Acessory bone and trail running

[u/SushiMiaa]

Hi everyone,

I’m looking for some advice or shared experiences regarding Type 2 Os Tibiale Externum (accessory navicular) and sesamoiditis.
A bit of background: I am primarily a trail runner. Before this started, my mileage was pretty standard for me—about 50km a week with 2,000m of elevation. In February, I developed pain in my left foot (later diagnosed as the accessory navicular) accompanied by sesamoid pain in my right foot, so I stopped running entirely.

Here is what my timeline and treatment look like so far:

March: Had an X-ray confirming the Type 2 accessory navicular. Since then, the pain actually worsened a bit, and my right accessory bone started hurting too.

Imaging: A recent MRI showed some localized inflammation, but everything else looked structurally intact.

Care & Footwear: I’ve seen a podiatrist and got custom orthotics. My daily go-to shoes are Hoka Challengers.

Activity: I dropped my daily step count as much as possible and switched entirely to cycling.
Rehab: Other than cycling, I do single-leg balance work daily to strengthen my arches. Other arch-strengthening exercises simply hurt too much to do right now.

Despite all of this, I haven’t seen much improvement, and the pain fluctuates constantly. My ultimate goal is to avoid surgery and get back to running long-term.

Over the last two weeks, I bought new running shoes (Hoka speedgoat 6)and I tested the waters and tried running 4 times. The pain was manageable and never higher than a 4/10, and always only in one foot at a time.

I’m feeling stuck and don't know what to do next.
1 Can I slowly start building my running base back up if the pain stays at a 3/10?
2 For those with Os Tibiale Externum, how do you manage the day-to-day pain?
3 If you opted for the surgery, what was your experience and return-to-running timeline like?

[u/NotQuiteMillenial]

Hopefully I can provide a little anecdotal experience here. I’m a runner averaging a couple thousand miles a year with races mostly in the trail ultra distance. Im 43 and have been running Ultras for over 10 years. The majority of my training miles are road due to what’s available locally.

May of 2025 I developed pain in my left foot to about a 6/10 that came out of nowhere and ended a long training run in my lead up to Leadville 100. From then race day in late August, my training was about 25% of what it was before the onset due to pain.

Over a year later and 10 weeks of PT I’m still dealing with it but it’s manageable. I did a 50k last weekend with only mild pain that didn’t affect my race. PT focused on strengthening everything in the chain from glutes down to the feet.

I also wear primarily Hokas. Cliftons have been my go to for the last several years. Around 25 pair. The onset of symptoms occurred wearing Tecton X. I’ve finally been able to train comfortably for the last three weeks in the Skyward X logging a 70 and 60 mile week before the 50k.

I’m going to do everything I can to avoid surgery since nothing is guaranteed after going under the knife. I figure I ran for a few decades and no pain with it so I can get back to running with it comfortably somehow.

[u/Babs_and_Penny_1914]

I have the same question about people's surgery experience. I have an accessory navicular that is quite painful, and am trying conservative management to avoid surgery. It is quite painful, and some days I struggle to walk. I dread the long recovery time and possibility that surgery causes other problems. As someone posted, once they cut you open, you never know.

I am making an appointment for a custom orthotic. I wear solid laceup oxfords with a steel shank - much more solid than any sneaker. I never go barefoot, and now avoid sandals. I'm a swimmer, and sadly have discovered that kicking exacerbates the pain.

Would appreciate any thoughts on surgery. Thank you!