Slide 037 — Accessory navicular

Clean FRCS notes with inline figures

Mostly asymptomatic

•Secondary ossification center failed to unite in childhood (usually ossify at age 9yo)

•Abnormal insertion of PTT

Pain source:

•Repeated microfracture of synchondrosis

•PTT insertion inflammation

Rigid flatfoot pathogenesis:

•PTT insert to accessory navicular → change in PTT pull

•Midfoot adduction → accessory navicular impingement onto MM → PTT pain → patient adopt a forefoot abduction

XR classification:

•Ray and Goldberg

•I Ossicle in PTT

•II Synchondrosis

•III Synostosis

Management

•Nonop

•Asymptomatic

•Mild- donut shaped moleskin

•Severe- cast 6 weeks then UCBL

•Operation

Indication: refractory to cast/ brace

•Kidner procedure

•Remove accessory navicular at synchondrosis

•Reattach PTT (advance distal and plantar? Controversial)

Direct Q&A

Q1 What are the radiographic findings for Accessory navicular?

Ray and Goldberg

•I Ossicle in PTT

•II Synchondrosis

•III Synostosis

Q2 How is Accessory navicular managed?

Nonop

•Asymptomatic

•Mild- donut shaped moleskin

•Severe- cast 6 weeks then UCBL

•Operation

Q3 What are the indications listed for Accessory navicular?

Kidner procedure

•Remove accessory navicular at synchondrosis

•Reattach PTT (advance distal and plantar? Controversial)

Raw speaker-note hierarchy audit

#	lvl	marL	indent	logical	original note line
1	0	None	None	0	Mostly asymptomatic
2	0	None	None	0	Secondary ossification center failed to unite in childhood (usually ossify at age 9yo)
3	0	None	None	0	Abnormal insertion of PTT
4	0	None	None	0	Pain source:
5	0	171450	-171450	1	Repeated microfracture of synchondrosis
6	0	171450	-171450	1	PTT insertion inflammation
7	0	0	0	0	Rigid flatfoot pathogenesis:
8	0	228600	-228600	1	PTT insert to accessory navicular → change in PTT pull
9	0	228600	-228600	1	Midfoot adduction → accessory navicular impingement onto MM → PTT pain → patient adopt a forefoot abduction
10	0	0	0	0	XR classification:
11	0	0	0	0	Ray and Goldberg
12	1	457200	0	1	I Ossicle in PTT
13	1	457200	0	1	II Synchondrosis
14	1	457200	0	1	III Synostosis
15	0	0	0	0	Mx:
16	0	0	0	0	Nonop
17	0	171450	-171450	1	Asymptomatic
18	0	171450	-171450	1	Mild- donut shaped moleskin
19	0	171450	-171450	1	Severe- cast 6 weeks then UCBL
20	0	0	0	0	OT
21	0	171450	-171450	1	Indication: refractory to cast/ brace
22	0	171450	-171450	1	Kidner procedure
23	1	628650	-171450	2	Remove accessory navicular at synchondrosis
24	1	628650	-171450	2	Reattach PTT (advance distal and plantar? Controversial)

lvl

marL

indent

logical

original note line

None

Mostly asymptomatic

None

Secondary ossification center failed to unite in childhood (usually ossify at age 9yo)

None

Abnormal insertion of PTT

None

Pain source:

171450

-171450

Repeated microfracture of synchondrosis

171450

-171450

PTT insertion inflammation

Rigid flatfoot pathogenesis:

228600

-228600

PTT insert to accessory navicular → change in PTT pull

228600

-228600

Midfoot adduction → accessory navicular impingement onto MM → PTT pain → patient adopt a forefoot abduction

XR classification:

Ray and Goldberg

457200

I Ossicle in PTT

457200

II Synchondrosis

457200

III Synostosis

Mx:

Nonop

171450

-171450

Asymptomatic

171450

-171450

Mild- donut shaped moleskin

171450

-171450

Severe- cast 6 weeks then UCBL

171450

-171450

Indication: refractory to cast/ brace

171450

-171450

Kidner procedure

628650

-171450

Remove accessory navicular at synchondrosis

628650

-171450

Reattach PTT (advance distal and plantar? Controversial)

Improved semantic hierarchy used for the study notes

#	semantic level	section?	rewritten line
1	0		Mostly asymptomatic
2	1		Secondary ossification center failed to unite in childhood (usually ossify at age 9yo)
3	1		Abnormal insertion of PTT
4	0	yes	Pain source:
5	1		Repeated microfracture of synchondrosis
6	1		PTT insertion inflammation
7	0	yes	Rigid flatfoot pathogenesis:
8	1		PTT insert to accessory navicular → change in PTT pull
9	1		Midfoot adduction → accessory navicular impingement onto MM → PTT pain → patient adopt a forefoot abduction
10	0	yes	XR classification:
11	1		Ray and Goldberg
12	1		I Ossicle in PTT
13	1		II Synchondrosis
14	1		III Synostosis
15	0	yes	Management
16	1		Nonop
17	1		Asymptomatic
18	1		Mild- donut shaped moleskin
19	1		Severe- cast 6 weeks then UCBL
20	1		Operation
21	0	yes	Indication: refractory to cast/ brace
22	1		Kidner procedure
23	2		Remove accessory navicular at synchondrosis
24	2		Reattach PTT (advance distal and plantar? Controversial)

semantic level

section?

rewritten line

Mostly asymptomatic

Secondary ossification center failed to unite in childhood (usually ossify at age 9yo)

Abnormal insertion of PTT

yes

Pain source:

Repeated microfracture of synchondrosis

PTT insertion inflammation

yes

Rigid flatfoot pathogenesis:

PTT insert to accessory navicular → change in PTT pull

Midfoot adduction → accessory navicular impingement onto MM → PTT pain → patient adopt a forefoot abduction

yes

XR classification:

Ray and Goldberg

I Ossicle in PTT

II Synchondrosis

III Synostosis

yes

Management

Nonop

Asymptomatic

Mild- donut shaped moleskin

Severe- cast 6 weeks then UCBL

Operation

yes

Indication: refractory to cast/ brace

Kidner procedure

Remove accessory navicular at synchondrosis

Reattach PTT (advance distal and plantar? Controversial)

037. Accessory navicular

Clean FRCS notes with inline figures

Mostly asymptomatic

Pain source:

Rigid flatfoot pathogenesis:

XR classification:

Management

Indication: refractory to cast/ brace

Direct Q&A

Ray and Goldberg

Nonop

Kidner procedure

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes