The navicular bone could get painful due to a stress fracture, misalignment during weight bearing, or having an extra bone called an accessory navicular that did not get fused with the navicular.
At Podiapro, we treat navicular pain mainly with custom insoles, sometimes with custom boots, that have rigid arch support. The rigidity of the arch support is reduced once the pain subsides.
The navicular is a bone that is shaped like a camping tent, located on the medial side of the foot and connects the ankle bone to the cuneiform bones of the foot. The navicular could get painful in conditions like accessory navicular and navicular drop that are explained below. It can also undergo a stress fracture, caused by excessive mechanical stress passing through the bone. Repititive stress causes swelling in the bone in the initial stages. This stress is caused by improper running and jumping activities during sports, shoes that are worn out or even a change in the running surface. If the stress continues, it will cause the bone’s cortex, the outside layer of the bone, to weaken and crack. A navicular stress fracture is usually treated by a cast and rest for about 6 weeks. Then the patient is eased into weight bearing activities wearing boots that support the navicular region.
An accessory navicular is an extra bone that can be seen on via X-ray, located on the inner aspect of the foot’s medial arch arch. Some individuals are born with the accessory navicular. For many, this condition remains unnoticed during childhood. As they reach adolescence, the accessory navicular starts becoming more prominent due to calcification. It can then be noticed as a bump near the navicular bone. However, it remains largely asymptomatic. However, if there is some kind of injury to the foot, including a sprain or a fall, sometimes even a stumble, the accessory navicular may become painful.
To treat this pain, Podiapro designs custom insoles to support the painful area are helpful. Sometimes, the patient may need custom shoes with more room in the area of the accessory navicular. And in some very painful cases, the patient may need to wear shoes that are tight, like a cast, for some time before we can make insoles for them. These insoles take some of the extra pressure off the accessory navicular and posterior tibial tendon.
A navicular drop is another term used to describe excessive pronation. In this condition, when the patient gets into weight bearing mode (standing or walking), the navicular bone shifts downwards from its actual position. This shift in position is called as navicular drop. A navicular drop test is conducted to measure the extent of this drop. If this measure is more than aproximately 10 milimeters, the patient’s foot is pronating excessively. This may cause pain in the navicular region. Orthoses with rigid medial arch support are recommended to help relieve the painful navicular.
The navicular drop has also been identified as one of the risk factors for Medial Tibial Stress Syndrome (MTSS), one of the most common exercise induced leg pain. Running or impact loading of the lower limb creates stress within the tibia, resulting in MTSS that typically limits activity. A person with a navicular drop of more than 10 mm is twice as likely to develop MTSS. Podiapro recommends rigid arch support insoles in such cases, where the rigidity of the arch is reduced once the pain has subsided.