Extra scaphoid bone causes risks and treatment

The accessory navicular bone is something you might have without even realizing it. In many cases, it causes no problems at all. However, for some people, it can lead to noticeable pain or a bothersome bump on the inner side of the foot. Some discover it accidentally during an X-ray, while others start experiencing discomfort when walking, exercising, or wearing tight shoes.In this Dalili Medical article, we’ll cover everything you need to know about the accessory navicular bone — including its causes, types, symptoms, and treatment options. We’ll discuss conservative treatments such as exercises and medications, as well as when surgery might be necessary.If you’d like to fully understand this extra bone and learn how to manage it properly, this article is definitely for you!

What Is an Accessory Navicular Bone?

The accessory navicular bone is a small extra bone located on the inner side of the foot, next to the main navicular bone. It is present from birth and, in most cases, does not cause any problems throughout life. However, in some individuals, it may lead to pain, discomfort, or difficulty with movement—especially during walking or physical activity.

Common Questions About the Accessory Navicular

1️⃣ Is the accessory navicular dangerous?

No, most cases are not serious.
Many people live with it without any symptoms. Problems usually appear only if inflammation or persistent pain develops.

2️⃣ Is it a congenital condition?

Yes.
It is present from birth due to the failure of an additional ossification center to fuse with the main navicular bone.

3️⃣ Does everyone with an accessory navicular need treatment?

No.
Treatment is only required if pain, inflammation, or walking difficulties occur.

4️⃣ Can it cause flat feet?

It can in some cases, especially if there is weakness in the posterior tibial tendon, which supports the foot arch.

5️⃣ Does it appear in children?

Yes, but symptoms usually begin during adolescence due to growth and increased physical activity.

6️⃣ Is sports activity restricted?

Not always.
In mild cases, light exercise is possible with proper arch support. However, intense running or excessive jumping may worsen the pain.

7️⃣ Does the accessory navicular disappear over time?

The bone itself does not disappear, but symptoms can improve or resolve with proper conservative treatment.

8️⃣ When is surgery needed?

Surgery may be necessary if:

  • Pain persists for more than 3–6 months

  • Conservative treatment fails

  • There is significant arch weakness

  • Chronic tendon inflammation develops

9️⃣ How long is recovery after surgery?

  • Light weight-bearing after 2–4 weeks

  • Gradual return to normal activities within 3–4 months
    Recovery time varies depending on the type of procedure.

???? Does body weight affect the condition?

Yes.
Excess weight increases pressure on the foot arch and may aggravate symptoms.

1️⃣1️⃣ Does footwear matter?

Absolutely.
Tight or unsupportive shoes can worsen symptoms. Supportive athletic shoes with orthotics are recommended.

1️⃣2️⃣ Can pain return after improvement?

Yes, especially if:

  • You suddenly resume intense activity

  • You stop doing strengthening exercises

  • You wear inappropriate footwear

Causes of the Accessory Navicular

The accessory navicular is not an acquired disease but a congenital anatomical variation. A person is born with it, but symptoms may appear later depending on daily stress or activity.

1️⃣ Congenital Cause (From Birth)

During fetal development, bones form from ossification centers (growth points).
Sometimes, an additional ossification center develops next to the main navicular bone. Normally, these centers fuse together. If fusion does not occur, a separate small bone remains—this is the accessory navicular.

Main cause:
Failure of an additional ossification center to fuse with the navicular bone.

2️⃣ Genetic Factors

In some families, more than one member has an accessory navicular.
This suggests a hereditary predisposition, although not everyone develops symptoms.

3️⃣ Foot Structure (Flat Feet)

Individuals with low arches or inward foot alignment place more pressure on the inner side of the foot.
This may make the accessory navicular more prominent and symptomatic.

4️⃣ Repetitive Stress and Overuse

Although present from birth, continuous pressure can trigger symptoms, such as:

  • Running or high-impact sports

  • Prolonged standing

  • Excess weight

  • Wearing tight shoes

This may lead to:

  • Inflammation of the bone

  • Posterior tibial tendon inflammation

  • Pain and swelling

5️⃣ Direct Foot Injury

A strong impact or ankle sprain can suddenly irritate the bone, causing acute symptoms—even if it had never caused problems before.

Types of Accessory Navicular

The accessory navicular is classified into three main types based on its shape and connection to the main navicular bone. The type often determines symptom likelihood and treatment approach.

