EXCISION OF ACCESSORY NAVICULAR WITH RECONSTRUCTION OF POSTERIOR TIBIAL TENDON INSERTION ON NAVICULAR FOR TREATMENT OF FLATFOOT RELATED WITH ACCESSORY NAVICULAR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAO Honghui , TANG Kanglai , DENG Yinshuan , TAN Xiaokang , ZHOU Binghua , TAO Xu , CHEN Lei , CHEN Qianbo.

Department of Orthopaedics, the Orthopaedic Surgery Center of Chinese PLA, Southwest Hospital, the Third Military Medical University, Chongqing, 400038, P.R.China.;

Corresponding author：

Keywords：

Flatfoot related with accessory navicular; Foot deformity; Posterior tibial tendon insertion reconstruction

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Objective To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Methods Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 ± 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. Results All patients got primary wound heal ing without any compl ication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain rel ief at 6 months after surgery and had
good appearance of the feet. The AOFAS ankle-midfoot score was 90.4 ± 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus incl ination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P lt; 0.01). Conclusion The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.

Citation： CAO Honghui,TANG Kanglai,DENG Yinshuan,TAN Xiaokang,ZHOU Binghua,TAO Xu,CHEN Lei,CHEN Qianbo.. EXCISION OF ACCESSORY NAVICULAR WITH RECONSTRUCTION OF POSTERIOR TIBIAL TENDON INSERTION ON NAVICULAR FOR TREATMENT OF FLATFOOT RELATED WITH ACCESSORY NAVICULAR. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(6): 686-690. doi: Copy

1.	王正义, 唐康来. 重视成年人平足症的诊断与治疗. 中华医学杂志, 2010, 90(33): 2305-2307.
2.	Kiter E, Günal I, Karatosun V, et al. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat, 2000, 182(1): 65-68.
3.	Kiter E, Erdag N, Karatosun V, et al. Tibialis posterior tendon abnormalities in feet with accessory navicular bone and flatfoot. Acta Orthop Scand, 1999, 70(6): 618-621.
4.	Bernaerts A, Vanhoenacker FM, Van de Perre S, et al. Accessory navicular bone: not such a normal variant. JBR-BTR, 2004, 87(5): 250-252.
5.	Sullivan JA, Miller WA. The relationship of the accessory navicular to the development of the flat foot. Clin Orthop Relat Res, 1979, (144): 233-237.
6.	Kanatli U, Yetkin H, Yalcin N. The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system. Foot Ankle Int, 2003, 24(6): 486-489.
7.	唐康来, 周建波, 杨会峰, 等. 三关节截骨矫形融合治疗ⅡB和Ⅲ期成年人获得性平足症. 中华医学杂志, 2010, 90(33): 2313-2316.
8.	Macnicol MF, Voutsinas S. Surgical treatment of the symptomatic accessory navicular. J Bone Joint Surg (Br), 1984, 66(2): 218-226.
9.	Bennett GL, Weiner DS, Leighley B. Surgical treatment of symptomatic accessory tarsal navicular. Pediatr Orthop, 1990, 10(4): 445-449.
10.	Kopp FJ, Marcus RE. Clinical outcome of surgical treatment of the symptomatic accessory navicular. Foot Ankle Int, 2004, 25(1): 27-30.
11.	Senses I, Kiter E, Gunal I. Restoring the continuity of the tibialis posterior tendon in the treatment of symptomatic accessory navicular with flat feet. J Orthop Sci, 2004, 9(4): 408-409.
12.	Swords MP, Shank JR, Hansen ST Jr, et al. Fusion of the primary and accessory navicular bones: a modification of the kidner procedure. Operative Techniques in Orthopaedics, 2004, 14 (1): 31-35.
13.	Scott AT, Sabesan VJ, Saluta JR, et al. Fusion versus excision of the symptomatic Type II accessory navicular: a prospective study. Foot Ankle Int, 2009, 30(1): 10-15.
14.	Dawson DM, Julsrud ME, Erdmann BB, et al. Modified Kidner procedure utilizing a Mitek bone anchor. J Foot Ankle Surg, 1998, 37(2): 115-121.
15.	Kiter E, Günal I, Turgut A, et al. Evaluation of simple excision in the treatment of symptomatic accessory navicular associated with flat feet. J Orthop Sci, 2000, 5(4): 333-335.
16.	Jasiewicz B, Potaczek T, Kacki W, et al. Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones. Foot Ankle Surg, 2008, 14(2): 57-61.
17.	Shurnas PS, Sanders A. A novel approach to the symptomatic accessory navicular. Techniques in Foot and Ankle Surgery, 2007, 6(3): 195-200.
18.	Knupp M, Hintermann B. Reconstruction in posttraumatic combined avulsion of an accessory navicular and the posterior tibial tendon. Techniques in Foot and Ankle Surgery, 2005, 4(2): 113-118.

