The accessory navicular

The accessory navicular is a common presence in the human foot and must be included in the differential diagnosis of medial foot pain in patients who are of appropriate age. Imaging modalities aid in diagnosis of a symptomatic ossicle and guide classification and treatment. Often, a combination of studies is needed to establish an accessory navicular as the source of foot pathology. Although conservative measures always are the first line of treatment, the benefits of surgical management are well-defined in the literature. Most foot surgeons rely on resection procedures with varied handling of the PTT insertion, although newer modifications that use bony fusion techniques are being investigated. As with any musculoskeletal condition, proper diagnosis and individually-tailored treatment plans are of the utmost importance to a satisfactory outcome. With meticulous patient selection and a thorough understanding of the condition, management of the painful accessory navicular often is successful in alleviating the disability it causes.