A 30-year-old male presents with the noted radiography. He states the accessory navicular has bothered him for years, and has tried with some relief most all reasonable conservative therapies and is ready for surgical correction. When you perform the surgical resection of the ossicle and navicular…
Common rearfoot deformities
Type 2 accessory navicular (larger, heart or triangular shaped ossicle, adjacent to the navicular) exposure is performed with an incision just distal to the naviculocuneiform joint to the talar neck proximally on the medial midfoot. The tibialis posterior tendon is reflected plantarly with the periosteum/joint capsule, only incising the medial (supero-medial) navicular insertion, maintaining the plantar/lateral insertion. Once the navicular is exposed, the foot is held in a rectus-to-pronated position to assess the amount of required navicular exostectomy, with the bone cut performed in-line with the medial surface of the medial cuneiform and medial margin of the talar head. When it is time to make the bone cut, the foot is held in a supinated position to protect the talar head from iatrogenic cartilage damage during the osteotomy. The ossicle within the tendon is removed, and the tendon is positioned back over the navicular resection point and secured with a suture anchor. The need for a tendon advancement is debated in the literature and is often predicated on foot type (supinated vs rectus vs pronated and the need for concomitant procedures).
Smith TF, Dowling LB (2013). Common pedal prominences (Ch. 38). In J.T. Southerland (Ed) McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, 4thEd. (pp. 471 – 493). Philadelphia, Pennsylvania: Wolters Kluwer Health| Lippincott Williams & Wilkins.