Accessory navicular syndrome

Last revised by Mina Sameh Rizk on 21 Oct 2023

The accessory navicular syndrome, also known as os naviculare syndrome occurs when a type II accessory navicular becomes painful due to movement across the pseudo-joint between the ossicle and the navicular bone.

Radiographic features

Ultrasound

It can be inferred on musculoskeletal ultrasound if a patient's pain is located at a type II accessory navicular and the patient is tender to transducer pressure. Ultrasound can also be useful to compare with the contralateral side.

MRI

The syndrome presents on MRI with bone marrow edema signal i.e.

  • T1: hypointense

  • T2/STIR: hyperintense

This can involve both the accessory ossicle and the navicular bone.

Treatment and prognosis

Once avulsion fracture is ruled out, acute pain can be managed by corticosteroid injection and immobilization of the foot for 2-3 weeks. For refractory cases, surgical management can be considered.

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