Hubbry Logo
Accessory navicular boneAccessory navicular boneMain
Open search
Accessory navicular bone
Community hub
Accessory navicular bone
logo
8 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
Accessory navicular bone
Accessory navicular bone
Accessory navicular bone
View on Wikipedia
from Wikipedia
Accessory navicular bone
X-ray of the foot showing an accessory navicular bone
Details
Identifiers
Latinos tibiale, os tibiale externum or naviculare secundarium
MeSHC536002
Anatomical terms of bone

An accessory navicular bone is an accessory bone of the foot that occasionally develops abnormally in front of the ankle towards the inside of the foot. This bone may be present in approximately 2-14% of the general population and is usually asymptomatic.[1][2][3] When it is symptomatic, surgery may be necessary.

Accessory navicular bone may cause a continuous stretch and stress on the tibialis posterior tendon which can progress to chronic disabling pain and may cause tendon rupture or secondary flat foot deformity; when this occurs this condition is commonly known as accessory navicular syndrome.[4]

Other conditions which closely mimic the symptoms of an accessory navicular bone include plantar fasciitis, bunions and heel spurs.

Classification

[edit]

The Geist classification divides the accessory navicular bones into three types.[3]

  • Type 1: An os tibiale externum is a 2–3 mm sesamoid bone in the distal posterior tibialis tendon. Usually asymptomatic.
  • Type 2: Triangular or heart-shaped ossicle measuring up to 12 mm, which represents a secondary ossification center connected to the navicular tuberosity by a 1–2 mm layer of fibrocartilage or hyaline cartilage. Portions of the posterior tibialis tendon sometimes insert onto the accessory ossicle, which can cause dysfunction, and therefore, symptoms.
  • Type 3: A cornuate navicular bone represents an enlarged navicular tuberosity, which may represent a fused Type 2 accessory bone. Occasionally symptomatic due to bunion formation.

Diagnosis

[edit]

To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion and the way the patient walks may also be evaluated. X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition.[5][citation needed]

Treatment

[edit]

Aside from surgery, there are a few options for handling an accessory navicular bone that has become symptomatic. This includes immobilization, icing, medicating, physical therapy, and orthotic devices. Immobilizing involves placing the foot and ankle in a cast or removable walking boot. This alleviates stressors on the foot and can decrease inflammation. Icing will help reduce swelling and inflammation. Medication involves usage of nonsteroidal anti-inflammatory drugs, or steroids (taken orally or injected) to decrease inflammation. Physical therapy can be prescribed in order to strengthen the muscles and help decrease inflammation. Physical therapy can also help prevent the symptoms from returning. Orthotic devices (arch support devices that fit in a shoe) can help prevent future symptoms.[6] Occasionally, the orthotic device will dig into the edge of the accessory navicular and cause discomfort. For this reason, the orthotic devices made for the patient should be carefully constructed.[7]

Radiological images

[edit]
  • From left to right: Type 1, 2 and 3
    From left to right: Type 1, 2 and 3
  • Lateral projection of type 2
    Lateral projection of type 2
  • Type 2
    Type 2
  • Cornuate navicular bone
    Cornuate navicular bone
  • Cornuate navicular bone
    Cornuate navicular bone
  • Cornuate navicular bone
    Cornuate navicular bone
  • Type 2 on one foot (dark arrow) and type 3 on the other (white arrow)
    Type 2 on one foot (dark arrow) and type 3 on the other (white arrow)

