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Imaging of the symptomatic type II accessory navicular bone
Leigh D Mosel1, Evelyn Kat, Frank Voyvodic
1Department of Radiology, Flinders Medical Centre, South Australia, Australia. leigh.davis@optusnet.com.au
Australasian Radiology
|July 3, 2004
Summary
Accessory navicular bones are often misdiagnosed as fractures. Type II accessory naviculars commonly cause medial foot pain, requiring advanced imaging for accurate diagnosis.
Area of Science:
- Orthopedics
- Radiology
- Podiatry
Background:
- Accessory ossicles, particularly the accessory navicular, are frequently misidentified as fractures on foot radiographs.
- The accessory navicular bone occurs more often in women and can be bilateral in up to 90% of cases.
- While often asymptomatic, accessory naviculars are more prevalent in individuals experiencing medial foot pain.
Observation:
- Three types of accessory navicular bones exist, with Type II being the most common symptomatic variant.
- Type II accessory naviculars present with chronic or acute-on-chronic medial foot pain, tenderness, and soft tissue inflammation.
- Radiographs alone are insufficient for attributing symptoms to an accessory navicular.
Findings:
- Ultrasound aids in pain localization and comparison with the contralateral asymptomatic foot.
- Bone scintigraphy shows high sensitivity but lacks specificity for symptomatic accessory naviculars.
- Magnetic resonance imaging (MRI) is highly valuable for detecting bone marrow and soft tissue edema associated with symptomatic accessory naviculars.
Implications:
- Accurate diagnosis of symptomatic accessory naviculars is crucial to differentiate from fractures.
- Advanced imaging modalities like ultrasound and MRI are essential for diagnosing symptomatic accessory naviculars.
- Understanding the imaging characteristics of accessory navicular variants improves patient management and treatment strategies.