1️⃣ Type I

  • Small, completely separate bone (about the size of a sesame seed)

  • Not attached to the main navicular bone

  • Usually located within the posterior tibial tendon

  • Rarely causes symptoms and is often discovered incidentally on X-rays

  • Mildest and least problematic type

2️⃣ Type II (Most Common)

  • Connected to the main bone by cartilage (not fully fused)

  • Larger than Type I

  • Most likely to cause pain and inflammation

  • Repetitive movement may irritate the connection site

  • Most common type requiring treatment if symptomatic

3️⃣ Type III

  • Complete bony fusion with the main navicular bone

  • Results in a larger or more prominent navicular bone

  • May cause noticeable inner foot prominence

  • Pain is often due to external pressure from footwear

Symptoms of Accessory Navicular

Some individuals have no symptoms, while others may experience:

1️⃣ Inner Foot Pain

  • Pain over the inner arch

  • Worsens with prolonged standing or walking

  • Increases with running or tight shoes

  • May feel throbbing or burning

2️⃣ Swelling or Visible Prominence

  • Noticeable bony bump

  • Swelling or redness if inflamed

  • Tenderness when touched

3️⃣ Difficulty Wearing Shoes

  • Pressure from tight shoes

  • Persistent discomfort

  • Preference for wider footwear

4️⃣ Posterior Tibial Tendon Inflammation

Since the accessory navicular is attached to the tendon supporting the arch, symptoms may include:

  • Pain along the tendon

  • Weak arch support

  • Foot fatigue

  • Increased pain when climbing stairs or standing on tiptoes

5️⃣ Flat Foot (Collapsed Arch)

  • Reduced arch height

  • Inward foot rolling during walking

  • Quick fatigue

6️⃣ Recurrent Pain After Activity

  • Appears after sports or long days of standing

  • Improves with rest

Stages of Accessory Navicular Symptoms

Stage 1: Asymptomatic

  • Bone present without pain

  • Often discovered incidentally on imaging

  • No swelling or inflammation

  • Normal daily life
    This is the most common stage.

Stage 2: Mild Irritation and Inflammation

  • Mild pain after walking or prolonged standing

  • Tenderness on the inner foot

  • Occasional mild swelling

  • Pain improves with rest
    Often associated with mild posterior tibial tendon inflammation or early stress at the cartilage connection (especially Type II).

Stage Three: Moderate to Chronic Inflammation

  • Persistent and noticeable pain

  • Visible swelling

  • Difficulty wearing tight shoes

  • Pain when climbing stairs or standing on tiptoes

  • Weakening of the foot arch

At this stage:

  • Chronic inflammation of the posterior tibial tendon is often present

  • Repeated pressure on the accessory bone continues

  • Early flattening of the foot arch may begin

Stage Four: Advanced Complications

  • Severe pain affecting movement

  • Clear flattening of the foot

  • Weak internal arch support

  • Quick fatigue while walking

In advanced cases, a partial tendon tear may occur.

This stage may require more aggressive treatment, and sometimes surgery if conservative management fails.

Diagnosis of Accessory Navicular

Diagnosing an accessory navicular is relatively straightforward. However, it is important for the doctor to distinguish it from other causes of inner foot pain. Diagnosis typically involves several integrated steps:

1️⃣ Medical History

The doctor will ask about:

  • The exact location of pain

  • When pain worsens (walking, running, prolonged standing)

  • Presence of swelling or visible prominence

  • Previous foot injuries

  • Whether you have flat feet

These answers help guide the clinical evaluation.

2️⃣ Clinical Examination

During the physical exam, the doctor may:

  • Press on the inner side of the foot. If pain is directly over the bone → strong suspicion of accessory navicular.

  • Observe for bony prominence (more obvious in Type III).

  • Perform a single heel rise test (standing on tiptoes). Pain or weakness may indicate posterior tibial tendon involvement.

  • Evaluate the foot arch for flattening or inward collapse.

3️⃣ X-ray

This is the most important step to confirm the diagnosis.

A standard X-ray can show:

  • The presence of an accessory bone

  • Its type (Type I, II, or III)

  • The shape and connection to the main navicular bone

In most cases, X-rays alone are sufficient.