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Accessory navicular bone

View on Grokipedia
from Grokipedia
The accessory navicular bone, also known as os naviculare or os tibiale externum, is a congenital accessory ossicle located on the medial aspect of the in the foot, often embedded within or adjacent to the posterior tibial tendon. It is classified into three main types based on its size, shape, and connection to the navicular: Type I, a small (2-3 mm) round or oval ossicle within the tendon's substance; Type II, a larger (at least 6 mm) triangular or heart-shaped bone connected by a (cartilaginous bridge); and Type III, a fully fused enlargement of the navicular's tuberosity (cornuate navicular). This condition is relatively common, with a pooled of approximately 17.5% among individuals and 12.6% among feet, though estimates vary by (higher in East Asian groups at up to 45%) and is often bilateral in about 50-70% of cases. While many cases are , the accessory navicular can lead to accessory navicular syndrome when it becomes symptomatic, typically during as the ossicle ossifies and causes irritation. The development of the accessory navicular is congenital, arising from a secondary of the navicular tuberosity that fails to fully fuse, and it may become painful due to factors such as trauma (e.g., ankle sprains), overuse, , or ill-fitting that increases friction on the posterior tibial insertion. Symptoms primarily include medial midfoot exacerbated by activities, localized swelling, redness, and tenderness over the navicular prominence, sometimes accompanied by a visible or palpable bony bump and difficulty with . Type II is most commonly associated with symptoms due to its partial connection and potential for misalignment, while Type I is least symptomatic. Diagnosis typically involves clinical evaluation, including history of foot pain and for tenderness along the posterior tibial , confirmed by such as weight-bearing X-rays to visualize the ossicle and assess alignment, with MRI useful for evaluating or if needed. Initial management is conservative, focusing on non-surgical approaches like rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), immobilization in a cast or for 4-6 weeks, custom or arch supports to reduce stress, and to strengthen the foot. , such as excision of the accessory bone with reattachment of the posterior tibial , is reserved for persistent cases unresponsive to 3-6 months of conservative treatment and has high success rates, with recovery involving 4-6 weeks of postoperative immobilization.

Overview and Anatomy

Definition

The accessory navicular bone is a congenital anatomical variant consisting of an extra ossicle situated on the medial aspect of the in the midfoot. It represents a common developmental anomaly present at birth, occurring in a small percentage of the population without typically causing issues unless irritated. This ossicle originates embryologically from a secondary in the navicular tuberosity that fails to fuse with the main body of the during childhood development. The incomplete union results in a separate fragment, which is a normal variant in foot rather than a pathological condition. Historically, the accessory navicular bone has been known by several names, including os naviculare and os tibiale externum. When symptomatic, it may form part of accessory navicular syndrome, characterized by irritation of the posterior tibial tendon where it inserts near the navicular.

Location and Structure

The accessory navicular bone is situated at the navicular tuberosity on the medial aspect of the midfoot, immediately posterior to the posteromedial tuberosity of the tarsal . It lies adjacent to the medial surface of the and is typically embedded within or in close proximity to the distal fibers of the posterior tibial . This positioning places it in the medial midfoot region, near the attachments of supporting structures that contribute to foot stability. Structurally, the accessory navicular is an extra ossicle that varies in size, generally ranging from 4 to 20 mm in length and 4 to 12 mm in width, with typical dimensions around 8 to 12 mm for more prominent forms. It consists of an osseous core but may appear partially or wholly cartilaginous if is incomplete, and it is often connected to the navicular by a thin of or measuring 1 to 3 mm. In density, it resembles cortical but can exhibit variability based on its developmental stage. The accessory navicular arises congenitally from a secondary of the navicular tuberosity that fails to fuse with the primary during childhood, typically between ages 8 and 13. In relation to surrounding anatomy, the accessory navicular is positioned medially and posteriorly to the primary navicular bone, without direct participation in its articulations. The primary navicular, a boat-shaped tarsal bone, forms the talonavicular joint proximally with the talus head and contributes to the distally by articulating with the three , thereby supporting the medial longitudinal arch of the foot. The accessory bone's medial protrusion may subtly alter the contour of this arch. It lies in close proximity to the via indirect connections and near the spring ligament (), which spans from the sustentaculum tali of the to the navicular's inferior surface to reinforce the arch. The posterior tibial often inserts broadly onto the accessory navicular, integrating it into the tendon's pathway.

