Management of Foot Pain Associated With Accessory Bones of the Foot: Two Clinical Case Reports

Abstract

Study Design: Case study. Objectives: To discuss the differential diagnosis, the nonsurgical and postoperative management of common accessory bones of the foot. Background: Accessory bones of the foot that are formed during abnormal ossification are commonly found in asymptomatic feet. Two of the most common accessory bones are the accessory navicular and the os peroneum. Their painful presence must be considered in the differential diagnosis of any acute or chronic foot pain. The optimal treatment for the conservative and postoperative management of painful os peroneum and accessory navicular bones remains undefined. Methods and Measures: Therapeutic management of the fractured os peroneum included bracing, taping, and foot orthotics to allow healing of involved tissues, and stretching. The focus of the postoperative management of the accessory navicular was joint mobilization and progressive strengthening. Dependent variables included level of pain with provocation and alleviation tests of joint and soft tissue; girth and sensory tests of the foot and ankle; goniometric measures of foot and ankle; strength of ankle and hip muscles; functional tests; and patient's self-reported pain status. Results:The patient with the fractured os peroneum was treated in 13 visits for 10 weeks. At discharge from physical therapy, the patient had the following outcomes relative to the noninvolved side: 1 W / o return of normal sensation tested by light touch and vibration; pain decreased from 6/10 to 1/10; 1 W h reduction of swelling with ankle girth to normal; ~W/O range of motion of ankle and subtalar joints. Strength in plantar flexion and ewrsion remained 20% impaired (80"/0 retum to normal) secondary to pain. Upon discharge, he still reported mild pain when walking but was able to return to previous leisure activities. The second patient with the accessory navicular was treated in 18 visits over 9 weeks. Relative to the uninvolved side, she was discharged with the following: 70% return of range of motion in the foot and ankle, 1 W / 0 of strength in hip and ankle, and ~W/O retum of balance. She could squat and jump without pain and she returned to full premorbid activity level. Conclusiom: Rehabilitative management of both cases addressed specific impairments and was successful in improving the patients' activity limitation. Clinicians should be aware that these accessory bones are possible sources of disability, secondary to foot pain. / Orthop Sports Phys Ther 2000;30:580-594.

Management of Dancers With Symptomatic Accessory Navicular: 2 Case Reports

“…4,21,23,28 However, nonsurgical management is not clearly defined in the literature, and there are currently no clinical trials that compare the outcomes of conservative measures and those of surgical procedures in adolescents. While the nonsurgical 39 and postsurgical 21,23,39 management of individuals with accessory bones in the general population has previously been described in the literature, rehabilitation of a dancer with a symptomatic accessory navicular has not. A symptomatic accessory bone in a dancer's foot can be devastating, particularly for dancers performing en pointe.…”

Ayak Bileği Burkulması Sonrası Naviküler Kırığı Taklit Eden Aksesuar Naviküler Kemik

“…Ağrılı ANK'ler travma bulgusu olmaksızın bile genç aktif kadınlarda daha sık bildirilmiştir. Çocuklarda da yine sık olarak bildirilmektedir (1,5,8).…”

“…Bu kırık genellikle zorlu eversiyonla yüksekten düşmeden kaynaklanır. ANK'ye zıt olarak kırıkla ilişkili duyarlılık daha yaygındır ve ayağın iç kısmında genellikle ekimoz vardır (1). Bizim hastamız bir inversiyon yaralanması bildiriyordu.…”

“…Aksesuar naviküler kemik (ANK), normal ayakta %10-14 oranında görülebilmektedir (1,2). Türk toplumunda %11,7 oranıyla ayaktaki en sık aksesuar kemik olarak bildirilmiştir (3).…”

“…Hastalar genellikle ayak medial kısmında egzersiz sonrası kötüleşen tekrarlayıcı ağrılardan şikayet eder (6). Tip 2 ANK, bir ayak bileği burkulması sonrası navikü-ler kemiğin kopma kırığı ile karıştırılabilir (1,8,9).…”