Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Surgical Treatment of Symptomatic Accessory Navicular in Adolescent

증상이 있는 청소년기 부주상골의 수술적 치료

  • Kim, Jong-Min (Department of Orthopaedic Surgery, Gwangmyeong Sung-Ae Hospital) ;
  • Jung, Sung-Hoon (Department of Orthopaedic Surgery, Gwangmyeong Sung-Ae Hospital) ;
  • Park, Byeong-Mun (Department of Orthopaedic Surgery, Gwangmyeong Sung-Ae Hospital) ;
  • Moon, Chan-Sam (Department of Orthopaedic Surgery, Sung-Ae Hospital) ;
  • Lee, Kil-Hyeong (Department of Orthopaedic Surgery, Gwangmyeong Sung-Ae Hospital)
  • Received : 2010.04.19
  • Accepted : 2010.05.13
  • Published : 2010.06.15
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Abstract

Purpose: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. Materials and Methods: 11 patients who were 11-16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. Results: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about $4.64^{\circ}$ and $5.79^{\circ}$ in average. Conclusion: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.

Keywords

References

  1. Shands Jr AR, Wentz IJ. Congenital anomalies, accessory bones and osteochondritis in the feet of 850 children. Surg Clin North Am.1953;33:16-43.
  2. Ray S, Goldbetg VM. Surgical treatment of the accessory navicular. Clin Orthop. 1983;177:61-6.
  3. Sella E, Lawson J. Biomechanics of the accessory navicular synchondrosis. Foot Ankle. 1987;8:156-63. https://doi.org/10.1177/107110078700800310
  4. Chen YJ, Shih HN, Huang TJ, Hsu RW. Posterior tibial tendon tear combined with a fracture of the accessory navicular: A new subclassification? J Tranma. 1995;39:993-6.
  5. Chen YJ, Hsu RW, Liang SC. Degeneration of the accessory navicular synchondrosis presenting as rupture of the posterior tibial tendon. J Bone joint Surg. 1997;79:1791-78.
  6. Leonard MH, Gonzalez S, Breck LW, Basom C, Palafox M, Kosicki W. Lateral transfer of the posterior tibial tendon in certain selected cases of pes plano valgus (kidner operation). Clin Orthop. 1965;40:139-44.
  7. Prichasuk S, Sinphurmsukskul O. Kidner procedure for symptomatic accessory navicular and it s relation to pes planus. Foot Ankle Int. 1995;16:500-3. https://doi.org/10.1177/107110079501600807
  8. Grogan DP, Gasser SI, Ogden JA. The painful accessory navicular: a clinical and histopathological study. Foot Ankle. 1989;10:164-9. https://doi.org/10.1177/107110078901000310
  9. Sullivan JA, Miller WA. The relationship of the accessory navicular to the development of the flat foot. Clin Orthop. 1979;144:233-7.
  10. Barbara J, Tomasz P, Wojciech K, Maciej T, Ewa LYW. Result of simple excision technique in the surgical treatment of symptomatic accessory navicular bones. Foot and Ankle Surg. 2008;14:57-61. https://doi.org/10.1016/j.fas.2007.12.002
  11. Lee WC, Nam KH, Pruk HS, Rha JD, Lee C, Ko KH. The symptomatic accessory navicucular in adult. J Korean Foot Ankle Soc. 2001;5:62-8.
  12. Lee KT, Young KW, Kim JY, Kim ES, CHa SD, Son SW. Accessory navicular in sports players. J Korean Foot Ankle Soc. 2004;8:161-5.
  13. Pruk JH, Choi SJ, HA JM. The treatment of failed kidner procedure for adolescent prehallux: A case report. J Korean Foot Ankle Soc. 2007;11:244-7.
  14. Pruk YW, Yoo JH, Pruk HJ, Cho YB, Yu SO, Lee HJ. Comparison of radiographic results from simple bone excision and bone excision with advancement of posterior tibial tendon for painful prehallux. J Korean Foot Ankle Soc. 2002;6:40-5.
  15. Sung IH, Kim YS. Adult acquired flat foot, associated with old synchondral diastasis of accessory navicular. J Korean Soc Foot Surg. 2002;6:256-60.
  16. Macnicol MF, Voutsinas S. Surgical treatment of the symptomatic accessory navicular. J bone joint Surg. 1984; 66-B:218-26.