Management of foot pain associated with accessory bones of the foot: Two clinical case reports

Study Design: Case study. Objectives: To discuss the differential diagnosis, the nonsurgical and post operative management of common accessory bones of the foot. Background: Accessory bones of the foot that are formed during abnormal oss ification are commonly found in asymptomatic feet. Two of the mast common a ccessory bones are the accessory navicular and the os peroneum. Their painf ul presence must be considered in the differential diagnosis of any acute o r chronic foot pain. The optimal treatment for the conservative and postope rative management of painful os peroneum and accessory navicular bones rema ins undefined. Methods and Measures: Therapeutic management of the fractured os peroneum i ncluded bracing taping, and foot orthotics to allow healing of involved tis sues, and stretching. The focus of the postoperative management of the acce ssory navicular was joint mobilization and progressive strengthening. Depen dent variables included revel of pain with provocation and alleviation test s 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 visit s for 10 weeks. At discharge from physical therapy, the patient had the fol lowing outcomes relative to the noninvolved side: 100% return of normal sen sation tested by light touch and vibration; pain decreased from 6/10 to 1/1 0; 100% reduction of swelling with ankle girth to normal; 100% range of mot ion of ankle and subtalar joints. Strength in plantar flexion and eversion remained 20% impaired (80% return to normal) secondary to pain. Upon discha rge, he still reported mild pain when walking but was able to return to pre vious leisure activities. The second patient with the accessory navicular w as 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 foo t and ankle, 100% of strength in hip and ankle, and 100% return of balance. She could squat and jump without pain and she returned to full premorbid a ctivity level. Conclusions: Rehabilitative management of both cases addressed specific imp airments 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.