4️⃣ MRI (Magnetic Resonance Imaging)

MRI is used when:

  • Pain is severe or the diagnosis is unclear

  • There is suspicion of tendon inflammation or tear

  • Preparing for possible surgery

MRI shows:

  • Degree of inflammation

  • Condition of the posterior tibial tendon

  • Bone marrow edema or internal swelling

5️⃣ CT Scan (Rare Cases)

Used mainly:

  • To assess the bone structure in detail

  • Before complex surgical procedures

Most cases are easily diagnosed through clinical examination and plain X-rays. CT scans are reserved for complicated cases or surgical planning.

Risks and Complications of Accessory Navicular

The accessory navicular itself is not dangerous. Many people live with it without any issues.

However, complications may develop if chronic inflammation or repeated pressure occurs.

1️⃣ Chronic Foot Pain

  • Persistent pain on the inner side of the foot

  • Worsens with walking or prolonged standing

  • Difficulty performing daily activities

Without treatment, pain may become chronic and last for months or years.

2️⃣ Posterior Tibial Tendonitis

The accessory bone is connected to the tendon responsible for arch support. Repeated stress may cause:

  • Chronic tendon inflammation

  • Weak arch support

  • Pain extending toward the ankle

In advanced cases, partial tendon tears may occur.

3️⃣ Acquired Flatfoot

Tendon weakness may lead to gradual arch collapse:

  • Inward rolling of the foot while walking

  • Quick fatigue

  • Altered weight distribution across the foot

4️⃣ Limited Mobility

  • Difficulty running or climbing stairs

  • Pain with prolonged standing

  • Avoidance of physical activity

This can significantly impact overall lifestyle.

5️⃣ Constant Shoe Friction

Especially in Type III:

  • Prominent bony bump

  • Continuous shoe irritation

  • Skin redness or recurrent inflammation

6️⃣ Surgical Complications (Rare)

  • Temporary swelling

  • Postoperative pain

  • Mild stiffness

  • Need for structured rehabilitation

Success rates are very high when surgery is performed for appropriate cases.

Surgical Treatment of Accessory Navicular

Surgery is typically considered when:

  • Pain persists for more than 3–6 months

  • Conservative treatment fails

  • Severe tendon inflammation or weakness exists

  • Progressive flattening of the foot develops

1️⃣ Simple Excision

Removal of the accessory bone only.

Suitable for cases where pain is mainly due to friction or pressure.

Advantages:

  • Simple procedure

  • Short surgical time

  • Faster recovery

Disadvantage:

  • May not be sufficient if tendon weakness is present

2️⃣ Kidner Procedure (Most Common)

  • Removal of the accessory bone

  • Reattachment of the posterior tibial tendon to its correct anatomical position

Suitable for:

  • Persistent pain

  • Arch weakness

  • Most Type II cases

Benefits:

  • Significant pain improvement

  • Better arch support

  • Excellent long-term results

3️⃣ Fusion (Fixation Instead of Removal)

  • The accessory bone is fused to the main navicular bone using a screw

  • Converts cartilaginous connection into solid bony fusion

Used for:

  • Painful Type II cases

  • Younger patients

Advantage:

  • Preserves natural bone structure

Disadvantage:

  • Risk of nonunion (failure of fusion) in some cases

4️⃣ Tendon Repair or Reconstruction

For cases involving:

  • Partial tendon tear

  • Severe chronic inflammation

The surgeon repairs or repositions the tendon, sometimes using a tendon graft.

5️⃣ Flatfoot Reconstruction (Advanced Cases)

In severe cases:

  • Arch reconstruction

  • Bone realignment

  • Correction of foot deformity

This is a more extensive procedure requiring longer recovery.

Anesthesia & Procedure Duration

  • Usually performed under regional or general anesthesia

  • Surgery lasts 45 minutes to 1.5 hours, depending on the type

Recovery Period

  • Cast or surgical boot for 2–6 weeks

  • Gradual weight-bearing

  • Physical therapy is essential

  • Full return to activity typically within 3–4 months

Success Rates

Very high (approximately 85–95%, depending on the case).
Most patients return to normal life pain-free.

Exercise Treatment for Accessory Navicular

Exercises aim to:

  • Strengthen the posterior tibial tendon

  • Support the arch

  • Reduce inflammation

  • Prevent flatfoot progression

⚠️ Important: Exercises should not cause severe pain. Stop if pain increases and consult your doctor.

