Midterm Outcome of Modified Kidner Procedure
ABSTRACT The results of modified Kidner procedures have generally been satisfactory at short-term followup. The objective of this study was to evaluate the midterm followup results including medial longitudinal arch height.
Forty-one patients (50 feet) with a symptomatic accessory navicular who underwent the modified Kidner procedure between July 1999 and February 2004 were evaluated. A midfoot AOFAS score, VAS score, and satisfaction rate were recorded. The talo-first metatarsal (T-MT1), talo-calcaneal (TC), and calcaneal pitch (CP) angles were measured on plain radiographs. Average clinical and radiological followup periods were 88.4 ±17.0 months and 85.7 ±15.0 months, respectively.
The mean preoperative and followup AOFAS scores were 40.8 ±7.1 (range, 32 to 57), and 88.4 ±7.9 (range, 72 to 100), respectively (p < 0.01). The mean preoperative and followup VAS scores were 7.1 ±1.0 (range, 4 to 9) and 1.8 ±1.0 (range, 0 to 5), respectively (p < 0.01). At last followup , the satisfaction rate was 82.0%. There were no significant differences between preoperative and followup T-MT1 (p = 1.00), TC (p = 0.84), and CP (p = 0.08) angles. Increased medial longitudinal arch was found in four of 16 feet in patients 15 years of age or younger with followup radiographs.
We found the modified Kidner procedure could result in symptomatic relief and high satisfaction rate without a loss of arch height in any patient.
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ABSTRACT: Background: Recently, many studies have argued against the Kidner procedure and its several modifications, with the accessory navicular considered an irritant rather than a hindrance to foot function, and simple excision has been advocated. We designed this prospective, comparative study of simple excision and the Kidner procedure in children and adolescents with flatfoot and evaluated functional and radiographic outcomes. Methods: From February 2004 to March 2009, we followed 50 consecutive feet of symptomatic type 2 accessory navicular. Simple excision and the Kidner procedure were performed in 25 feet each, respectively. The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, the visual analogue scale (VAS), and the talo-first metatarsal, talocalcaneal, and calcaneal pitch angles were evaluated preoperatively and postoperatively for a minimum of 3 years. Patient satisfaction was assessed. Results: The preoperative AOFAS midfoot scale and VAS of each group were improved at final follow-up. The talo-first metatarsal and talocalcaneal angles were not significantly different pre- and postoperatively. However, the calcaneal pitch angle of both groups was improved at the final follow-up. At the final follow-up, we observed no significant differences between the 2 groups in the AOFAS midfoot scale, the VAS, and the talo-first metatarsal, talocalcaneal, and calcaneal pitch angles. The satisfaction frequencies were 86% and 82% in groups 1 and 2, respectively. Conclusions: We found that in children and adolescents with accessory navicular and flatfoot, simple excision and the Kidner procedure both gave satisfactory results and both minimally restored the medial longitudinal arch similarly. Level of Evidence: Level II, prospective therapeutic study.Foot & Ankle International 02/2013; 34(2):167-72. DOI:10.1177/1071100712467616 · 1.63 Impact Factor
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ABSTRACT: Background Accessory navicular can become symptomatic in childhood, and in some cases, the condition is associated with progressive flattening of the longitudinal arch. Moreover, some severe, rigid flatfoot deformities are associated with an accessory navicular. We investigated the results of concomitant calcaneo-cuboid-cuneiform osteotomies (triple C) and the modified Kidner procedure for severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.Methods Twenty-one feet of 13 patients (nine boys, four girls; mean age 12.7 years) with severe flatfoot associated with a symptomatic accessory navicular who were treated with concomitant triple C and the modified Kidner procedure were evaluated based on clinical and radiographic examinations preoperatively and at a mean follow-up of 22.4 months (range, 12¿36 months). We measured 12 variables on the anteroposterior (AP) and lateral weight-bearing radiographs, and we used the American College of Foot and Ankle Surgeons (ACFAS) score for clinical assessment.ResultsWe found significant improvements (p¿<¿0.001) in eight of the 12 radiographic measurements: the AP talo-first metatarsal (MTT) angle, AP talo-navicular coverage angle, AP talo-calcaneal angle, lateral talo-first MTT angle, calcaneal pitch, lateral talo-calcaneal angle, lateral talo-horizontal angle, and naviculo-cuboid overlap. Average ACFAS scores were significantly improved at the time of the last follow-up (p¿<¿0.001). The only complication was overcorrection of the hindfoot in one patient.Conclusions Concomitant triple C and the modified Kidner procedure result in favorable radiographic and clinical outcomes in the treatment of severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.Journal of Orthopaedic Surgery and Research 12/2014; 9(1):131. DOI:10.1186/s13018-014-0131-2 · 1.58 Impact Factor