Running with Accessory Navicular Syndrome

In early summer of 2018, I was sitting with me legs out, rubbing my feet and ankles. While doing so, I noticed there was a hard bump (like from a bone) on the inside of my left foot above the arch. Upon Googling , I learned it is called an accessory navicular. It most commonly forms in youth, when bones are growing. I had never before noticed it, so I have no idea if I’ve had it for ages, or if it happened in adulthood.

The discovery explained some foot pain and the trouble I was having finding a shoe that provided the support and cushion necessary for long runs. Some can go their whole lives with an accessory navicular and it doesn’t bother them. If it does bother you, it’s called Accessory Navicular Syndrome (ANS).

Since the beginning of my running days, the muscle on the inside of my foot/ankle gets sore easily. The accessory navicular is part of the posterior tibial tendon-that exact area that would get easily aggravated. It also gives you flat arches, which tells why I couldn’t seem to find shoes that had the arch support I needed. I tried a variety of shoes, but none seemed to make the cut. I thought stability shoes were the answer, but me feet don’t dramatically overpronate so they didn’t solve the problem (I still wear some stability shoes, along with neutral shoes).

Last year I found a site that talked about ANS, saying that Foot Chair Insoles are best option. I put them in almost all my running shoes. Despite being a bit stiff, they work great. When my husband saw them he said it was the most intense arch support insole he’d seen! I would still like to find a shoe that can last through a marathon without having to use the Foot Chair (here’s what I found to be the best running shoes for flat feet), but for now I’m grateful I at least have the insole.

Another way to ease arch soreness is to will roll your foot on a tennis ball or trigger point ball. Most runners with normal feet do this as well. If you’ve never tried it you really should!

It was nice to discover the reason for the easily irritated tendon on my foot, and why my arches would get sore. I know now what the problem is, and how to deal with it. Since using the proper insole and compression gear, I have able to run many 20+ mile runs, including marathons. The good news is that after a marathon I really don’t notice pain in my foot, I’m almost always more sore in my legs themselves.

When I wear casual shoes, or running shoes that don’t have the foot chair insole, I will wear arch supports. These have helped a lot, especially since we’ve lived in cities where we do a lot of walking. In warm weather and around the house I wear recovery sandals. Oofoos is a popular brand, I also use the Hoka One One recovery sandals. A lot of running shoes offer their own version, but those are the only two brands that I have worn. The Oofoos are much softer than the Hoka’s, but some days I prefer that stiffness of Hoka.

Wearing Oofoos, they also have flip flops

For some, surgery may be the best option if accessory navicular pain is severe and can’t seem to be relieved. They would remove that small bone (which isn’t needed at all) and reshape the posterior tibial tendon. Of course I’m hoping I will never need that surgery. For now, the insoles, compression ankle sleeves, and ice seem to do the trick.

If you have Accessory Navicular Syndrome, you certainly don’t need to think that running is out of the question. Even running a marathon isn’t out of the question! You just need to be mindful to take the right precautions ahead of time. Here are some other massage tools that could help with various foot and leg pain/soreness.

~~Just a random thing I’m adding to this post-Last night Shalane Flanagan posted on her Instagram about the two surgeries she’s had. Turns out she had ANS and surgery to have the accessory bone removed. This only occurs in 4-14% of the population, so I find it interesting that she happened to have it as well.

Have you ever heard of ANS? Do you have it? What shoes/shoe products have helped?

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  1. Hi Laura! Thank you so much for this post. I have severe ANS. I’ve had it since high school but luckily, my dad is a track coach and longtime runner so I have had access to physical therapy and other resources. I’ve also been steered away from surgery by many people. Anyways, I get pain often after runs. I didn’t educate myself about all the shoe options until pain presented itself more these past few years. I am wondering what types of shoes you wear? I have had some luck with certain models of Hoka One One paired with SOLE customizable insoles. Ironically, I found out about the shoe/insert combo from a fellow ANS sufferer on Shalane Flanagan’s Instagram post earlier this year!

    1. I wear a variety of shoes, you can read about them in this section of the blog
      For longer runs I always wear shoes with an insole. Even shoes that claim that have good arch support, it’s just never enough! For shorter runs I’m not as picky. If I have a shorter run, and am using shoes without an insole, I wear an arch sleeve (like these and that has helped a lot! I’ve worn Hoka One One Ahari and it has good arch support, but again, for a run longer than 15 miles I don’t think it’s enough.

      1. Thank you for your response! I am having trouble finding a consistent daily trainer- what is your current go to? I looked at your other posts and noticed you wear some New Balances for longer distances. I recently hit a wall after trying out some Mizuno Wave Horizons and Hoka Cliftons. I am feeling a little lost, shoe-wise. I would like to run a marathon at some point and I’ve always held back for fear that nothing will support me long enough, but I do like to walk in New Balance 860s. I find that, at times, NB’s are not quite cushiony enough even though the support is there. Whereas, my Hoka Cliftons are certainly cushiony enough but don’t have enough support. I am just in this loooong, ongoing process of testing out shoes. The ANS makes it harder!

