title: Concomitant calcaneo-cuboid-cuneiform osteotomies and the modified Kidner procedure for severe flatfoot associated with symptomatic accessory navicular in children and adolescents.
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.
  
  
  RESULTS
  We 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.
authors.affiliation: Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea. jrkeem@jbnu.ac.kr.
authors.forename: Jung Ryul
authors.initials: JR
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea. chanill0922@gmail.com.
authors.forename: Chan Il
authors.initials: CI
authors.lastname: Park
authors.affiliation: Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea. yj-lunar@daum.net.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Moon
authors.affiliation: Department of Orthopaedics Surgery, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea. wsi1205@hanmail.net.
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Wang
authors.affiliation: Department of Preventive Medicine, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju, 561-756, South Korea. drkeunsang@chonbuk.ac.kr.
authors.forename: Keun Sang
authors.initials: KS
authors.lastname: Kwon
mesh_terms: D000293:Adolescent; D002111:Calcaneus / Q000601:surgery*; D002648:Child; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D005534:Foot Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D010027:Osteotomy / Q000379:methods*; D013639:Tarsal Bones / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome