Elsevier

The Journal of Foot and Ankle Surgery

Volume 50, Issue 5, September–October 2011, Pages 551-557
The Journal of Foot and Ankle Surgery

Original Research
Radiographic Evaluation of Navicular Position in the Sagittal Plane—Correction Following an Extraosseous Talotarsal Stabilization Procedure

https://doi.org/10.1053/j.jfas.2011.04.027Get rights and content

Abstract

The navicular drop in the sagittal plane on weight-bearing is a valid indicator of foot pronation. Dislocation of the talus on the tarsal mechanism results in hyperpronation, which can lead to excessive navicular drop. The purpose of the present study was to radiographically determine the efficacy of HyProCure® in realigning the navicular bone in hyperpronating feet. We hypothesized that following the placement of HyProCure®, the navicular height would increase significantly compared to its preoperative value. Radiographs of 61 adult patients (86 feet) who received HyProCure® without adjunctive hindfoot or midfoot soft tissue or osseous procedures were analyzed. The distance of the navicular with respect to the cuboid was measured from the pre- and postoperative weight-bearing lateral radiographs. Additionally, we measured foot length to normalize the navicular to cuboid distance. The postoperative radiographs were taken at an average follow-up of 17 days. The mean preoperative true navicular to cuboid distance was 19 ± 6 mm as compared to a mean postoperative value of 24 ± 5 mm. The mean pre- and postoperative normalized navicular to cuboid distances were 0.098 ± 0.029 and 0.125 ± 0.027, respectively (± 1 SD). The postoperative increase in the true and normalized navicular to cuboid distance was statistically significant (p < .001). HyProCure® was effective in improving the anatomic alignment of the talonavicular joint by reducing excessive navicular drop. This indicates reduction of excessive abnormal pronation and stabilization of the medial column of the foot, which can also lead to reduction in the excessive forces placed on the supporting soft tissue structures.

Section snippets

Patients and Methods

According to the patient history and preoperative clinical and radiographic evaluation, the patients who were diagnosed with talotarsal dislocation were considered suitable candidates for an extraosseous talotarsal stabilization procedure using HyProCure®. The clinical signs and/or symptoms relating to talotarsal dislocation presented by these patients before surgery were 1 or more of the following: excessive pain in the medial column of the foot, hyperpronation, collapse of the medial

Results

A total of 83 patients (34 men and 49 women) with 117 operated feet (34 patients with bilateral and 49 patients with unilateral procedures) responded for participation in this cohort study. The mean age at the time of surgery for this group was 58 (range 22 to 85) years. The radiographically measured pre- and postoperative values of the true navicular to cuboid distance, truncated foot length, and normalized navicular to cuboid distance are shown in Table 1. The mean preoperative true navicular

Discussion

Instability of the TTM leading to hyperpronation is one of the most common underlying etiologies of foot and ankle pathologies. The relationship between hyperpronation and pathologies of the lower extremity has been widely reported and considered valid 3, 24. Hyperpronation is associated with conditions such as posterior tibial tendon dysfunction, plantar fasciopathy, Achilles tendinitis, tarsal tunnel syndrome, first ray disorders, hallux abductovalgus, anterior cruciate ligament injury, and

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    Financial Disclosure: GraMedica, LLC (Macomb, MI) funded the research for the present study.

    Conflict of Interest: Michael E. Graham is the inventor of HyProCure® and the sole owner of GraMedica, LLC, which manufacturers and distributes HyProCure® nationally and internationally. He lectures on an on-going basis about HyProCure® to foot surgeons worldwide.

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