        1. Yeah for every marathon I’ve worn New Balance with the foot chair insole. Not the most cushiony, but my feet feel great! The Mizuno’s I have are really comfy, but they don’t provide enough arch support on their own. I’ve heard cliftons are good for ANS but I still haven’t tried those particular Hoka’s. It does feel like a never ending search!

  2. Both of my girls have bad ANS that they developed in high school. They both required custom orthotics ($400 each!), and their physical therapist recommended New Balance 1240s (possibly wide to accommodate the orthotics). This worked for them. Good luck!

  3. Hi Laura, I wrote you a few months back in August. I was wondering which foot chair model you use with your New Balances? I love my NB Fresh Foam Vongo v4’s but the SOLE inserts are a bit too hard for me and I think I need something with more cushion. I wanted to give your method a try! Thanks again.

  4. Hi Laura! Thanks for posting. I have this on my right foot and am the slowest runner going. My right foot is totally flat and my left is not. I’m excited to try some other footwear/ things to try that will Aid this. I don’t think surgery is needed but I want to be more active and keep it on supported.


    1. I hope it works! Two years later and I am still using the Foot Chair insole! I have some running shoes I don’t put it in, but I wonly wear those on short runs. Let me know if it helps you!

  5. I have been reading all your comments. I have ANS that really began to bother me about 5 years ago and now I am 52. I went to a Foot Care Clinic which diagnosed my problem and they fitted me with orthodics in a pair of Asics Running Shoe and my feet are not sore after wearing them all day. The foot clinic suggested a firm sandal and I purchased their Mephisto which is similar to the Birkenstock sandal. I wear these throughout the summer and in the house. I would like to have an ankle boot that would prevent sore feet at the end of the day. Any suggestions?

    1. hm, I have never tried an ankle boot, just the products I have listed in this post. I also recently bought the Oofos shoes, so wearing those in the colder months help since it’s too cold for sandals.

  6. Hi ive always noticed my ankle would get sore easily after runs but it never really bothered me. A couple of days ago the pain was bad I had to stop running I haven’t ran since. Do you have flare ups if so how long do they last? I’m only 17 and I’ve only noticed a possible accessory navicular I’m just really hoping it won’t cut my running career short.

    1. Hi! Sorry for the delay in responding. When I have a flare up I will ice the area that evening in 30 minute increments. Also, wearing the zensah ankle sleeves I link to help a ton! I wear them when I have a flare up (unless the flare up is really bad, in which case it’s good to take a day or two off) and I also wear them when I run over 10 miles.

  7. Hi! I’m coming across your post as I’ve had the Kidner Procdure (removing ANS) and I’m looking for the best shoes. I had the surgery in December and just started walking two weeks ago in a boot and transitioned to an ankle brace today. The only reason I discovered I had ANS was because of a severe fall I had in which I twisted my ankle and permanently injured that food. Most people don’t need to get surgery, thankfully!!

    1. Wow! Glad you are healing well! Since you have had it removed, I don’t know if the Foot Chair insole will be necessary. But I am sure a show with good arch support will still be important. The Brooks Glycerin is a good one.

    2. Hi Maria ,I wonder if you can give me advice I had kidner done feb19 ..I am 45 years old and doing physical therapy..I wonder how do you feel so far I am still trying to walk with boot for now ..

  8. hi, my name is jessica and i am 15. i run cross country and track but in the past year had to take both seasons of due to discomfort durning and running because of my extra bones. i have been contemplating the surgery but am still not sure what the best route to go would be. i have tried the inserts and braces. i was wondering if anyone on here has had the surgery an dif so, could let me know if it has helped them in a big way or if it is not worth it?

    1. I still haven’t had the surgery. Using the footchair insole as well as an ankle compression sleeve has prevented pain and allowed me to run fine. It can be kind of annoying needing the insole, but I just don’t want to get the surgery unless it is absolutely necessary. Sorry I can’t be more helpful!

  9. HI Jessica, I had surgery as a child and it was very beneficial. The surgery was however very painful and there was a period of downtime, having to wear a cast, etc. About 25 years later, I am seeing that all of the sneakers I’m trying on lately are creating friction and discomfort against the navicular again. It concerns me because the constant friction is what led me to eventually need surgery. I’ll be seeing an orthopedist next week and will leave an update.

  10. Hey Jessica, thank you for your post! A few years ago I struggled with ANS in my left foot after running a half marathon and wore an offloading boot for 6 weeks. I then used a compression sock, Powerstep foot insoles, and Saucony Hurricanes when getting back into running. I still wear the insoles and shoes, but did not wear compression socks or ice regularly when training for another half. I have had no trouble with my left foot, but naively didn’t think I’d have the same problem with my right foot. Fast forward and I’m currently in a boot again for the right foot. I’ll follow the same protocol but want to be more proactive in preventing the issue all together. I love the Powerstep insoles but will probably try a different pair of running shoes and ice regularly once I’m running again. What exactly is your protocol for icing? Also, do you do any specific exercises for the tendon? I know this is long after your original post but I appreciate your response!

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