RESUMEN
BACKGROUND: HyProCure subtalar stabilization has been widely used in the treatment of flexible flatfoot, but there is no unified treatment for adolescent flexible flatfoot with painful accessory navicular bone. OBJECTIVE: To evaluate the effectiveness of HyProCure subtalar stabilization for adolescent flexible flatfoot combined with painful accessory navicular bone. METHODS: Between January 2015 and September 2019, 24 cases (39 feet) of adolescent flexible flatfoot combined with painful accessory navicular bone were treated with HyProCure subtalar stabilization in National Rehabilitation Hospital. There were 13 males (22 feet) and 11 females (17 feet) with the age of 5-15 years. Visual analogue scale score and American Orthopaedic Foot & Ankle Society (AOFAS) ankle and foot function score were used to evaluate the effectiveness. The talus-the first metatarsal angle (Meary’s angle), the talus-the second metatarsal angle, calcaneal inclination angle (Pitch angle), the talar declination angle, calcaneal valgus angle, talonavicular coverage angle, and talocalcaneal angle were measured on the X-ray films. This study was approved by the Ethics Committee of National Rehabilitation Hospital. RESULTS AND CONCLUSION: (1) All incisions of 24 patients healed well in the first stage. Two cases (2 feet) had tarsal sinus pain; one case (1 foot) appeared with mild hindfoot varus and insufficient weight-bearing under the 1st metatarsal head, also one case (1 foot) complained mild painful remain at local site. (2) All 24 patients were followed up for 6-36 months. No case suffered from hardware failure or hardware removal. (3) At last follow-up, visual analogue scale score was significantly decreased compared with that before surgery (P < 0.01); AOFAS ankle and foot function score was significantly increased compared with that before surgery (P < 0.01). (4) At last follow-up, Meary’s angle, the talus-the second metatarsal angle, Pitch angle, the talar declination angle, calcaneal valgus angle, talonavicular coverage angle, and talocalcaneal angle in 24 patients were significantly improved compared with that before surgery (P < 0.01 or P < 0.05). (5) The results suggested that HyProCure subtalar stabilization is effective for adolescent flexible flatfoot combined with painful accessory navicular bone in short term.
RESUMEN
Objective: To explore the effectiveness of modified internal fixation and fusion in treatment of type Ⅱ painful accessory navicular (PAN) in adults. Methods: Between January 2016 and December 2017, 29 patients (37 feet) with type Ⅱ PAN were treated with modified internal fixation and fusion. There were 12 males and 17 females with an average age of 41.4 years (range, 18-50 years). The injury caused by sprain in 24 cases and no obvious inducement occurred in 5 cases. All patients received conservative treatment for more than 6 months with no significant improvement. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score before operation and at last follow-up. The inclination angle of calcaneus, the first metatarsal angle of talus, the inclusion angle of talonavicular joint, and the second metatarsal angle of talus were measured on X-ray films. Results: Superficial infection of incision occurred in 1 case after operation, and the incision healed after enhanced dressing change. The incisons of the other patients healed by first intention. There was no deep infection or osteomyelitis. All patients were followed up 12-33 months (mean, 25.1 months). X-ray films showed that the articular surfaces healed at 2-5 months after operation, with an average of 3.4 months. No loosening or rupture of internal fixator was found during the follow-up. At last follow-up, the pain, function, alignment scores, and total score of AOFAS were significantly improved when compared with those before operation (P<0.05). The inclusion angle of talonavicular joint, the first metatarsal angle of talus, and the second metatarsal angle of talus were also significantly improved when compared with those before operation (P<0.05). But there was no significant difference in the inclination angle of calcaneus between pre- and post-operation (t=1.097, P=0.276). Conclusion: Modified internal fixation and fusion in treatment of type Ⅱ PAN can effectively relieve the symptoms and obtain good recovery of feet function with less complications.