Classification

Type I

Type I accessory navicular is characterized as a small, round or oval sesamoid ossicle, typically measuring 2-3 mm in size, that is embedded within the substance of the posterior tibial tendon and remains completely separate from the . This ossicle lacks any cartilaginous or bony connection to the navicular tuberosity. The formation of Type I occurs through independent of a separate , distinct from the primary development, resulting in an isolated structure that is frequently identified as an incidental finding on radiographic . This type represents approximately 30% of all accessory navicular cases within the Geist classification system, which was originally proposed by Emil S. Geist in and modified by Sella and Lawson in 1987. Clinically, Type I accessory navicular exhibits low symptomatic potential and is typically throughout life, as its position within the does not disrupt normal foot mechanics. Rare or discomfort may occur solely in the context of posterior tibial inflammation, such as tendonitis, which can indirectly affect the embedded ossicle.

Type II

The Type II accessory navicular, as defined in the Geist classification, is characterized by a larger ossicle, typically triangular or heart-shaped and measuring 8-12 mm in size, that is positioned adjacent to the navicular tuberosity. This variant forms a pseudo-joint through its connection to the via a 1-3 mm composed of and/or , with fibers of the posterior tibial inserting directly onto the ossicle. The allows for limited mobility, creating a semi-attached structure that distinguishes it from the isolated Type I and the fully fused Type III variants within the Geist framework. Developmentally, the Type II accessory navicular arises from a secondary of the navicular tuberosity that fails to fully unite with the primary , typically during between ages 8 and 13. This incomplete fusion results in a prominent medial eminence on the midfoot, which can alter local and contribute to the high symptomatic potential of this type. Among accessory navicular cases, Type II represents a substantial proportion, often cited as accounting for 50-70% of instances, and it is responsible for over 70% of symptomatic presentations due to its structural features. The mobility at the enables micro-motion during weightbearing activities, leading to repetitive and tension that irritate the posterior tibial tendon insertion and surrounding soft tissues, thereby causing . This tendon irritation manifests as chronic medial foot discomfort, particularly in adolescents and young adults, and underscores the Type II variant's predisposition to clinical issues compared to other types.

Type III

Type III accessory navicular, the final category in the classification, is defined by the complete fusion of an ossicle to the , forming an enlarged, cornuate (horn-shaped) tuberosity without any separate bony element. This fused structure creates a prominent medial projection on the navicular's tuberosity, which is stably integrated into the main bone rather than mobile or separate as in other types. The condition arises from the development of a secondary that fuses with the navicular but results in an overly prominent tuberosity due to incomplete resorption during growth. This variant accounts for 20-30% of all accessory navicular cases, making it less common than Type II but still notable in foot variations. The permanent bony prominence often leads to variable symptomatology, primarily influenced by the size of the tuberosity and mechanical pressure from the posterior tibialis , which inserts nearby and can become irritated over the enlarged area. While many individuals remain , larger prominences may cause medial foot , especially with activity or ill-fitting , though symptoms are generally milder than in non-fused types due to the lack of a mobile ossicle. The fused enlargement alters the medial arch profile of the foot, potentially contributing to pes planus (flatfoot) by disrupting the normal support provided by the navicular tuberosity and posterior tibialis tendon complex. This structural change can affect load distribution during weight-bearing, though the direct causal link to flatfoot varies by individual and is not universal.

Epidemiology

Prevalence

The accessory navicular bone is a common anatomical variant, with overall estimates ranging from 4% to 21% in the general based on radiographic and cadaveric studies. A 2024 meta-analysis of 39 studies covering 11,015 patients and 36,837 feet reported a pooled of 17.5% (95% CI: 11.5–25.7%) among patients and 12.6% (95% CI: 10.1–15.5%) among feet, drawing from both radiographic (12.2%) and cadaveric (9.5%) data, though no significant differences were found between these study types. Higher rates, up to 34%, have been observed in specific radiographic studies of adult populations, particularly in Asian cohorts, suggesting potential ethnic variations in detection or incidence. Prevalence is notably elevated in symptomatic cohorts, where imaging is more frequently performed, reaching 17.5% in patient-based studies compared to lower cadaveric rates, indicating toward those with foot complaints. Bilateral occurrence is common, affecting 50–70% of cases, which points to a genetic or developmental rather than sporadic formation. This bilaterality is consistent across genders, with approximately 50% of affected individuals showing involvement on both feet in meta-analytic data. A recent found no statistically significant differences between and cadaveric methods, attributing variations to study populations rather than technique. The condition is predominantly , occurring in the vast majority of cases without clinical notice, leading to underdiagnosis in the general population where routine foot imaging is absent. This underestimation is exacerbated by reliance on plain films, which may miss subtle variants, potentially lowering reported prevalences in unselected groups. Among symptomatic cases, the Type II variant is the most prevalent form, accounting for over 70% of presentations. Recent studies as of confirm prevalence variations, such as 15.1% in Japanese children and 24.5% in the Indian population.

Demographics

No significant gender differences in prevalence have been identified in comprehensive meta-analyses, though some clinical studies report higher rates in females. The condition itself is congenital, forming during fetal development and present at birth, but it often remains until later. Symptoms typically manifest during , particularly between the ages of 10 and 18, coinciding with periods of rapid skeletal growth and of the navicular region. This timing aligns with the maturation of foot structures, where increased mechanical stress from activity and growth can exacerbate at the site. In contrast to the overall , which varies globally from 8% to 38%, demographic patterns highlight subgroup differences that influence clinical awareness. Ethnic variations in prevalence are notable, with the accessory navicular being most common in East Asian populations (38.4%) and least frequent in North American cohorts (8.0%). These differences suggest potential genetic or environmental factors tied to population ancestry. Additionally, familial patterns indicate a strong hereditary component, with estimates reaching 0.88 after adjusting for age and sex, pointing to substantial genetic influence. In rare cases, follows an autosomal dominant pattern with incomplete , as observed in multi-generational pedigrees.

Clinical Presentation

Symptoms

The primary symptom of a symptomatic accessory navicular bone is pain located on the medial aspect of the foot at the navicular tuberosity, often described as a dull ache that intensifies during activities such as walking or running. This pain typically arises from mechanical irritation or at the site and impacts a minority of individuals with the condition, affecting daily walking. Swelling and tenderness frequently occur over the bony prominence, which patients may notice as a visible or palpable bump in the medial arch, sometimes accompanied by localized redness. These symptoms can lead to fatigue or persistent aching in the foot arch after prolonged standing, potentially resulting in a to alleviate discomfort. Symptoms often onset during due to growth-related stresses or following trauma such as a or overuse, presenting with intermittent exacerbations that worsen at the end of the day or with increased activity. This presentation may briefly involve irritation of the adjacent posterior tibial tendon, contributing to the overall medial foot discomfort.

Associated Conditions

The accessory navicular bone contributes to flexible flatfoot (pes planus) by disrupting the normal alignment of the medial longitudinal arch, leading to collapse and increased strain on the supporting structures of the foot. This association arises because the anomalous bone alters the insertion site of the posterior tibial tendon, which is crucial for maintaining arch integrity, often resulting in a hypermobile flatfoot . Studies indicate that patients with pes planus and an accessory navicular are more prone to progressive arch collapse, particularly in type II variants where the bone is connected by a . A key comorbidity is posterior tibial tendon dysfunction (PTTD), where the accessory navicular interferes with the tendon's normal , causing attenuation, , or insufficiency. In severe cases, this dysfunction progresses to adult-acquired flatfoot deformity, characterized by hindfoot valgus and forefoot abduction due to unopposed eversion forces. Clinical evidence shows PTTD is evident in most symptomatic type II accessory navicular cases, with the anomalous bone exacerbating tendon strain during weightbearing activities. Altered from the accessory navicular also increase the risk of stress fractures in the navicular or adjacent midfoot bones, as repetitive loading concentrates abnormal forces on the tarsal region. Additionally, it predisposes individuals to midfoot tendonitis, particularly involving the posterior tibial or flexor tendons, due to friction and irritation at the anomalous site. These secondary effects stem from the bone's position within the tendon's path, promoting chronic and microtrauma. Rarely, the accessory navicular co-occurs with other congenital foot anomalies, though these associations are not causally linked and typically represent independent developmental variations. In active individuals, these comorbidities may exacerbate biomechanical imbalances, leading to earlier onset of symptoms during high-impact activities.

Diagnosis

Physical Examination

The physical examination for accessory navicular bone begins with inspection and palpation of the medial aspect of the foot to identify any visible prominence or enlargement at the navicular tuberosity. Palpation typically reveals a firm, bony enlargement that is tender to direct pressure, particularly along the medial and plantar surfaces of the navicular, often correlating with a history of medial foot pain. This tenderness may extend along the course of the posterior tibial tendon insertion, indicating potential irritation or inflammation at the site. Observation of foot posture during stance is essential to evaluate arch height and hindfoot alignment. Patients may exhibit a flattened medial longitudinal arch (pes planus) or hindfoot valgus, which can contribute to stress on the and associated structures. The navicular prominence should be differentiated from other bony landmarks, such as the talar head, by assessing motion while stabilizing the area with manual pressure. Functional tests assess the integrity of the posterior tibial tendon and provoke symptoms related to the accessory navicular. The single-leg heel rise test involves having the patient rise onto the toes of the affected foot while maintaining balance; weakness, inability to perform the rise, or pain during this maneuver suggests compromised posterior tibial tendon strength and arch support. Pain provocation maneuvers, such as applying direct pressure to the medial navicular prominence or performing resisted foot inversion (with the foot in plantarflexion), often reproduce localized pain at the site, confirming involvement of the .

Imaging

Plain radiography serves as the initial imaging modality for evaluating suspected accessory navicular bone, typically using lateral oblique views to identify the ossicle and differentiate it from fractures through smooth cortication and lack of irregularity. views are employed to assess the longitudinal arch and any associated flatfoot , confirming the presence of type I (small oval ossicle within the tibialis posterior ), type II (separate ossicle with ), or type III (fused prominent tuberosity) variants. Magnetic resonance imaging (MRI) provides comprehensive evaluation, particularly for soft tissue involvement, utilizing T1-weighted and T2-weighted fat-suppressed sequences to detect in the ossicle or , indicating symptomatic stress or osteonecrosis. It visualizes , such as tibialis posterior or tears, and assesses the integrity of the in type II variants, with patterns correlating to focal pain in affected individuals. Computed tomography (CT) provides detailed bony , especially useful in preoperative planning, by delineating the ossicle's size, shape, and fusion status while distinguishing it from acute fractures via well-corticated margins. Axial and sagittal reformats highlight the relationship between the accessory bone and the navicular, aiding in type classification and evaluation of any osseous irregularities. Ultrasound offers dynamic assessment of the tibialis posterior gliding over the accessory navicular, particularly valuable in pediatric patients, by demonstrating swelling, , or displacement during motion. High-resolution probes can confirm type II variants and detect associated inflammation without .

Treatment

Conservative Management

Conservative management serves as the primary treatment for symptomatic accessory navicular bone, focusing on symptom relief and functional improvement without invasive procedures. The protocol—rest, , compression, and —provides effective acute pain relief by reducing and swelling in the medial arch area. involves avoiding activities that exacerbate pain, such as high-impact sports, while application for 20 minutes several times daily helps control local symptoms; compression with a wrap and above heart level further minimize . Orthotic devices play a key role in offloading pressure from the accessory navicular and supporting the posterior tibial tendon. Arch supports or custom shoe inserts redistribute weight away from the medial foot, alleviating irritation at the navicular-tuberosity junction. These devices are often combined with wider, more accommodating footwear to prevent rubbing over the prominence. Physical therapy emphasizes targeted exercises to enhance foot stability and tendon function. routines focus on the posterior tibial tendon and calf muscles to improve flexibility, while strengthening exercises for the intrinsic foot muscles and ankle stabilizers promote better arch support and reduce recurrent strain. Balance and training may also be incorporated to aid overall recovery. Pharmacologic interventions typically include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to manage and associated with irritation. These are used alongside other measures for short-term relief. For severe or persistent symptoms, immobilization with a short-leg cast or walking boot is employed for 4 to 6 weeks to allow and reduce mechanical stress on the accessory bone. This is followed by gradual reintroduction of activity and supportive therapies.

Surgical Interventions

Surgical interventions for the accessory navicular bone are indicated in cases refractory to conservative management after approximately 6 months of treatment. The Kidner procedure, first described in , involves excision of the accessory navicular ossicle and reattachment or advancement of the posterior tibial to the to restore tendon function and alleviate pain. This approach is particularly suited for Type II accessory naviculars, where the ossicle is connected by a , as it addresses tendon insertion abnormalities. For Type I accessory naviculars, which consist of a small ossicle embedded within the posterior tibial , or non-fused Type II cases with minimal tendon involvement, simple excision of the ossicle without tendon repair is often sufficient to relieve symptoms. In Type III accessory naviculars, characterized by fusion of the ossicle to the navicular forming a prominent cornuate shape, surgical options include resection of the bony prominence (naviculoplasty) to reduce impingement. Postoperative care typically involves immobilization in a cast or boot with non- for 4-6 weeks, followed by protected and to restore and strength. Success rates for these procedures range from 85% to 95%, with most patients reporting significant pain relief and improved function.

Prognosis

Outcomes

Conservative management of symptomatic accessory navicular bone achieves in approximately 69% of pediatric cases, with 28% experiencing complete resolution and 41% partial sufficient to avoid , typically within 8 months. Surgical interventions yield high success rates, with simple excision resulting in excellent outcomes in 80% of patients, moderate in 18%, and overall satisfaction ranging from 85% to 95% across procedures, accompanied by restored foot function and low recurrence rates. Success is influenced by early intervention to prevent chronicity and by navicular type, with Type II cases more commonly symptomatic due to their cartilaginous connection and thus often requiring excision. Patients generally return to full activities, including sports, within 3 to 6 months post-surgery, with 94% resuming pre-injury levels.

Complications

If left untreated, symptomatic accessory navicular bone can contribute to chronic posterior tibial tendon dysfunction (PTTD), a progressive condition that weakens the tendon's ability to support the foot's arch. This may lead to flatfoot deformity, including adult-acquired rigid flatfoot in advanced stages, due to ongoing irritation and altered at the tendon's insertion site. Surgical management, such as the Kidner procedure involving excision and relocation, carries risks including wound in low rates (reported in isolated cases across systematic reviews) and scarring or wound irritation as minor complications. weakening or degeneration of the posterior tibial can occur post-relocation, potentially leading to insufficiency if healing is impaired. Over-resection of the navicular prominence may increase tension. Conservative approaches, including , may cause skin irritation over the prominence due to from ill-fitting devices or persistent rubbing against . In adolescents, delayed symptom resolution can occur during growth phases, prolonging reliance on immobilization. Rare long-term issues include persistent pain and the need for revision , depending on procedure type and foot alignment. These complications are more frequent in type III accessory navicular or cases with delayed intervention.

