A small bursa is present between the insertion of the tibialis posterior tendon and the medial surface of the navicular tuberosity, reducing friction as the broad fan-shaped tendon fans out to its multiple insertion sites. The bursa is particularly relevant at the navicular tuberosity, where the primary tendon slip inserts against a bony prominence.
Accessory navicular syndrome involves a prominent accessory ossicle at the navicular tuberosity where the tibialis posterior tendon inserts. The bursa between the tendon and the ossicle or tuberosity becomes inflamed by direct shoe pressure and repetitive tendon loading, producing medial midfoot pain. Ossicle excision with tibialis posterior tendon advancement is performed when conservative measures fail. Distinguishing bursitis from tibialis posterior tendinopathy at this level is clinically important and aided by MRI and ultrasound.
Friction bursitis between the tibialis posterior tendon and a prominent accessory navicular produces medial midfoot pain and tenderness directly over the navicular tuberosity, exacerbated by footwear pressure and managed with orthotics, padding, and surgical ossicle excision when conservative management fails.
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