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Accessory navicular

Dr Mostafa El-Feky and A.Prof Frank Gaillard ◉ ◈ et al.

An accessory navicular is a large accessory ossicle that can be present adjacent to the medial side of the navicular bone. The tibialis posterior tendon often inserts with a broad attachment into the ossicle. Most cases are asymptomatic but in a small proportion it may cause painful tendinosis due to traction between the ossicle and the navicular. Such changes are best seen on MRI.

On this page:

Article:

Epidemiology
Clinical presentation
Gross anatomy
Classification
Radiographic features
Treatment and prognosis
History and etymology
See also
Related articles
References

Images:

Cases and figures

Epidemiology

an accessory navicular bone is present in ~10% (range 4-21%) of the population
first appears in adolescence
more common in female patients
reported bilateral prevalence is ~70% (range 50-90%)

Clinical presentation

Most of the time it is asymptomatic and found incidentally on radiographs, although medial side foot pain (os naviculare syndrome) is the most common presenting feature of accessory navicular bone. The pain is aggravated by walking, running and weight-bearing activities. When large, it can protrude medially and cause friction against footwear.

Gross anatomy

An accessory navicular bone is located posterior to the posteromedial tuberosity of the tarsal navicular bone.

Classification

This classification was proposed by Geist ⁷ in 1914 and at the time of writing (July 2016) remains the most widely used classification system.

The Geist classification divides these into three types:

type 1 accessory navicular bone (os tibiale externum, os naviculare secundarium)
- 2-3 mm sesamoid bone embedded within the distal portion of the posterior tibial tendon
- no cartilaginous connection to the naviculam tuberosity and may be separated from it by up to 5 mm
- accounts for 30% of accessory navicular bones
- usually asymptomatic
type 2 accessory navicular bone (prehallux, bifurcate hallux)
- accounts for ~55% (range 50-60%) of all accessory navicular bones
- triangular or heart-shaped
- typically measures around 12 mm
- connected to the navicular tuberosity by a 1-2 mm thick layer of either fibrocartilage or hyaline cartilage
- eventual osseous fusion to the navicular tuberosity may take place
type 3 accessory navicular bone
- an especially prominent navicular tuberosity called a cornuate navicular
- thought to represent a fused type 2 and is occasionally symptomatic as a result of painful bunion formation over the bony protuberance

Radiographic features

Radiographs show a medial navicular eminence that is best visualized on the lateral-oblique view. Symptomatic accessory navicular bones may appear as a 'hot spot' on bone scan and on MRI bone marrow edema can be seen.

Treatment and prognosis

Acute pain can be managed can be achieved by corticosteroid injection and immobilization of the foot for 2-3 weeks. For refractory cases, surgical management can be considered.

History and etymology

It is thought to have been first described by Bauhin in 1605 ⁶.

See also

accessory ossicles

References

Anatomy: Lower limb

skeleton of the lower limb
joints
- hip joint
  - ligaments
  - additional structures
  - ossification centers
- knee joint
- tibiofibular joints
  - proximal tibiofibular joint
  - distal tibiofibular syndesmosis
- ankle joint
  - regional anatomy
    - medial ankle
    - lateral ankle
    - anterior ankle
  - ligaments
    - medial collateral (deltoid) ligament
    - lateral collateral ligament
    - additional structures
    - ankle bursae
      - retrocalcaneal bursa
      - subcutaneous calcaneal bursa
    - ossification centers of the ankle
  - variants
    - ball and socket ankle joint
- foot joints
  - subtalar joint
    - articulations
      - talocalcaneal joint
      - talonavicular joint
    - ligaments
    - associated structures
  - mid-tarsal (Chopart) joint
    - calcaneonavicular joint
    - calcaneocuboid joint
  - tarsometatarsal (Lisfranc) joint
    - ligaments
      - Lisfranc ligament
  - intermetatarsal joint
  - metatarsophalangeal joint
  - interphalangeal joint
spaces of the lower limb
- adductor canal
- femoral sheath
  - femoral canal
    - femoral ring
- femoral triangle (contents mnemonic | boundaries mnemonic)
- foot subdivisions
- popliteal fossa (mnemonic)
- tarsal tunnel (mnemonic)
- triangular space of cruciate ligaments
muscles of the lower limb
- muscles of the pelvic group
  - inner hip group
    - iliopsoas muscle
  - gluteal region
    - gluteal muscles
    - tensor fasciae latae muscle
  - lateral rotator group
- muscles of the thigh
- muscles of the leg
  - anterior compartment of the leg
  - posterior compartments of the leg
    - superficial posterior compartment of the leg (calf)
      - triceps surae
        
        medial and lateral heads of the gastrocnemius muscle
        
        soleus muscle
        accessory soleus muscle
      - plantaris muscle
      - calcaneal tendon
    - deep posterior compartment of the leg
  - lateral compartment of the leg
    - peroneus brevis muscle
    - peroneus longus muscle
- muscles of the foot
  - dorsal muscles
    - extensor hallucis brevis muscle
    - extensor digitorum brevis muscle
  - plantar muscles
    - 1st layer
    - 2nd layer
      - quadratus plantae muscle
      - lumbrical muscles
    - 3rd layer
    - 4th layer
      - dorsal interossei muscles
      - plantar interossei muscles
- accessory muscles
  - accessory peroneal muscles
vascular supply
- arterial supply of the lower limb
- venous drainage of the lower limb
  - deep system
    - common femoral vein
      - femoral vein
        
        deep femoral vein
        
        popliteal vein
        
        peroneal vein
        
        posterior tibial vein
        
        anterior tibial vein
  - superficial system
    - great saphenous vein
      - dorsal venous plexus
    - small saphenous vein
      - vein of Giacomini
innervation of the lower limb
- lumbar plexus (mnemonic)
  - femoral nerve
    - saphenous nerve
  - obturator nerve
- sacral plexus
  - sciatic nerve (motor distribution)
    - common peroneal nerve
      - superficial peroneal nerve
      - deep peroneal nerve
    - tibial nerve
lymphatics

Article information

rID: 1785

System: Musculoskeletal

Section: Anatomy

Tag: foot, bone, variant, ossicle

Synonyms or Alternate Spellings:

Os tibiale externum
Bifurcate hallux
Prehallux
Os naviculare secundarium
Os tibiale externum
Os naviculare accessorium
Geist classification
Os naviculare

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Cases and figures

Figure 1: the three typesFigure 1: the three types

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Case 1Case 1

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Figure 2: Geist classificationFigure 2: Geist classification

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Case 2Case 2

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Case 3: bilateral Case 3: bilateral

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Case 4: type IICase 4: type II

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Case 5Case 5

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Case 6Case 6

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Case 7: fractured type 3Case 7: fractured type 3

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Case 8Case 8

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Case 9: also with a os calcaneous secundariusCase 9: also with a os calcaneous secundarius

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Case 10: type II and IIICase 10: type II and III

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Case 11: type IICase 11: type II

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Case 12: with os naviculare syndromeCase 12: with os naviculare syndrome

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Case 13: type IICase 13: type II

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Case 14: type II Case 14: type II

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Case 15Case 15

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Case 16: type III and IICase 16: type III and II

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