Concomitant calcaneo-cuboid-cuneiform osteotomies and the modified Kidner procedure for severe flatfoot associated with symptomatic accessory navicular in children and adolescents.

Jung Ryul Kim,Keun Sang Kwon,Sung Il Wang,Young Jae Moon,Chan Il Park

doi:10.1186/s13018-014-0131-2

Jung Ryul Kim, Keun Sang Kwon + Show 3 more

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https://doi.org/10.1186/s13018-014-0131-2

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BackgroundAccessory navicular can become symptomatic in childhood, and in some cases, the condition is associated with progressive flattening of the longitudinal arch. Moreover, some severe, rigid flatfoot deformities are associated with an accessory navicular. We investigated the results of concomitant calcaneo-cuboid-cuneiform osteotomies (triple C) and the modified Kidner procedure for severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.MethodsTwenty-one feet of 13 patients (nine boys, four girls; mean age 12.7 years) with severe flatfoot associated with a symptomatic accessory navicular who were treated with concomitant triple C and the modified Kidner procedure were evaluated based on clinical and radiographic examinations preoperatively and at a mean follow-up of 22.4 months (range, 12–36 months). We measured 12 variables on the anteroposterior (AP) and lateral weight-bearing radiographs, and we used the American College of Foot and Ankle Surgeons (ACFAS) score for clinical assessment.ResultsWe found significant improvements (p < 0.001) in eight of the 12 radiographic measurements: the AP talo-first metatarsal (MTT) angle, AP talo-navicular coverage angle, AP talo-calcaneal angle, lateral talo-first MTT angle, calcaneal pitch, lateral talo-calcaneal angle, lateral talo-horizontal angle, and naviculo-cuboid overlap. Average ACFAS scores were significantly improved at the time of the last follow-up (p < 0.001). The only complication was overcorrection of the hindfoot in one patient.ConclusionsConcomitant triple C and the modified Kidner procedure result in favorable radiographic and clinical outcomes in the treatment of severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.

Highlights

Accessory navicular can become symptomatic in childhood, and in some cases, the condition is associated with progressive flattening of the longitudinal arch
Many investigators have suggested that joint-sparing procedures, such as lateral column lengthening (LCL) and calcaneo-cuboid-cuneiform osteotomies, should be the treatment of choice for the correction of flatfoot deformities in children [9,10,11]
The presence of an accessory navicular was confirmed on plain radiographs, and the diagnosis of flatfoot deformity was based on a poor formation of the arch and a valgus position of the heel during weight bearing

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Introduction

Accessory navicular can become symptomatic in childhood, and in some cases, the condition is associated with progressive flattening of the longitudinal arch. We investigated the results of concomitant calcaneo-cuboid-cuneiform osteotomies (triple C) and the modified Kidner procedure for severe flatfoot associated with a symptomatic accessory navicular in children and adolescents. Current operative treatments include simple excision of the accessory bone from within the TPT and the modified Kidner procedure, which involves excision with takedown and reattachment of the TPT (with or without advancement) [5,6,7]. These techniques give good results for symptomatic accessory navicular. Kim et al found that the triple C is a more effective procedure than LCL for the correction of severe pediatric flatfoot deformity [12]

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