References

  1. https://radiopaedia.org/articles/accessory-navicular-2
  2. https://www.hss.edu/health-library/conditions-and-treatments/list/accessory-navicular
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC11405447/
  4. https://orthoinfo.aaos.org/en/diseases--conditions/ortho-pinion-accessory-navicular/
  5. https://www.physio-pedia.com/Accessory_Navicular_Bone
  6. https://www.ncbi.nlm.nih.gov/books/NBK547675/
  7. https://www.orthobullets.com/pediatrics/4070/accessory-navicular
  8. https://www.cambridge.org/core/journals/twin-research-and-human-genetics/article/genetic-influence-on-accessory-navicular-bone-in-the-foot-a-korean-twin-and-family-study/46E640E6A73957E41EB565CF95F245C5
  9. https://radiopaedia.org/articles/accessory-navicular-2?lang=us
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC9557784/
  11. https://www.foothealthfacts.org/conditions/accessory-navicular-syndrome-%281%29
  12. https://www.resurgens.com/education/accessory-navicular
  13. https://www.nature.com/articles/s41598-024-68211-2
  14. https://ajronline.org/doi/10.2214/AJR.10.5167
  15. https://pmc.ncbi.nlm.nih.gov/articles/PMC2698172/
  16. https://journals.sagepub.com/doi/10.1177/107110078700800310
  17. https://radiopaedia.org/articles/geist-classification-of-accessory-navicular?lang=us
  18. https://academic.oup.com/jscr/article/2024/8/rjae544/7743335
  19. https://www.sciencedirect.com/science/article/pii/S1110116417300248
  20. https://www.sciencedirect.com/science/article/abs/pii/S1619998720300118
  21. https://pubmed.ncbi.nlm.nih.gov/39136746/
  22. https://ecios.org/DOIx.php?id=10.4055/cios19123
  23. https://www.researchgate.net/publication/383085316_The_prevalence_and_anatomy_of_accessory_navicular_bone_a_meta-analysis
  24. https://pubmed.ncbi.nlm.nih.gov/39854496/
  25. https://jocr.co.in/wp/2025/03/incidence-of-accessory-navicular-bone-among-the-indian-population-an-original-article/
  26. https://pubmed.ncbi.nlm.nih.gov/28390446/
  27. https://pmc.ncbi.nlm.nih.gov/articles/PMC1888424/
  28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9557784/
  29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047241/
  30. https://www.ncbi.nlm.nih.gov/books/NBK430802/
  31. https://www.orthobullets.com/pediatrics/4069/flexible-pes-planovalgus-flexible-flatfoot
  32. https://pmc.ncbi.nlm.nih.gov/articles/PMC6376442/
  33. https://pmc.ncbi.nlm.nih.gov/articles/PMC10731211/
  34. https://www.orthobullets.com/foot-and-ankle/7020/posterior-tibial-tendon-insufficiency-ptti
  35. https://pmc.ncbi.nlm.nih.gov/articles/PMC8781933/
  36. https://med.emory.edu/departments/radiology/clinical_divisions/nuclear-medicine/documents/2020/msk/radionuclide-bone-scintigraphy-in-sports-injuries.pdf
  37. https://www.jospt.org/doi/10.2519/jospt.2012.3809
  38. https://posna.org/physician-education/study-guide/accessory-navicular
  39. https://www.hmpgloballearningnetwork.com/site/podiatry/blogged/treating-accessory-navicular-young-athletes
  40. https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0747-1
  41. https://pmc.ncbi.nlm.nih.gov/articles/PMC5915634/
  42. https://pubs.rsna.org/doi/10.1148/radiology.195.3.7754020
  43. https://pmc.ncbi.nlm.nih.gov/articles/PMC6604528/
  44. https://pmc.ncbi.nlm.nih.gov/articles/PMC9463416/
  45. https://pmc.ncbi.nlm.nih.gov/articles/PMC5435664/
  46. https://www.royalberkshire.nhs.uk/media/yxvhaz2n/accessory-navicular-surgery_apr25.pdf
  47. https://pubmed.ncbi.nlm.nih.gov/35377309/
  48. https://pubmed.ncbi.nlm.nih.gov/33852436/
  49. https://pmc.ncbi.nlm.nih.gov/articles/PMC8283076/
  50. https://ajronline.org/doi/10.2214/ajr.175.3.1750627
  51. https://www.sciencedirect.com/science/article/pii/S2667396723000356
  52. https://www.arthroscopytechniques.org/article/S2212-6287(24)00048-3/fulltext
  53. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-025-08689-7
Add your contribution
Related Hubs
User Avatar
No comments yet.