Accessory navicular syndrome

Case contributed by Krzysztof Nocoń

Presentation

History of recurring ankle sprains. Currently complains about persisting medial foot pain.

Patient Data

Age: 35 years
Gender: Male
MRI

A triangular osseous structure at the insertion site of the markedly thickened tibialis posterior muscle tendon - type II of accessory navicular bone. Localized bone marrow edema around the cartilaginous junction with the navicular bone.

The initial diagnosis of accessory navicular syndrome was later verified in ultrasound performed about four weeks after this MRI study. Skin over the lesion remained swollen and sensitive to touch of the transducer with mild color Doppler signals in tissues surrounding the synchondrosis.

Additional findings: thickened and irregular capsule of tibiotalar joint in place of previously torn anterior talofibular ligament with small osseous fragment, which is presumed to be an avulsed fibula fragment. In a dynamic ultrasound examination, the scar tissue proved to be stable. Torn calcaneofibular ligament.

Case Discussion

This patient had a radiograph done two months before this study, but the accessory ossicle was then not reported.

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