![]() However, in adolescence, when the accessory navicular begins to calcify, the bump on the inner aspect of the arch becomes noticed. Throughout early childhood, this condition is not noticed. Up to 2.5 percent of individuals are born with the accessory navicular. The calcification process occurs at a variety of different times in life depending on the bone.Īn accessory navicular is an extra bone that is on the inner center arch of the foot. ![]() These cartilage “bones” are difficult to see on x-ray until they become calcified. What is this bump and why is it painful?Īs infants and children, many of our bones start off as cartilage. Oftentimes, these patients have a bump in this inner center arch area. Typically, these patients tend to be athletic however, not all are. Over the years, I have had a number of patients who come in with complaints of pain in the inner center part of their arch. This places maximum stress on the flexor hallucis tendon.Any views or recommendations shared in the Ortho-pinions blog are solely those of the authors and do not necessarily represent those of the American Academy of Orthopaedic Surgeons. If this causes no pain or discomfort in the offending area, ask the person to transfer most of his or her weight onto the big toes. If this second test does not cause discomfort, move on to the third test.įor this final test, have the client face a wall and lean against it at approximately a 35-degree angle, while rising up onto the balls of the feet ( Figure 3). If the reproduced pain is in the Achilles' area, you'll need to do further testing to determine whether it's coming from the Achilles' or the flexor hallucis. If this reproduces the person's pain, and the pain is in the medial arch, you have confirmed the presence of flexor hallucis tendon strain. While holding the client's hands for balance, ask the person to rise onto the balls of the feet ( Figure 2). The second test is performed in a standing position. If the tendon is only mildly strained, you'll need to perform one or two additional tests to place more stress on the tendon. If the injury is relatively severe, this test will be positive (causing a little pain). Question: What assessment test would you perform to verify this injury?Īnswer: Resisted plantar flexion of the great toeįirst, hold the great toe in slight dorsiflexion ( Figure 1) with your thumb and ask the person to push the toe down against you (into plantar flexion). If a person feels pain not just at the medial arch, but in a wider area under the arch of the foot, this might indicate that the flexor tendons of several other toes also are strained or that a plantar fasciitis is present. Injuries to this tendon near the anterior portion of the heel often are mistaken for plantar fasciitis. ![]() Injuries to the flexor hallucis tendon at the back of the ankle, where the tendon is running parallel to the Achilles', are sometimes mistaken for Achilles' tendinitis. See Also: Trigger Points in the Fibularis Tertius Muscleįlexor hallucis injuries occur most commonly in the medial arch of the foot. In cases where poor alignment is placing pressure on the medial arch, there often is a callus at the medial edge of the great toe and/or the medial aspect of great toe joint. In such cases, strain or tendinitis of the flexor hallucis tendon is fairly common. If the feet are turned out while standing and walking, even more weight falls onto the great toe - and therefore onto its flexor tendon. In a normally aligned foot, roughly one-third of the body's weight falls onto the great toe, with one-sixth falling onto each of the other toes. Poor alignment makes the flexor hallucis tendon more susceptible to injury. The tendon passes under the medial heel and travels along the medial arch of the foot to attach distally at the great toe. The muscle is located in the calf, and its tendon begins just medial to the Achilles' tendon. The flexor hallucis is a very strong muscle-tendon unit that takes the lion's share of our weight while we walk, stand and rise onto the balls of our feet. Question: If a person experiences pain under the medial arch of the foot while walking or while rising onto the balls of the feet to reach for something, which structure is likely to be injured?Īnswer: The flexor hallucis. ![]()
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