This 16-year-old had been struggling since he commenced walking – marked and multiple symptoms on the foot, including lateral midfoot and rearfoot pain, and bunion formation. However, his main symptoms were being experienced on the medial longitudinal arch. The non-weight-bearing image was taken on the day of his surgery, but, when he first presented, this region was markedly inflamed, painful and heavily callused. He had attempted multiple orthotics over the years and had tried physiotherapy with no success.
On examination, he has a rigid flat foot, with almost no ability to supinate his rearfoot, a firm prominence on the plantar medial longitudinal arch and a bunion formation. He was unable to resupinate or raise his arch on weight bearing and there was no resupination of the heel-on-toe stance. X-ray imaging and MRI showed he had a fibrous calcaneonavicular coalition, a large type 3 accessory navicular, bunion and angular measurements showing a flat foot.
I had a long discussion with both the patient and his father regarding the non-surgical and surgical options including the lengthy recuperation and possible complications. He was very keen for surgery ASAP, as he was in so much pain and the condition was having a key impact on his quality of life.
The surgery was quite involved as I had to excise the coalition, remove the accessory navicular and tighten up the tibialis posterior tendon, create an arch via a Cotton osteotomy of the medial cuneiform, realign the bunion and insert a HyProCure. Note the hardware in the post-operative X-ray with excellent alignment. An important point to note with this case is the ability to realign the foot and produce a corrected and flexible foot without fusing any joints.
As mentioned, this patient struggled for many years with multiple attempts at physical therapy and orthotics. However, due to the multi-factorial etiologies and the rigidity of the conditions, they could not achieve a satisfactory result. In this situation, a surgical opinion was warranted and a full return to sport was achieved.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Calcaneonavicular coalition
Biomechanics of a pathology (bunions and pes planus)
Post-operative pes planus/flat feet/excess pronation
Pes planus
Accessory navicular with pes planus
Hyperpronation cure
Rigid flat feet
(This content is intended for healthcare professionals only)