• Journal of Korean Foot and Ankle Society
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• v.20 no.2
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• pp.73-77
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• 2016

Purpose: The purpose of this study was to evaluate the clinical outcome of a modified Kidner procedure using a suture bridge technique in symptomatic type II accessory navicular. Materials and Methods: Between January 2013 and December 2014, a total of 35 cases with symptomatic type II accessory navicular were treated with a modified Kidner procedure using the suture bridge technique. The patients were evaluated preoperatively, 3 months after surgery, and at the latest follow-up (at least six months postoperatively) clinically via the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS), and the self-subjective satisfaction score. Results: The mean AOFAS midfoot score demonstrated significant improvement from a mean of 45.3 preoperatively to a mean of 89.2 at 3 months after surgery. At the latest follow-up, the mean AOFAS midfoot score was 92.6 (p<0.001). The mean VAS also improved significantly, decreasing from 6.7 out of 10 preoperatively to 1.8 at 3 months after surgery. At the latest follow-up, the VAS was 1.2 (p<0.001). The mean time of a single-limb heel raise was 4.6 months postoperatively and the self-subjective satisfaction score was 1.4 out of 4 at the latest follow-up. Conclusion: The short-term surgical results of the modified Kidner procedure with a suture bridge technique for symptomatic type II accessory navicular were good to excellent in terms of pain, functional and clinical assessments. In conclusion, the modified Kidner procedure with the suture bridge technique is a reasonable treatment option for symptomatic type II accessory navicular.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.2
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• pp.82-86
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• 2012

Purpose: The purpose of this study was retrospectively to evaluate the results of the modified Kidner procedure for symptomatic accessory navicular in athletes. Materials and Methods: Between July 1999 and December 2004, 26 feet in 22 patients with symptomatic accessory navicular who had underwent modified Kidner procedure were available for clinical follow-up, and 12 cases in 9 patients were available for clinical and radiological follow-up with a minimum follow-up of 5 years were included in this study. All those patients had symptomatic accessory navicular bone who underwent modified Kidner procedure. American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, Visual Analogue Scale (VAS), and satisfaction rate were investigated. Talo-first metatarsal (T-MT1) angle, talo-calcaneal (TC) angle, and calcaneal pitch (CP) angle were measured in standing lateral radiograms. Results: AOFAS score was improved from $40.8{\pm}7.5$ (32~57) preoperatively to $88.7{\pm}8.0$ (72~100) postoperatively, and the difference was significant (p<0.01). VAS was improved from $7.0{\pm}0.9$ (5~9) preoperatively to $1.8{\pm}0.8$ (1~4) postoperatively, and the difference was significant (p<0.01). At the lastest follow up, 11 feet were very satisfied, 11 feet satisfied, and 4 feet unsatisfied (a satisfaction rate 85.0%). No significant difference was observed for T-MT1 angle (p=0.67), TC angle (p=0.93), and CP angle (p=0.49). Conclusion: Modified Kidner procedure for the symptomatic accessory navicular showed satisfactory results and is appeared to be one of the useful treatments.

• Journal of Korean Foot and Ankle Society
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• v.16 no.3
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• pp.162-168
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• 2012

Accessory navicular is a congenital anomaly of the tuberosity of the navicular from a secondary ossification center. The accessory navicular is occasionally the source of pain and local tenderness over the medial side of midfoot. If conservative treatment fails for the painful accessory navicular, surgical treatment is required. There are several surgical option for accessory navicular, which vary from simple excision, percutaneous drilling, modified Kidner procedure and osteosynthesis of the accessory ossicle to the navicular body. In addition, symptomatic flatfoot deformity should be addressed concomitantly.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.36-40
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• 2010

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.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.212-216
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• 2011

Purpose: This study was designed to analyze the usefulness of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in diagnosing symptomatic accessory tarsal bones. Materials and Methods: Twenty four feet (16 patients) with symptomatic accessory navicular and/or os trigonum, who agreed to take SPECT/CT, were included in this study. Fifteen feet had accessory navicular, five had os trigonum, and four had both. According to the uptake in the SPECT/CT, 11 feet were classified into high and 13 into low uptake groups. The low uptake group was treated non-operatively, while the high uptake group received operations when initial conservative management failed. A modified Kidner procedure was performed for accessory navicular and arthroscopic excision was done for os trigonum. After a mean follow-up of 6.8 (range, 3~13) months, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Scale (VAS) for pain were compared. Results: Patients in the high uptake group had a higher initial mean VAS score ($7.0{\pm}0.8$ vs $2.2{\pm}0.9$, p<0.05) and a lower initial mean AOFAS score ($45.9{\pm}9.2$ vs $83.9{\pm}4.2$, p<0.05) compared to the low uptake group. All patients in the low uptake group improved after non-operative treatment. Seven patients underwent operations and had a decreased VAS ($1.6{\pm}0.5$) and an increased AOFAS score ($88.3{\pm}1.8$) at the last follow-up. Four patients in the high uptake group demonstrated erratic symptoms. Conclusion: SPECT/CT can be a useful diagnostic tool and helpful in designing treatment plans for symptomatic accessory navicular and os trigonum.