A navicular bursa develops between the tibialis posterior tendon and the medial navicular tuberosity, particularly in patients with a prominent accessory navicular (Type II os naviculare accessorium). The bursa forms adventitially in response to friction between the tendon and the accessory navicular prominence, becoming symptomatic with direct footwear pressure on the medial midfoot prominence.
Navicular bursitis associated with accessory navicular syndrome produces medial midfoot pain aggravated by shoe pressure directly over the prominence. Ultrasound demonstrates bursal fluid adjacent to the navicular prominence and the tibialis posterior tendon. Treatment is initially conservative with shoe modification (wider footwear, medial prominence relief) and corticosteroid injection into the bursa. Persistent symptoms are treated surgically by Kidner procedure — excision of the accessory navicular, elimination of the bursa, and advancement of the tibialis posterior insertion to the main navicular tuberosity.
A prominent Type II accessory navicular creates a medial foot prominence that is directly compressed by footwear, developing an adventitial bursa between the tibialis posterior tendon and the os accessorium that produces medial midfoot pain and swelling; corticosteroid injection into the bursa and shoe modification provide temporary relief while Kidner procedure provides definitive treatment.
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