1. 王正义, 唐康来. 重视成年人平足症的诊断与治疗. 中华医学杂志, 2010, 90(33): 2305-2307.
2. Kiter E, Günal I, Karatosun V, et al. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat, 2000, 182(1): 65-68.
3. Kiter E, Erdag N, Karatosun V, et al. Tibialis posterior tendon abnormalities in feet with accessory navicular bone and flatfoot. Acta Orthop Scand, 1999, 70(6): 618-621.
4. Bernaerts A, Vanhoenacker FM, Van de Perre S, et al. Accessory navicular bone: not such a normal variant. JBR-BTR, 2004, 87(5): 250-252.
5. Sullivan JA, Miller WA. The relationship of the accessory navicular to the development of the flat foot. Clin Orthop Relat Res, 1979, (144): 233-237.
6. Kanatli U, Yetkin H, Yalcin N. The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system. Foot Ankle Int, 2003, 24(6): 486-489.
7. 唐康来, 周建波, 杨会峰, 等. 三关节截骨矫形融合治疗ⅡB和Ⅲ期成年人获得性平足症. 中华医学杂志, 2010, 90(33): 2313-2316.
8. Macnicol MF, Voutsinas S. Surgical treatment of the symptomatic accessory navicular. J Bone Joint Surg (Br), 1984, 66(2): 218-226.
9. Bennett GL, Weiner DS, Leighley B. Surgical treatment of symptomatic accessory tarsal navicular. Pediatr Orthop, 1990, 10(4): 445-449.
10. Kopp FJ, Marcus RE. Clinical outcome of surgical treatment of the symptomatic accessory navicular. Foot Ankle Int, 2004, 25(1): 27-30.
11. Senses I, Kiter E, Gunal I. Restoring the continuity of the tibialis posterior tendon in the treatment of symptomatic accessory navicular with flat feet. J Orthop Sci, 2004, 9(4): 408-409.
12. Swords MP, Shank JR, Hansen ST Jr, et al. Fusion of the primary and accessory navicular bones: a modification of the kidner procedure. Operative Techniques in Orthopaedics, 2004, 14 (1): 31-35.
13. Scott AT, Sabesan VJ, Saluta JR, et al. Fusion versus excision of the symptomatic Type II accessory navicular: a prospective study. Foot Ankle Int, 2009, 30(1): 10-15.
14. Dawson DM, Julsrud ME, Erdmann BB, et al. Modified Kidner procedure utilizing a Mitek bone anchor. J Foot Ankle Surg, 1998, 37(2): 115-121.
15. Kiter E, Günal I, Turgut A, et al. Evaluation of simple excision in the treatment of symptomatic accessory navicular associated with flat feet. J Orthop Sci, 2000, 5(4): 333-335.
16. Jasiewicz B, Potaczek T, Kacki W, et al. Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones. Foot Ankle Surg, 2008, 14(2): 57-61.
17. Shurnas PS, Sanders A. A novel approach to the symptomatic accessory navicular. Techniques in Foot and Ankle Surgery, 2007, 6(3): 195-200.
18. Knupp M, Hintermann B. Reconstruction in posttraumatic combined avulsion of an accessory navicular and the posterior tibial tendon. Techniques in Foot and Ankle Surgery, 2005, 4(2): 113-118.

Chinese Journal of Reparative and Reconstructive Surgery

EXCISION OF ACCESSORY NAVICULAR WITH RECONSTRUCTION OF POSTERIOR TIBIAL TENDON INSERTION ON NAVICULAR FOR TREATMENT OF FLATFOOT RELATED WITH ACCESSORY NAVICULAR

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