Clin Orthop Surg.  2017 Jun;9(2):232-238. 10.4055/cios.2017.9.2.232.

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

Affiliations
  • 1Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea. cool-cool0829@hanmail.net
  • 2Department of Orthopedic Surgery, Institute for Research of Foot and Ankle Diseases, Inje University Seoul Paik Hospital, Seoul, Korea.

Abstract

BACKGROUND
The 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.
METHODS
We 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).
RESULTS
The 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.
CONCLUSIONS
Recurrent 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.

Keyword

Accessory navicular; Hindfoot valgus; Pes planovalgus; Kidner procedure

MeSH Terms

Adolescent
Adult
Female
Flatfoot
Foot/surgery
Foot Diseases/*surgery
Humans
Male
Middle Aged
Osteotomy/*adverse effects
Pain Measurement
*Pain, Postoperative/epidemiology/surgery
*Reoperation/adverse effects/methods
Retrospective Studies
Tarsal Bones/*abnormalities/surgery
*Tendon Transfer/adverse effects/methods
Tendons/surgery
Young Adult

Figure

  • Fig. 1 (A) The intraoperative finding revealed degeneration of the tibialis posterior tendon. (B) To lengthen the tibialis posterior tendon, a 6-cm longitudinal incision was made on the posterior aspect of the medial border of the tibia. (C) The tibialis posterior tendon was lengthened by 2 cm and repaired with interrupted 3-0 nylon sutures and the distal end of the tibialis posterior tendon was securely fixed using 2.7-mm suture anchors.


Cited by  1 articles

Results of Kidner Procedure Combined with Medial Displacement Calcaneal Osteotomy for the Symptomatic Accessory Navicular with Hindfoot Valgus
Chul Hyun Park
J Korean Foot Ankle Soc. 2020;24(2):75-80.    doi: 10.14193/jkfas.2020.24.2.75.


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