Foot

What It Is

The accessory navicular is an extra foot bone (or piece of cartilage) found on the inner side of the foot, next to the navicular bone (a bone on the inside of the foot). It is present from birth (congenital) and is thought to have a genetic basis (Stolarz et al., 2024). It is not part of the foot's normal structure, and most people do not have one (Connecticut Children's, n.d.).

The accessory navicular bone is a sesamoid bone (a small bone that sits inside a tendon) and sits within the posterior tibial tendon. The bone can be small, or it can simply be a protuberance on the end of the navicular.

The navicular (named from the Latin for "little boat", because of its shape) sits between the talus (ankle bone) and the cuneiform bones, and is located in the inside arch of the foot.

Accessory navicular syndrome may be associated with flat feet and usually causes symptoms in adolescence (Parekh, n.d.). Pain occurs when the extra bone or the tendon is aggravated by:

Trauma, such as a foot or ankle sprain

Friction between the bump of the extra bone and shoes

Overuse

It is also commonly associated with problems in the posterior tibial tendon. Flat feet put extra strain on the posterior tibial tendon, which can lead to irritation around the extra bone (Connecticut Children's, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

Signs & Symptoms

Bump (bony prominence) on the inner side of the foot above the arch
Tenderness, redness and swelling
Pain in the middle of the foot and arch, usually during or after activity

The majority of people with an accessory navicular bone never have symptoms (Parekh, n.d.). In symptomatic cases, pain is activity-related.

Treatment

Self-Care & Treatment

How to Manage Pain

Physical therapy (exercise-based treatment) is part of the usual first treatment (Parekh, n.d.). I can help you settle the pain and strengthen the muscles that support your arch, with hands-on treatment, exercises and advice on footwear and arch supports. See the My Approach tab for how I work.

Ice: ice is one of the options that can help ease pain and swelling (Connecticut Children's, n.d.). Wrap an ice pack (or a bag of frozen vegetables) in a tea towel and apply it for up to 20 minutes every 2 to 3 hours (NHS, 2024). Never put ice directly on the skin.

Tips

Medication: Connecticut Children's (n.d.) lists anti-inflammatory medicine, such as ibuprofen, as one of the non-surgical treatment options for accessory navicular syndrome. (This medicine information comes from Connecticut Children's, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)
Arch supports: for some people, an arch support or custom orthotic (insole) can help take some of the pressure off the extra bone and the tendon (Parekh, n.d.). I can help you work out whether one might help and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic.
Avoid excessive activities that aggravate symptoms until pain improves. As the pain settles, activities can usually be resumed (Parekh, n.d.).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Cast or boot: if the foot is very painful, a doctor may recommend a short period in a cast or walking boot to rest the foot (Parekh, n.d.).
Surgery: if non-surgical treatment has not helped, or symptoms keep coming back, an operation to remove the extra bone and reattach the posterior tibial tendon to the navicular may be considered (Parekh, n.d.).

How I can help (see the My Approach tab)

Hands-on treatment for the foot, ankle and calf
Exercises to strengthen the muscles that support your arch
Advice on footwear, arch supports and getting back to activity

Treatment

My Approach

This condition usually flares when the tendon on the inside of your foot is working hard, or when a shoe keeps rubbing the bump. My aim is to calm it down, take strain off that tendon, and build strength in your foot and lower leg so they cope with your activities again.

I start by assessing your foot and ankle, how your arch behaves when you stand and walk, and the strength and flexibility of your calf and lower leg. That tells us what is loading the extra bone and where to focus.

When It's Sore

I keep pressure off the tender bump and work the calf and the muscles along the inside of the shin and foot to ease tension pulling on the tendon
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Cutting back the activities that flare it, rather than stopping everything
Taping to support your arch in the short term
Padding or shoe changes so nothing presses on the bump

As It Settles

Strengthening for the muscles that hold up your arch, starting with gentle holds and building to heel raises, balance and single-leg work
Calf and foot mobility work
A home programme to do between visits
A gradual return to sport, building the load back up step by step

I'll also help you work out whether an arch support would help and how to get one, and point you to a chiropodist or podiatrist if you need a custom orthotic. Many people with this condition are teenagers; parents are welcome to sit in, with their child's agreement.

If the pain keeps coming back despite treatment, or you can't put weight on the foot, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Early on, most people come in once or twice a week while the pain settles, then weekly as we build strength, spacing visits out as you manage more on your own, with a reassessment at about 4 to 6 weeks. Usually the pain settles over a few weeks, and getting fully back to sport often takes a few months, a little longer if it has been sore for a long time.

What I Focus On

Assessment

Tendon & Calf Release

Arch Strength

Footwear & Arch Support Advice

Gradual Return to Activity

Sources

References

Connecticut Children's (n.d.) Accessory navicular syndrome. Available at: https://www.connecticutchildrens.org/specialties-conditions/orthopedics/conditions/accessory-navicular-syndrome (Accessed: 7 October 2026).
Parekh, S.G. (n.d.) The accessory navicular: 'I have an extra bone in my foot?'. American Academy of Orthopaedic Surgeons OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/ortho-pinion-accessory-navicular (Accessed: 7 October 2026).
Stolarz, K., Osiowski, A., Preinl, M., Osiowski, M., Jasiewicz, B., Taterra, D. and Taterra, D. (2024) 'The prevalence and anatomy of accessory navicular bone: a meta-analysis', Surgical and Radiologic Anatomy, 46(10), pp. 1731–1743. doi: 10.1007/s00276-024-03459-x
NHS (2024) Sprains and strains. Available at: https://www.nhs.uk/conditions/sprains-and-strains/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooAccessory Navicular Syndrome

What It Is

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Manage Pain

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooAccessory Navicular Syndrome

What It Is

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Manage Pain

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Achilles Tendinopathy

Bunions

Cavus Foot (High Arches)

Claw Foot

Book a session