# Sustainable treatment success of an Os naviculare syndrome using conservative measures, infiltration therapy, and shock waves

## TL;DR

A 53-year-old man with foot pain caused by an accessory navicular syndrome found lasting relief through shockwave therapy after conservative treatments failed.

## Contribution

This case study demonstrates the effectiveness of shockwave therapy in treating accessory navicular syndrome when conservative methods are insufficient.

## Key findings

- Conservative measures provided only moderate relief for the patient's foot pain.
- Shockwave therapy resulted in sustainable symptom relief.
- The condition was linked to pes planovalgus and tibialis posterior tendon inflammation.

## Abstract

Medial plantar foot pain can have various causes, and the painful Os tibiale externum should be considered in the differential diagnosis. A reliable diagnosis can be made through physical examination and multimodal imaging. We report on a 53-year-old man with severe, load-dependent pain consistent with an accessory navicular syndrome, caused by a pes planovalgus, which consecutively induced focal inflammation and tenosynovitis of the tibialis posterior tendon. Multifactorial conservative measures, including infiltration therapy, provided only moderate symptom relief. A final shockwave therapy ultimately led to a sustainable symptom relief.