Treatment of the symptomatic accessory navicular that has failed casting and shoe gear modifications has varied from simple excision, Kidner procedure, excision and reconstructive procedures for associated deformity, open reduction internal fixation, and arthrodesis. The results of various procedures have been reported, but simple excision appeared to have reliable pain relief and lowest complications and morbidity. However, any mechanical deformity, if present, is not addressed with simple excision or Kidner procedure, and it is not known if there is an association of posterior tibial tendon tendonosis with an accessory navicular.
The technique detailed in this article has been used in the authors' practice concomitantly with medial displacement calcaneus osteotomy, gastrocnemius lengthening, lateral column lengthening procedures, and various other flat foot reconstructive options. However, this article is focused on cases where other associated procedures were not required in the authors' opinions.
The purpose of this article is to describe a simple technique that improves hindfoot biomechanical alignment while maintaining the reliable healing and low morbidity of simple excision. Excision of the accessory navicular, transfer and advancement of the posterior tibial tendon into the navicular with biotenodesis screw fixation, and repair of the plantar limb to the advanced posterior tibial tendon are described.
Columbia Orthopaedic Group, Columbia, MO
Address correspondence and reprint requests to Paul S. Shurnas, MD, Columbia Orthopaedic Group, PO Box O, 400 Keene St, Columbia, MO 65201. E-mail: firstname.lastname@example.org.
P. S. Shurnas is a consultant for Arthrex, Naples, FL.