Outcome of Modified Kidner Procedure with Subtalar Arthroereisis for Painful Accessory Navicular Associated with Planovalgus Deformity

Abstract

Background: Type II accessory naviculars are frequently associated with planovalgus deformity. Operative treatment for patients recalcitrant to nonoperative treatment involves resection, with or without takedown, and reattachment of the tibialis posterior tendon as described by Kidner. This does not address the planovalgus deformity. The authors hypothesized that adding a subtalar arthroereisis to the Kidner procedure would lead to improvement of pain and function and correction of the deformity. Methods: Institutional Review Board-approved, prospectively collected data were reviewed for 20 patients (23 feet), who underwent a combined modified Kidner and subtalar arthroereisis for painful type II accessory navicular with planovalgus deformity recalcitrant to nonoperative treatment. The average age at the time of surgery was 18 years. Patients were evaluated preoperatively and at final follow-up clinically, radiographically, and via the visual analog pain scale (VAPS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score, and a satisfaction rating. Mean follow-up was 53.9 months. Results: The mean AOFAS scores improved from 53 preoperatively to 95 at final follow-up and the mean VAPS score decreased from 7.4 preoperatively to 1.7 at final follow-up. Radiographically, the average Meary's angle improved from 18.5° apex plantar preoperatively to 3° apex plantar on weight-bearing lateral radiographs, and the average talar head uncoverage percentage on weight-bearing anteroposterior radiographs improved from 24% preoperatively to 3%. Nineteen of 20 patients reported good or excellent results. Three patients required implant removal because of pain; no recurrence of planovalgus deformity occurred after implant removal. No patients developed subtalar arthritis. Conclusion: The modified Kidner procedure combined with a subtalar arthroereisis resulted in significant pain and functional improvement. The deformity correction obtained at surgery was maintained even if the arthroereisis plug was removed. The extra-articular plug did not lead to subtalar arthritis.

Level of Evidence: IV, Case Series

Keywords

Accessory Navicular Arthroereisis Flexible Planovalgus Kidner

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References

1. Arangio

Reinert

Salathe

: A biomechanical model of the effect of subtalar arthroereisis on the adult flexible flat foot. Clin Biomech (Bristol, Avon). 19(8): 847–852, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.clinbiomech.2003.11.002

2. Chang

Lee

: Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction. Clin Podiatr Med Surg. 24(4): 687–697, viii, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.cpm.2007.07.008

3. Chung

Chu

: Outcome of fusion of a painful accessory navicular to the primary navicular. Foot Ankle Int. 30(2): 106–109, 2009. https://dx-doi-org.web.bisu.edu.cn/10.3113/FAI.2009.0106

4. Dawson

Julsrud

Erdmann

Jacobs

Ringstrom

: Modified Kidner procedure utilizing a Mitek bone anchor. J Foot Ankle Surg. 37(2): 115–121; discussion 174, 1998.

5. Geist

: The accessory scaphoid bone. J Bone Joint Surg. 7:570–574, 1925.

6. Giannini

Ceccarelli

Benedetti

Catani

Faldini

: Surgical treatment of flexible flatfoot in children a four-year follow-up study. J Bone Joint Surg Am. 83(suppl 2 pt 2): 73–79, 2001.

7. Grogan

Gasser

Ogden

: The painful accessory navicular: a clinical and histopathological study. Foot Ankle. 10(3): 164–169, 1989.

8. Kidner

: The prehallux (accessory scaphoid) in its relation to flatfoot. J Bone Joint Surg Am. 11(4): 831–837, 1929.

9. Kidner

: The prehallux (accessory scaphoid) in its relation to flat foot. JAMA. 101(20): 1539–1542, 1933.

10.

10. Kitaoka

Alexander

Adelaar

: Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 15(7): 349–353, 1994.

11.

11. Kopp

Marcus

: Clinical outcome of surgical treatment of the symptomatic accessory navicular. Foot Ankle Int. 25(1): 27–30, 2004.

12.

12. Leonard

Gonzalez

Breck

: Lateral transfer of the posterior tibial tendon in certain selected cases of pes plano valgus (Kidner operation). Clin Orthop Relat Res. 40:139–144, 1965.

13.

13. Macnicol

Voutsinas

: Surgical treatment of the symptomatic accessory navicular. J Bone Joint Surg Br. 66(2): 218–226, 1984.

14.

14. Micheli

Nielson

Ascani

Matanky

Gerbino

: Treatment of painful accessory navicular: a modification to simple excision. Foot Ankle Spec. 1(4): 214–217, 2008. https://dx-doi-org.web.bisu.edu.cn/10.1177/1938640008321405

15.

15. Needleman

: Current topic review: subtalar arthroereisis for the correction of flexible flatfoot. Foot Ankle Int. 26(4): 336–346, 2005.

16.

16. Needleman

: A surgical approach for flexible flatfeet in adults including a subtalar arthroereisis with the MBA sinus tarsi implant. Foot Ankle Int. 27(1): 9–18, 2006.

17.

17. Prichasuk

Sinphurmsukskul

: Kidner procedure for symptomatic accessory navicular and its relation to pes planus. Foot Ankle Int. 16(8): 500–503, 1995.

18.

18. Ray

Goldberg

: Surgical treatment of the accessory navicular. Clin Orthop Relat Res. 177:61–66, 1983.

19.

19. Rockett

Mangum

Mendicino

: Bilateral intraosseous cystic formation in the talus: a complication of subtalar arthroeresis. J Foot Ankle Surg. 37(5): 421–425, 1998.

20.

20. Scher

Bansal

Handler-Matasar

Bohne

Green

: Extensive implant reaction in failed subtalar joint arthroereisis: report of two cases. HSS J. 3(2): 177–181, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1007/s11420-007-9057-0

21.

21. Schon

: Subtalar arthroereisis: a new exploration of an old concept. Foot Ankle Clin. 12(2): 329–339, vii, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.fcl.2007.03.011

22.

22. Ugolini

Raikin

: The accessory navicular. Foot Ankle Clin. 9(1): 165–180, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1016/S1083-7515(03)00176-1

23.

23. Veitch

: Evaluation of the Kidner procedure in treatment of symptomatic accessory tarsal scaphoid. Clin Orthop Relat Res. 131:210–213, 1978.

24.

24. Viladot

Pons

Alvarez

Omana

: Subtalar arthroereisis for posterior tibial tendon dysfunction: a preliminary report. Foot Ankle Int. 24(8): 600–606, 2003.

25.

25. Younger

Sawatzky

Dryden

: Radiographic assessment of adult flatfoot. Foot Ankle Int. 26(10): 820–825, 2005.

26.

26. Zaret

Myerson

: Arthroerisis of the subtalar joint. Foot Ankle Clin. 8(3): 605–617, 2003. https://dx-doi-org.web.bisu.edu.cn/10.1016/S1083-7515(03)00041-X