Revision Surgery for Recurrent Pain after Excision of the Accessory Navicular and Relocation of the Tibialis Posterior Tendon

Abstract

BackgroundThe results of operative treatments for symptomatic accessory navicular are debatable. In some cases, recurrent pain may develop after the Kidner procedure. The purpose of this study is to review the reasons for recurrent pain after the Kidner procedure and to suggest possible options for revision surgery.MethodsWe reviewed the clinical and radiological outcomes in 9 patients who underwent revision surgery for recurrent pain after the Kidner procedure. During the revision surgery, the tibialis posterior tendon was reattached to the navicular either by advancing the tendon in 4 patients or by lengthening the tendon in another 4 patients. In the other 1 patient, the flexor digitorum longus tendon was transferred. Surgeries for the accompanying deformities were performed simultaneously in all patients. The results were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and a visual analog scale. The mean follow-up was 2.3 years (range, 1 to 5 years).ResultsThe mean American Orthopedic Foot and Ankle Society ankle-hindfoot score improved from 71.25 to 81.50 in the advancement group, and 71.75 to 90.00 in the lengthening group. The mean visual analog scale improved from 7.75 to 4.25 in the advancement group and from 7.50 to 1.75 in the lengthening group.ConclusionsRecurrent pain after the Kidner procedure was associated with pes planovalgus or hindfoot valgus deformity. In revision surgery, correction of the associated deformities and reattachment of the tibialis posterior tendon after lengthening may need to be considered.

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

“…In the literature, only 1 clinical study investigated recurrent pain after the Kidner procedure. In a study of 9 revision cases after a primary Kidner procedure, Choi and Lee 5 observed 7 patients (78%) demonstrating a planovalgus deformity. In our study, only 11 patients (52%) had a planovalgus deformity.…”

“…Despite its relatively successful outcomes, pain after the Kidner procedure has been reported from several studies. 5,31,33 However, the etiology of these symptoms and its surgical management have not been clearly determined. Vaughan and Singh 33 reviewed 6 studies on the outcomes of the Kidner procedure and found that 80 of 124 (65%) feet that had preoperative flatfoot deformity still had postoperative flatfoot deformity.…”

“…Scott et al 31 reported that recalcitrant pain following the Kidner procedure predominated in patients with progressive collapse of the medial longitudinal arch. Similarly, Choi and Lee 5 found that patients who had undergone revision surgery due to recurrent pain following the Kidner procedure demonstrated planovalgus or hindfoot valgus deformity. Despite these findings, radiographic analysis of patients with recurrent pain following the Kidner procedure has not been detailed in the literature.…”

“…Although clinical outcomes were generally favorable, 9,18 recurrent pain following the procedure has been reported. 5,31,33 Furthermore, the ability of correcting flatfoot as originally advocated by Kidner has been questioned in more recent research. 16,19,27 In this regard, an association of recurrent pain following the Kidner procedure and malalignment of the foot has been a recent topic of investigation.…”

Maximum standardized uptake value of foot SPECT/CT using Tc-99m HDP in patients with accessory navicular bone as a predictor of surgical treatment

“…Some of the ANB patients experience persistent pain even after the surgery, which reflects the necessity for more accurate risk stratification of ANB. [11]…”