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The accessory navicular synchondrosis.

E J Sella, J P Lawson, J A Ogden

    Clinical Orthopaedics and Related Research
    |August 1, 1986
    PubMed
    Summary
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    Accessory navicular bone, a common foot variant, can cause pain in athletes. Type II accessory naviculars may lead to injury due to tendon forces and pronation, often requiring surgical removal.

    Area of Science:

    • Orthopedics
    • Sports Medicine
    • Podiatry

    Background:

    • Accessory navicular bone is an anatomical variant potentially causing foot pain in athletes.
    • Three types exist: Type I (ossicle in tendon), Type II (synchondrosis with navicular), and Type III (cornuate navicular).

    Purpose of the Study:

    • To investigate the biomechanical factors and resulting injuries associated with Type II accessory naviculars in athletes.
    • To describe diagnostic methods and treatment strategies for symptomatic Type II accessory naviculars.

    Main Methods:

    • Analysis of nine feet with Type II accessory naviculars.
    • Evaluation of biomechanical forces (posterior tibial tendon pull, foot pronation) acting on the synchondrosis.
    • Correlation of imaging findings (roentgenograms, 99mTc methylene diphosphonate scans) with microscopic injury patterns.

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    Main Results:

    • Tension, shear, and compression forces on the Type II synchondrosis, influenced by tendon pull and pronation, cause microscopic injury.
    • These alterations, resembling physeal fractures, are often not visible on standard X-rays but detectable via 99mTc MDP scans.
    • Nonsurgical treatments (orthotics, casts) are initial recommendations.

    Conclusions:

    • Type II accessory naviculars can cause pain in athletes due to biomechanical stress leading to injury.
    • 99mTc MDP scans are crucial for diagnosing these injuries when X-rays are inconclusive.
    • Surgical excision of the accessory navicular and synchondrosis is recommended if conservative treatment fails.