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Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular.
Foot Ankle Int. 2020 Aug 07 [Online ahead of print]FA

Abstract

BACKGROUND

The Kidner procedure is performed to treat painful accessory navicular syndrome, with varying results. Recurrent pain remains a complication, and to date, there is a paucity of literature regarding the causes of recurrent pain and surgical outcomes of revision.

METHODS

Twenty-one patients who underwent revision surgery for recurrent pain after the Kidner procedure were identified. All patients had their tendon inspected and treated, and all had a medial displacement calcaneal osteotomy. Revision was indicated after 6 months of failed conservative therapy. Pre- and postrevision radiographic measurements included lateral talo-first metatarsal angle (Meary's angle), talonavicular coverage angle, calcaneal pitch, and hindfoot moment arm (HMA). Meary's angle >4 degrees was considered a planus deformity and HMA >9.1 mm was considered a hindfoot valgus deformity; patients fulfilling both criteria were categorized as having planovalgus deformity. Measurements in the contralateral foot were performed to determine whether alignment of the involved side was attributed to failed treatment or a preexisting deformity. Visual analog scale and Foot and Ankle Outcome Scores were compared and average follow-up was 20.1 months (range, 14-26).

RESULTS

Preoperatively, 20 of 21 (95%) patients had a form of valgus heel alignment (planovalgus, n = 11; hindfoot valgus only, n = 9), and 1 had an isolated planus deformity. The contralateral side revealed similar deformity, with 17 of 21 (81%) patients having a form of valgus heel alignment (planovalgus, n = 13; hindfoot valgus only, n = 4) and 4 patients with an isolated planus deformity. All patients underwent realignment surgery with medial displacement calcaneal osteotomy. All radiographic parameters except Meary's angle (P = .885) significantly improved postoperatively along with significantly improved clinical outcomes.

CONCLUSION

Recurrent pain following the Kidner procedure was associated with valgus heel alignment. Revision surgery including realignment procedure alleviated pain and improved functional outcomes with minimal complications. Therefore, we recommend assessing heel alignment in patients presenting with recurrent pain following the Kidner procedure.

LEVEL OF EVIDENCE

Level IV, case series.

Authors+Show Affiliations

Hospital for Special Surgery, New York, NY, USA.Hospital for Special Surgery, New York, NY, USA.Hospital for Special Surgery, New York, NY, USA. Medical University of Vienna, Vienna, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32762355

Citation

Kim, Jaeyoung, et al. "Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular." Foot & Ankle International, 2020, p. 1071100720943843.
Kim J, Day J, Seilern Und Aspang J. Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular. Foot Ankle Int. 2020.
Kim, J., Day, J., & Seilern Und Aspang, J. (2020). Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular. Foot & Ankle International, 1071100720943843. https://doi.org/10.1177/1071100720943843
Kim J, Day J, Seilern Und Aspang J. Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular. Foot Ankle Int. 2020 Aug 7;1071100720943843. PubMed PMID: 32762355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular. AU - Kim,Jaeyoung, AU - Day,Jonathan, AU - Seilern Und Aspang,Jesse, Y1 - 2020/08/07/ PY - 2020/8/9/entrez KW - Kidner KW - accessory navicular KW - calcaneal osteotomy KW - recurrent pain KW - revision SP - 1071100720943843 EP - 1071100720943843 JF - Foot & ankle international JO - Foot Ankle Int N2 - BACKGROUND: The Kidner procedure is performed to treat painful accessory navicular syndrome, with varying results. Recurrent pain remains a complication, and to date, there is a paucity of literature regarding the causes of recurrent pain and surgical outcomes of revision. METHODS: Twenty-one patients who underwent revision surgery for recurrent pain after the Kidner procedure were identified. All patients had their tendon inspected and treated, and all had a medial displacement calcaneal osteotomy. Revision was indicated after 6 months of failed conservative therapy. Pre- and postrevision radiographic measurements included lateral talo-first metatarsal angle (Meary's angle), talonavicular coverage angle, calcaneal pitch, and hindfoot moment arm (HMA). Meary's angle >4 degrees was considered a planus deformity and HMA >9.1 mm was considered a hindfoot valgus deformity; patients fulfilling both criteria were categorized as having planovalgus deformity. Measurements in the contralateral foot were performed to determine whether alignment of the involved side was attributed to failed treatment or a preexisting deformity. Visual analog scale and Foot and Ankle Outcome Scores were compared and average follow-up was 20.1 months (range, 14-26). RESULTS: Preoperatively, 20 of 21 (95%) patients had a form of valgus heel alignment (planovalgus, n = 11; hindfoot valgus only, n = 9), and 1 had an isolated planus deformity. The contralateral side revealed similar deformity, with 17 of 21 (81%) patients having a form of valgus heel alignment (planovalgus, n = 13; hindfoot valgus only, n = 4) and 4 patients with an isolated planus deformity. All patients underwent realignment surgery with medial displacement calcaneal osteotomy. All radiographic parameters except Meary's angle (P = .885) significantly improved postoperatively along with significantly improved clinical outcomes. CONCLUSION: Recurrent pain following the Kidner procedure was associated with valgus heel alignment. Revision surgery including realignment procedure alleviated pain and improved functional outcomes with minimal complications. Therefore, we recommend assessing heel alignment in patients presenting with recurrent pain following the Kidner procedure. LEVEL OF EVIDENCE: Level IV, case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/32762355/Outcomes_Following_Revision_Surgery_After_Failed_Kidner_Procedure_for_Painful_Accessory_Navicular_ L2 - https://journals.sagepub.com/doi/10.1177/1071100720943843?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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