The Kidner procedure is a surgical intervention designed to address accessory navicular syndrome, a specific foot condition. It aims to alleviate persistent pain and improve overall foot function. By precisely targeting the source of discomfort, the surgery works to restore the foot’s natural mechanics. It offers a solution when non-surgical approaches have not provided sufficient relief.
Understanding the Accessory Navicular
An accessory navicular is an extra bone or piece of cartilage located on the inner side of the foot, near the arch. It lies adjacent to the main navicular bone, often embedded directly within the posterior tibial tendon. This additional bone is a congenital condition, present from birth, forming when a secondary ossification center fails to fully fuse with the primary navicular bone during development.
Though a common anatomical variation, affecting 2% to 25% of individuals, it frequently causes no symptoms. Many people remain unaware of its presence. However, for some, this extra bone can become problematic, leading to accessory navicular syndrome.
When is a Kidner Procedure Necessary?
The Kidner procedure is typically considered when an accessory navicular bone becomes symptomatic, causing significant pain and discomfort. Patients often experience persistent pain, tenderness, and swelling along the inner arch of the foot. This irritation can be exacerbated by physical activities, prolonged standing, or pressure from footwear. The accessory navicular can also lead to dysfunction of the posterior tibial tendon, which supports the foot’s arch.
Diagnosis involves a physical examination, X-rays to confirm the bone’s presence, and sometimes an MRI to assess tendon involvement. Surgery is not the initial treatment. The Kidner procedure is recommended only after conservative treatments fail. These non-surgical approaches include rest, ice, anti-inflammatory medications, supportive footwear, custom orthotics, and physical therapy.
The Surgical Process
The procedure typically begins with the patient receiving either regional or general anesthesia. A surgeon makes a small incision, usually along the inner side of the foot, directly over the accessory navicular bone.
Once exposed, the accessory navicular bone is carefully separated from surrounding tissues, including the posterior tibial tendon, and then completely removed. After its removal, the posterior tibial tendon, which may have been displaced or irritated, is repositioned or securely reattached to its correct anatomical location on the main navicular bone. This reattachment helps stabilize the foot’s arch and improves tendon function. The incision is then closed with sutures, completing the procedure, which often takes less than an hour and can be performed on an outpatient basis.
Recovery and Rehabilitation
Following a Kidner procedure, the recovery process typically involves a period of immobilization to allow the surgical site to heal properly. Patients are often placed in a cast or protective boot for several weeks, commonly around six weeks, during which weight-bearing is restricted initially. Pain management strategies, including prescribed medications, help control discomfort in the immediate post-operative period.
Physical therapy plays a crucial role in rehabilitation, beginning once the initial healing phase has progressed. These sessions focus on regaining strength, flexibility, and a full range of motion in the foot and ankle. Patients gradually increase their activity levels, progressing from non-weight-bearing to partial, and eventually full weight-bearing. While initial healing takes several weeks, a full return to normal activities can take several months, often between three to four months, depending on the individual’s progress and the extent of their rehabilitation efforts.