1️⃣ Posterior Tibial Tendon Strengthening

How to do it:

  • Sit on a chair

  • Place a resistance band around the front of your foot

  • Pull your foot inward against resistance

  • Return slowly

Dosage: 3 sets × 10–15 repetitions, every other day

This is the most important strengthening exercise.

2️⃣ Towel Curl Exercise

How to do it:

  • Place a towel on the floor

  • Use your toes to pull it toward you for 2–3 minutes

Strengthens small intrinsic foot muscles that support the arch.

3️⃣ Heel Raises

How to do it:

  • Stand upright

  • Rise onto your toes, then lower slowly

  • For more challenge, perform on one leg

Dosage: 3 sets × 10 repetitions

Strengthens calf muscles and supports the arch.

4️⃣ Calf Stretch

How to do it:

  • Place hands against a wall

  • Back leg straight, front leg bent

  • Hold 20–30 seconds per leg

Stretching reduces foot strain and muscle tension.

5️⃣ Short Foot Exercise

How to do it:

  • While standing, lift the arch without curling your toes

  • Hold for 5 seconds

  • Repeat 10–15 times

Excellent for flatfoot support.

Medication Treatment for Accessory Navicular

1️⃣ Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Examples: Ibuprofen, Diclofenac, Naproxen

Benefits:

  • Reduce pain and inflammation

  • Calm posterior tibial tendon inflammation

⚠️ Use short-term and under medical supervision, especially if you have stomach, blood pressure, or kidney issues.

2️⃣ Simple Pain Relievers

Example: Paracetamol

Suitable for mild to moderate pain but does not treat inflammation.

3️⃣ Topical Gels and Ointments

Example: Diclofenac gel

Benefits:

  • Useful for mild, localized pain

  • Fewer stomach side effects compared to oral medications

Can be combined with ice packs (15–20 minutes).

4️⃣ Corticosteroid Injections (Selective Cases)

Used for severe, resistant inflammation.

Provides rapid pain relief but is not first-line treatment.

⚠️ Should not be repeated frequently because it may:

  • Weaken the tendon

  • Increase tear risk

Must be administered under medical supervision.

5️⃣ Supportive Medications (Special Cases)

For severe inflammation or persistent swelling, a doctor may prescribe:

  • Muscle relaxants

  • Neuropathic pain medications (rare cases)

Are Medications Alone Enough?

Usually not.

Best results occur with a combination of:

  • Rest and activity modification

  • Ice therapy (15–20 minutes)

