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 hadgood 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.
Objective To review the appl ication progress of subtalar arthroereisis for the correction of pediatric flatfoot in children and to analyze the problems at present as well as to predict the trend of development in the field. Methods Domestic and abroad l iterature concerning the methods of subtalar arthroereisis applied in pediatric flatfoot in recent years was reviewed extensively and thoroughly analyzed. Results Subtalar arthroereisis has proved to yield good results for correction of the flatfoot in children. In addition to the advantages of subtalar arthroereisis for pediatric flatfoot treatment(simple procedure, mature technology, and less compl ications), it allows further surgery if needed. Conclusion Subtalararthroereisis is a simple and effective way to treat flatfoot in children, however, its biomechanics mechanism and managements to complication need to explore further.
ObjectiveTo investigate the effectiveness of double arthrodesis to correct flatfoot deformity with pes valgus. MethodsBetween May 2009 and May 2012, 12 patients with flatfoot deformity and pes valgus were treated using subtalar and talonavicular joints arthrodesis through a single medial incision approach. There were 5 males and 7 females with an average age of 53.3 years (range, 21-78 years), including 5 left feet and 7 right feet. Of them, 11 cases had posterior tibial tendon dysfunctions; 6 cases were at Johnson-Strom stageⅢ, 5 cases at stageⅡ(c); and 1 case had tarsal coal ition. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 48.75±3.46 and 6.08±1.14, respectively. ResultsThe mean operation time was 85.6 minutes (range, 65-125 minutes). Eleven patients were followed up for 19.4 months on average (range, 13-30 months). All of the cases obtained primary healing of incision, with no complication of infection and nerve or blood vessel injury. X-ray film showed that the mean time of bone union was 9.8 weeks (range, 7-18 weeks); no bone nonunion occurred. No loosening or breakage of internal fixation was observed. Pain occurred at the calcaneal-cuboid joint (1 case) and at fixation site (1 case), and was relieved after symptomatic treatment. The mean AOFAS score and VAS score were significantly increased to 81.36±2.98 and 0.72±0.11 respectively, showing significant differences when compared with preoperative scores (t=19.946, P=0.000; t=16.288, P=0.000). ConclusionSubtalar and talonavicular joints arthrodesis by a single medial incision approach is a useful alternative to tri ple arthrodesis for the correction of flatfoot deformity with pes valgus