Case Of the Week (COW) 10 August 2014
Answer:
Accessory Navicular with PTT tendinopathy.
Discussion:
Accessory navicular has three variants of which type 2 and 3 variants have been associated with pathologic conditions such as posterior tibial tendon (PTT) tear & painful navicular syndrome. This is caused by an altered insertion of the PTT by the accessory navicular. Three distinct types Small, round separate ossicle imbedded in the PTT(type 1) Larger, triangular ossification centre adjacent to the navicular tuberosity and connected by synchondrosis (type 2) Enlarged medial horn of navicular- cornuate navicular (type 3). Type 2 may become symptomatic if repetitive contractions of the PTT as it inserts onto the accessory ossicle can produce shearing stress forces at the synchondrosis, and generate pain and tenderness along the medial aspect of the midfoot.
Contributed By:
Dr. Balaji Ayyamperumal
Tanjore Medical College
Answer:
Accessory Navicular with PTT tendinopathy.
Discussion:
Accessory navicular has three variants of which type 2 and 3 variants have been associated with pathologic conditions such as posterior tibial tendon (PTT) tear & painful navicular syndrome. This is caused by an altered insertion of the PTT by the accessory navicular. Three distinct types Small, round separate ossicle imbedded in the PTT(type 1) Larger, triangular ossification centre adjacent to the navicular tuberosity and connected by synchondrosis (type 2) Enlarged medial horn of navicular- cornuate navicular (type 3). Type 2 may become symptomatic if repetitive contractions of the PTT as it inserts onto the accessory ossicle can produce shearing stress forces at the synchondrosis, and generate pain and tenderness along the medial aspect of the midfoot.
Contributed By:
Dr. Balaji Ayyamperumal
Tanjore Medical College