  • Strengthening exercises

  • Arch support orthotics

  • Proper, supportive footwear

ما هو عظم الزورقي الإضافي في القدمأسباب ألم الزورقي الإضافي عند المشيأنواع الزورقي الإضافي والفرق بينهاأعراض الزورقي الإضافي عند الأطفال والمراهقينالتهاب الوتر الظنبوبي الخلفي وعلاقته بالزورقي الإضافيمتى تحتاج عظمة الزورقي الإضافي إلى جراحةالعلاقة بين الزورقي الإضافي والقدم المسطحةدور الرنين المغناطيسي في تشخيص الزورقي الإضافيالفرق بين النوع الأول والثاني والثالث من الزورقي الإضافيهل الزورقي الإضافي يسبب ألم مزمن في القدمأفضل حذاء طبي لعلاج الزورقي الإضافيعلاج بروز عظمي في القدم من الداخلهل يختفي الزورقي الإضافي مع الوقتما سبب ظهور عظمة زائدة في الجانب الداخلي للقدمهل الزورقي الإضافي عيب خلقي أم مرض مكتسبهل عظمة الزورقي الإضافي خطيرةالفرق بين الزورقي الإضافي والعظمة الطبيعيةلماذا تظهر عظمة بارزة في باطن القدم من الداخلأعراض الزورقي الإضافي عند المشيتورم في الناحية الداخلية للقدم مع بروز عظميألم عند طلوع السلم بسبب الزورقي الإضافيهل الوقوف الطويل يسبب التهاب الزورقي الإضافيإصابة القدم وعلاقتها بظهور أعراض الزورقيهل يمكن الشفاء من الزورقي الإضافي بدون عمليةتمرين الشريط المطاطي لعلاج الزورقي الإضافيما هو عظم الزورقي الإضافي في القدم وهل يسبب ألم مستمر عند المشيأسباب ظهور عظمة بارزة في الجانب الداخلي للقدم مع تورم وألمهل الزورقي الإضافي يسبب تسطح القدم وضعف قوس القدم الداخليالفرق بين النوع الأول والثاني والثالث من الزورقي الإضافي وأيهم أخطرأفضل تمارين لتقوية الوتر الظنبوبي الخلفي لعلاج ألم الزورقيهل الزورقي الإضافي يظهر في الأشعة العادية أم يحتاج رنين مغناطيسيأسباب ألم قوس القدم من الداخل عند الوقوف لفترات طويلةعلاج التهاب الوتر الظنبوبي الخلفي المصاحب للزورقي الإضافيأفضل حذاء طبي مناسب لحالات الزورقي الإضافي والقدم المسطحةعلاج بروز عظمي في القدم من الداخل يسبب صعوبة في لبس الحذاءهل الزورقي الإضافي يؤدي إلى تمزق في الوتر الظنبوبي الخلفيطرق علاج القدم المسطحة الناتجة عن ضعف دعم القوس الداخليما هي نسبة نجاح عملية تثبيت الزورقي الإضافي بمسماركيف أعرف أن ألم القدم سببه الزورقي الإضافي وليس مشكلة أخرىأعاني من ألم في الناحية الداخلية للقدم مع وجود بروز عظمي فهل هذا زورقي إضافيعندي عظمة بارزة في منتصف القدم من الداخل وتؤلمني عند لبس الحذاء ماذا أفعلهل عظمة الزورقي الإضافي تحتاج جراحة أم يمكن علاجها بالتمارين فقطكم تستغرق فترة الشفاء بعد عملية إزالة الزورقي الإضافيأعاني من ألم في قوس القدم يختفي مع الراحة ويعود مع النشاط ما السببهل يمكن علاج التهاب الوتر الظنبوبي الخلفي بدون عمليةما هي مخاطر إهمال علاج الزورقي الإضافي لفترة طويلةهل وجود زورقي إضافي يمنع ممارسة التمارين الرياضيةأعاني من ألم مستمر في الجانب الداخلي للقدم مع وجود عظمة بارزة فهل هذا زورقي إضافي وكيف أعالجهما سبب ظهور بروز عظمي في منتصف القدم من الداخل مع تورم وألم عند الضغط عليههل الزورقي الإضافي يسبب ألم شديد عند الوقوف لفترات طويلة في العملكيف أفرق بين ألم الزورقي الإضافي والتهاب أربطة القدم الداخليةأعاني من ألم في قوس القدم عند صعود السلم فهل السبب الزورقي الإضافيمتى يكون ألم الزورقي الإضافي مؤشر لتمزق في الوتر الظنبوبي الخلفيأفضل علاج لألم منتصف القدم من الداخل بعد ممارسة الرياضةهل يمكن الشفاء من التهاب الوتر الظنبوبي الخلفي بالعلاج الطبيعي فقطهل وجود زورقي إضافي يمنعني من ممارسة الجري أو التمارين العنيفةكيف أعرف أن الألم في قدمي سببه عظمة زائدة وليس التهاب عضليعندي عظمة بارزة في رجلي من الداخل بتوجعني لما ألبس جزمة ضيقة أعمل إيهبروز عظمي في القدم من الداخل مع ألم شديد عند المشي لفترات طويلةما سبب الألم المتكرر في قوس القدم الذي يزداد مع الوقوف الطويلأعاني من تسطح في القدم وألم في الداخل هل السبب الزورقي الإضافيأفضل دعامة طبية لدعم قوس القدم في حالات الزورقي الإضافيهل يمكن أن يعيش الشخص طوال حياته بزورقي إضافي بدون أعراضأعاني من ألم في قدمي يمنعني من ممارسة الرياضة هل السبب عظمة زائدةالفرق بين الزورقي الإضافي والقدم المسطحة من حيث الأعراض والعلاجهل الزورقي الإضافي أخطر عند الرياضيين أم الأشخاص العاديينمقارنة بين العلاج التحفظي والجراحة في حالات الزورقي الإضافيأيهما أفضل استئصال الزورقي الإضافي أم تثبيته جراحيًاهل يمكن أن يعود ألم الزورقي الإضافي بعد سنوات من العمليةهل الأطفال المصابون بالزورقي الإضافي يحتاجون علاج مبكرهل التهاب الزورقي الإضافي يظهر فجأة بعد إصابة في القدمكم تستغرق مدة التعافي بعد استئصال عظمة الزورقي الإضافي
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