Procedure
Accessory Navicular Excision & Tibialis Posterior Advancement
For Accessory Navicular
What It Involves
The operation involves two key steps through a single incision over the inner side of the foot. First, the accessory navicular bone is excised and the bony prominence on the navicular is smoothed flush, removing the bony lump entirely. Second, the tibialis posterior tendon (often partially displaced by the presence of the extra bone) is reattached firmly to the navicular in an optimal position, restoring its mechanical function and supporting the arch.
The procedure is performed under general or regional anaesthesia as a day surgery case and typically takes 45–60 minutes.
Benefits
- Removes the source of direct bony pressure and local irritation.
- Restores the tibialis posterior tendon to a mechanically optimal attachment point.
- High satisfaction rates — the majority experience complete or near-complete resolution of inner foot pain.
- The foot typically feels more stable and the arch better supported.
Recovery Timeline
Everyone heals at a different rate. This timeline is a guide.
Weeks 1–2
Non-weight-bearing in a cast, with strict elevation. The wound is checked and sutures removed at 2 weeks.
Weeks 2–6
Transition into a boot, remaining non-weight-bearing for a further 4 weeks while the tendon repair consolidates, with continued elevation. Sedentary work is typically possible from this point.
Weeks 6–12
Weight-bearing begins in a CAM boot from around 6 weeks, with a clinical review and physiotherapy for tendon strengthening and arch rehabilitation. Roles requiring prolonged standing or walking need approximately 10–12 weeks off.
3 months
Most daily activities have resumed, transitioning out of the boot into supportive footwear.
3–6 months
An arch-supporting orthotic is recommended to protect the repaired tendon and maintain the corrected arch position, particularly if you have an associated flat foot.
6–12 months
As this is a major reconstruction, full return to sport and higher-demand activity is expected to take 6–12 months, with a final review and discharge once achieved.