Simple excision vs the Kidner procedure for type 2 accessory navicular associated with flatfoot in pediatric...

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Foot and Ankle Surgery

Background:

• Accessory navicular is debated as an irritant vs. hindrance in pediatric flatfoot.
• Simple excision is increasingly advocated over the Kidner procedure.
• This study compares simple excision and the Kidner procedure for symptomatic accessory navicular in children and adolescents.

Purpose of the Study:

• To prospectively compare functional and radiographic outcomes of simple excision versus the Kidner procedure.
• To evaluate patient satisfaction following both surgical interventions.
• To determine the efficacy of each procedure in correcting pediatric flatfoot associated with accessory navicular.

Main Methods:

• Prospective comparative study of 50 pediatric feet with symptomatic type 2 accessory navicular.
• 25 feet underwent simple excision, and 25 underwent the Kidner procedure.
• Evaluated American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, visual analogue scale (VAS), and radiographic angles (talo-first metatarsal, talocalcaneal, calcaneal pitch) pre- and postoperatively for at least 3 years.

Main Results:

• Both groups showed significant improvement in AOFAS and VAS scores postoperatively.
• No significant pre- to postoperative changes were noted in talo-first metatarsal and talocalcaneal angles.
• Calcaneal pitch angle improved in both groups, with no significant differences between the procedures at final follow-up. Patient satisfaction was high (86% vs. 82%).

Conclusions:

• Both simple excision and the Kidner procedure yield satisfactory results for pediatric accessory navicular and flatfoot.
• Both methods demonstrate similar, minimal restoration of the medial longitudinal arch.
• The choice between simple excision and the Kidner procedure may depend on surgeon preference and specific patient factors.