Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular

Abstract

Background: The Kidner procedure is performed to treat painful accessory navicular syndrome, with varying results. Recurrent pain remains a complication, and to date, there is a paucity of literature regarding the causes of recurrent pain and surgical outcomes of revision. Methods: Twenty-one patients who underwent revision surgery for recurrent pain after the Kidner procedure were identified. All patients had their tendon inspected and treated, and all had a medial displacement calcaneal osteotomy. Revision was indicated after 6 months of failed conservative therapy. Pre- and postrevision radiographic measurements included lateral talo–first metatarsal angle (Meary’s angle), talonavicular coverage angle, calcaneal pitch, and hindfoot moment arm (HMA). Meary’s angle >4 degrees was considered a planus deformity and HMA >9.1 mm was considered a hindfoot valgus deformity; patients fulfilling both criteria were categorized as having planovalgus deformity. Measurements in the contralateral foot were performed to determine whether alignment of the involved side was attributed to failed treatment or a preexisting deformity. Visual analog scale and Foot and Ankle Outcome Scores were compared and average follow-up was 20.1 months (range, 14-26). Results: Preoperatively, 20 of 21 (95%) patients had a form of valgus heel alignment (planovalgus, n = 11; hindfoot valgus only, n = 9), and 1 had an isolated planus deformity. The contralateral side revealed similar deformity, with 17 of 21 (81%) patients having a form of valgus heel alignment (planovalgus, n = 13; hindfoot valgus only, n = 4) and 4 patients with an isolated planus deformity. All patients underwent realignment surgery with medial displacement calcaneal osteotomy. All radiographic parameters except Meary’s angle ( P = .885) significantly improved postoperatively along with significantly improved clinical outcomes. Conclusion: Recurrent pain following the Kidner procedure was associated with valgus heel alignment. Revision surgery including realignment procedure alleviated pain and improved functional outcomes with minimal complications. Therefore, we recommend assessing heel alignment in patients presenting with recurrent pain following the Kidner procedure. Level of Evidence: Level IV, case series.

Calcifying aponeurotic fibroma around posterior tibialis tendon in an elderly patient with flatfoot

“…By medially shifting the calcaneal tubercle, MDCO can not only improve the deformity, but also effectively relieve the tension around the PTT attachment. [15,16] Numerous studies have reported significant pain relief, corrected alignment, and improved function following MDCO. [17][18][19] As a result, MDCO is generally accepted for mild flat foot deformity.…”

FE Analysis of the Symptomatic Navicular - A Case Report

“…Kidner's assumption is that the presence of AN modifies the position and biomechanics of the insertion of the posterior tibialis tendon. This causes weakness in the longitudinal arch of the foot and flatfoot [8]. The method of final elements (FE analysis) is included in the contemporary methods of numerical analyses.…”

Subtalar arthroereisis combined with medial soft tissue reconstruction in treating pediatric flexible flatfoot with accessory navicular

“…Recent studies have shown that accessory navicular is associated with flatfoot, which induces or worsens the accessory navicular-related symptoms. Simply treating painful accessory navicular could not correct the flatfoot deformity satisfactorily [ 1 , 5 – 7 ]. The progression of flatfoot deformity induces the progressive collapse of the arch, leading to rigid flatfoot and arthritis [ 8 , 9 ].…”

“…Kidner procedure reconstructs can alleviate or eliminate the pain in navicular tuberosity. However, whether could persistently correct the collapse of the arch is yet to be elucidated [ 7 ]. Subtalar arthroereisis is an effective method for the treatment of flexible flatfoot in children [ 10 – 12 ].…”