently, my daughter is taking a percription pain and inflammation drug as well as orthodics.
Answered by Dr. K. Naga Ravi Prasad 4 hours later
Hi, thanks for getting back.

From your given description, I am of the opinion that the unresponsiveness of the pain is due to strain being exerted on the tendon as well as bone (in the form of dances 10-12 hrs a week).

Any amount of inflammation to settle down needs rest to the local part and additional strain should be laid on the injured tissues (that is your daughter needs to give up dancing untill the pain & inflammation comes down).

Yes, any surgery being done on a tendon in the form of repair or tenodesis will require rest for minimum of 6 weeks.

As you rightly said, the ACCESSORY navicular bone is excised only if the pain is not improving with conservative measures.

I suggest you try a local steroid injection which in some cases will provide promising pain relief.

Above answer was peer-reviewed by
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