Comparison of the effectiveness of two kinds of surgeries for treatment of flexible flatfoot combined with painful accessory navicular bone in children / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children.@*METHODS@#The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation.@*RESULTS@#Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05).@*CONCLUSION@#Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.

Simple HyProCure subtalar stabilization in treatment of adolescent flexible flatfoot combined with painful accessory navicular bone / 中国组织工程研究

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.

Evaluation of Accessory Navicular Bone Using a Bone Scan and Its Clinical Significance for the Prognosis and Treatment / 대한족부족관절학회지

PURPOSE: To evaluate the clinical significance and usefulness of a bone scan in accessory navicular bone. MATERIALS AND METHODS: Eighty-five patients with foot pain and accessory navicular bone on radiography, who underwent bone scan from 2012 to 2015, were analyzed retrospectively. The subjects was divided into a symptomatic and asymptomatic group according to the presence of navicular bone tenderness. The grade of bone scan uptake was divided into 3 grades. Age, gender, grade of bone scan and size of the accessory navicular bone were analyzed. The symptomatic group were divided into a low (grade 0, 1) and high uptake (grade 2) group to determine the appropriate treatment. The low uptake group was treated conservatively for 3 months. The high uptake group was initially treated conservatively for 3 months and surgery was performed if pain persisted. For the clinical evaluation, the visual analogue scale, American Orthopaedic Foot and Ankle Society midfoot scale were evaluated in the first examination and last follow-up date. The patient's satisfaction grade was also evaluated at the last follow-up. RESULTS: The asymptomatic group mostly showed no uptake in the bone scan. On the other hand, some patients in the asymptomatic group showed an increase in uptake. In these patients, the size of accessory navicular bone was related to the grade of bone scan uptake, showing that the bone scan uptake grade can be predicted when applying different cut off values for the bone size. The symptomatic group mostly showed uptake in the bone scan and the grade of uptake had a positive correlation with the size of the accessory navicular bone (p<0.05). Age and gender were not related to the bone scan uptake. In the clinical evaluation, conservative and surgical treatment showed a good outcome. CONCLUSION: The bone scan uptake grade alone cannot be used to completely predict the symptoms. On the other hand, the size of the accessory bone can increase the bone scan uptake. Therefore, the size of the accessory bone, and patient symptoms should be considered in patients with a high uptake when deciding treatment.

Hipodoncia y hueso navicular accesorio: una interesante asociación sindrómica / Hypodontia and accessory navicular bone: an interesting syndromic association

Los dientes se desarrollan a partir de múltiples interacciones recíprocas entre células del epitelio oral y el ectomesénquima. Una serie de genes participan en el desarrollo del diente, así como de otros órganos y miembros superiores e inferiores. PAX9, miembro de la familia de factores de transcripción, es uno de los principales responsables de este desarrollo, y juega un rol fundamental en la hipodoncia dental y malformaciones en los huesos del miembro inferior. El objetivo de este reporte es presentar un caso de asociación entre hipodoncia y el hueso navicular accesorio. Se trata de una paciente de 18 años de edad, que acude a la consulta dental por dolor agudo en la pieza dentaria 3.6 y dolor de 9 meses de evolución en la cara interna del pie izquierdo. Al examen radiográfico, se observó ausencia de las piezas dentarias 1.7, 2.7, 2.8, 3.8 y 4.8, además en el pie izquierdo se vio la presencia de un hueso navicular accesorio. Es interesante proponer esta rara asociación, de clara herencia autosómica dominante, dado que la agenesia dental y la presencia del hueso navicular accesorio, poseen una prevalencia semejante, lo que hace que pueda existir una nueva asociación sindrómica probablemente relacionada con la ausencia de PAX9(AU)

Teeth are developed from many interactions between oral epithelium and mesenchymal cells. A number of genes are involved in tooth development, as well as in other organs, and upper and lower limbs. PAX9, a member of the transcriptional factor family, is one of the main drivers of this development, playing a key role in dental hypodontia and malformations in the lower limb bones. The aim of this report was to present the association between hypodontia and the accessory navicular bone based on a case report. This is a 18 years old female patient, who attended a dental clinic because she had acute pain in the 3.6 tooth and also pain on the left foot's inner area. The radiographic examination showed loss of the teeth 1.7, 2.7, 2.8, 3.8 and 4.8; and the presence of an accessory navicular bone in the left foot. It is interesting to suggest that this rare association, with clear dominant autosomal inheritance, might exist; since the dental agenesis and the presence of accessory navicular bone have similar prevalence, which could point to a new syndromic association probably related to the lack of PAX9(AU)

Accessory Navicular in Sports Players / 대한족부족관절학회지

PURPOSE: To analyze clinical symptom and clinical course of accessory navicular bone and to evaluation of surgery of accessory navicular bone in sports players MATERIALS AND METHODS: Twenty-two patients with accessory navicular bone were identified between January 1 2001 and June 30. 2003 RESULTS: Subjective satisfaction of 23 patients rated very satisfaction (16), satisfaction (6), common (1). Symptomatic pain were thoroughly disappeared at average 2.5 months (1~6 months) after operation. On one year follow-up, most of patients could maintain daily life and could go back to their sports carreer at 3 months. CONCLUSION: In athlete, excision of accessory navicular and reattachment of posteior tibial tendon to navicular like non-athletes is the best solution to management of symptomatic accessory navicular failed to manage conservatively