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Fusion Versus Excision of the Symptomatic Type II Accessory Navicular: A Prospective Study.
Scott AT, Sabesan VJ, Saluta JR, Wilson MA, Easley ME. Foot Ankle Int. 2009 Jan;30(1):10-5.
Quote:
BACKGROUND: Patients with symptomatic Type II accessory naviculars that fail nonoperative measures may be treated with excision, percutaneous drilling, a modified Kidner procedure, or a fourth option, arthrodesis of the accessory ossicle to the navicular body. There is little information in the literature on the relative merits of arthrodesis.
MATERIALS AND METHODS: A prospective evaluation of 20 patients undergoing surgical intervention for symptomatic Type II accessory naviculars was performed. The decision to perform either an arthrodesis (10 feet) or a modified Kidner (10 feet) was made intraoperatively based on the size of the accessory ossicle. Outcomes were measured using pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot scores, plain radiographs, and chart reviews.
RESULTS: At an average followup of 35 months, the mean AOFAS score for the arthrodesis group improved from 50 to 93 points. There were two non-unions (20%) and one patient complained of painful hardware. At an average followup of 48 months, the mean AOFAS score for the modified Kidner group improved from 52 to 80 points. However, in this group, three of ten patients (30%) had persistent midfoot pain and radiographic evidence of progressive loss of the longitudinal arch.
CONCLUSION: Although the methods do not represent a randomized comparison of treatments for the same condition, the results suggest that arthrodesis may be a reasonable treatment option in selected cases of patients with symptomatic recalcitrant Type II accessory naviculars that are large enough to accept small fragment screws.
Re: Fusion Versus Excision of the Symptomatic Type II Accessory Navicular
Surgical treatment of the accessory navicular syndrome with simple excision
Chi LT, Li C, Zhang D, Li Z, Huang B, Zhang TJ, Yu M, Wang PX. Zhongguo Gu Shang. 2009 Dec;22(12):933-4.
Quote:
OBJECTIVE: To observe and evaluate the clinical effects of surgical treatment for the accessory navicular syndrome with simple excision.
METHODS: From November 2006 to December 2008, 23 patients (twenty-five feet) with accessory navicular syndrome received simple excision of the accessory navicular bone. The chief complains were intermittent pain of feet after running or walking. Physical examination showed local tenderness on palpation in the region of the navicular bone. X-ray or CT showed there was an accessory navicular bone. The present history ranged from 6 months to 12 years. There were 14 males and 9 females. The mean age was 14.6 years, ranging from 8 to 35 years. About 2 cm long incision was made at the tip of the medial prominence of the navicular bone. After partial dissection of the posterior tibial tendon, the accesssory navicular bone was exposed and excisied. The prominence of the tuberosity of the navicular bone was cut and shaved. The posterior tibial tenden was repaired before closing the wound. The foot was immobilized with cast or brace in inversion position and no weight-bearing for 2 weeks. Strenuous jumping or dancing must be avoided in 3 months after surgery. The patients with residual symptoms and signs received physical therapy and an arch support for shoes without flatfoot deformity.
RESULTS: The average clinical follow-up during was 12 month (ranged, 3 to 18 months). The excellent results in 21 feet and good in 4 feet (3 feet with mild flat deformity and 1 foot with old sprain injury). The average hospital stay was 5 days and no wound infection occurred. All patients resumed the normal life and study after operation.
CONCLUSION: Surgical treatment of the accessory navicular syndrome with simple excision has the advantages of less invasive to the posterior tibial tenden and the medial longitudinal arch of the foot, shorter time of immobilization of the foot and stay in hospital, small incision and good clinical results. This procedure is one of the best selective treatments for the accessory navicular syndrome, especially for the patients without flatfoot deformity and old sprain injury.
Re: Fusion Versus Excision of the Symptomatic Type II Accessory Navicular
Quote:
Originally Posted by drsarbes
The question is "why do we want to leave an accessory Navicular?"
Does anyone have a logical reason for this?
Steve
Steve:
Because no one has ever published a paper before where they screwed the two together? You know how those surgeons are......not happy with only 20 ways to do a bunionectomy....they want their name on the 21st way to do a bunionectomy.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: Fusion Versus Excision of the Symptomatic Type II Accessory Navicular
Quote:
Originally Posted by drsarbes
BTW: Kevin - this obviously won't make YOU as happy as it made ME, but, I was able to GOLF last week in St Thomas and the achilles felt pretty good!
Steve:
Good news! Probably just starting to appreciate the benefits of having that surgical repair just about now? If I was you, I would probably avoid the racketball for awhile.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Fusion Versus Excision of the Symptomatic Type II Accessory Navicular
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