Revision Surgery for Recurrent Pain after Excision of the Accessory Navicular and Relocation of the Tibialis Posterior Tendon

BACKGROUND: The results of operative treatments for symptomatic accessory navicular are debatable. In some cases, recurrent pain may develop after the Kidner procedure. The purpose of this study is to review the reasons for recurrent pain after the Kidner procedure and to suggest possible options for revision surgery. METHODS: We reviewed the clinical and radiological outcomes in 9 patients who underwent revision surgery for recurrent pain after the Kidner procedure. During the revision surgery, the tibialis posterior tendon was reattached to the navicular either by advancing the tendon in 4 patients or by lengthening the tendon in another 4 patients. In the other 1 patient, the flexor digitorum longus tendon was transferred. Surgeries for the accompanying deformities were performed simultaneously in all patients. The results were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and a visual analog scale. The mean follow-up was 2.3 years (range, 1 to 5 years). RESULTS: The mean American Orthopedic Foot and Ankle Society ankle-hindfoot score improved from 71.25 to 81.50 in the advancement group, and 71.75 to 90.00 in the lengthening group. The mean visual analog scale improved from 7.75 to 4.25 in the advancement group and from 7.50 to 1.75 in the lengthening group. CONCLUSIONS: Recurrent pain after the Kidner procedure was associated with pes planovalgus or hindfoot valgus deformity. In revision surgery, correction of the associated deformities and reattachment of the tibialis posterior tendon after lengthening may need to be considered.

Extraarticular Subtalar Arthrodesis for Pes Planovalgus: An Interim Result of 50 Feet in Patients with Spastic Diplegia

BACKGROUND: There are no reports of the pressure changes across the foot after extraarticular subtalar arthrodesis for a planovalgus foot deformity in cerebral palsy. This paper reviews our results of extraarticular subtalar arthrodesis using a cannulated screw and cancellous bone graft. METHODS: Fifty planovalgus feet in 30 patients with spastic diplegia were included. The mean age at the time of surgery was 9 years, and the mean follow-up period was 3 years. The radiographic, gait, and dynamic foot pressure changes after surgery were investigated. RESULTS: All patients showed union and no recurrence of the deformity. Correction of the abduction of the forefoot, subluxation of the talonavicular joint, and the hindfoot valgus was confirmed radiographically. However, the calcaneal pitch was not improved significantly after surgery. Peak dorsiflexion of the ankle during the stance phase was increased after surgery, and the peak plantarflexion at push off was decreased. The peak ankle plantar flexion moment and power were also decreased. Postoperative elevation of the medial longitudinal arch was expressed as a decreased relative vertical impulse of the medial midfoot and an increased relative vertical impulse (RVI) of the lateral midfoot. However, the lower than normal RVI of the 1st and 2nd metatarsal head after surgery suggested uncorrected forefoot supination. The anteroposterior and lateral paths of the center of pressure were improved postoperatively. CONCLUSIONS: Our experience suggests that the index operation reliably corrects the hindfoot valgus in patients with spastic diplegia. Although the operation corrects the plantar flexion of the talus, it does not necessarily correct the plantarflexed calcaneus and forefoot supination. However, these findings are short-term and longer term observations will be needed.

The Results of Treatment of Planovalgus Deformity by Modified Grice-Green Procedure / 대한족부족관절학회지

PURPOSE: The author modified the technique of Grice-Green, for managing flexible flat foot, with severe hindfoot valgus and possible dorsiflexion more than 15 degrees. The purpose of this study was to evaluate the efficacy and results of this modified technique. MATERIAL AND METHODS: Total of 6 patients, 11 cases of pes planovalgus were operatively managed with Modified Grice-Green procedure from Nov. 1996 to April 2002. Total 11 cases in 6 patients were managed; 9 cases in 5 males, 2 cases in one female. The average age of the patients were 7.3 years (5.1-13.3 years). Average follow up period was 3.9 years (1.2-6.7 years). Patients were evaluated preoperatively and at last follow up radiologically and clinically. Radiologic evaluation were done by measuring the talocalcaneal and talo-1st metatarsal angles with the anteroposterior view; and by measuring the talo-1st metatarsal angles with the lateral view. The clinical outcome were rated by subjective and objective improvement level. RESULTS: On follow up, 9 cases were complete satisfied, 2 cases were satisfied with minor reservation and no case had major reservations or dissatisfaction. Objective results were rated as excellent in 9 cases, good in 2 cases. Average preoperative talo-calcaneal and talo-1st metatarsal angles on anteroposterior radiograms were 34.4 degrees (16-40 degrees) and 32 degrees (8-48 degrees) respectively; which postoperatively on last follow up were 20 degrees (3-37 degrees) and 15.6 degrees (3-34 degrees) respectively. Average Preoperative talo-1st metatarsal angle on lateral radiogram was 18.4 degrees (6-30 degrees); which postoperatively on last follow up was 6.7 degrees (-6-17 degrees). CONCLUSION: Modified Grice-Green operative procedure is effective and satisfactory procedure for planovalgus deformity in children. but for more accurate results, more patients and further follow up period are needed.