Primary spring ligament repair through a navicular tubercle osteotomy in flexible progressive collapsing foot deformity: results of a case series.

BACKGROUND

Spring ligament complex (SLC) insufficiency is regarded as an important component of progressive collapsing foot deformity (PCFD). Reconstruction of this ligament complex is often favored over primary repair since the latter has not proven successful in chronic injuries. We present the clinical and radiographic outcomes of primary repair in PCFD performed using the navicular osteotomy technique which improves visualization and repair of SLC and compare the results with augmentation and reconstruction series reported in the literature.

METHODS

We retrospectively reviewed 17 PCFD of 16 patients with flexible deformities who underwent lateral column lengthening, distal advancement of the posterior tibial tendon (PTT), gastrocsoleus recession, and primary SLC repair via the navicular osteotomy technique. Clinical (the European Society for Foot and Ankle Surgery (EFAS) daily- living and sports scores) and eight weight-bearing radiographic parameters were compared preoperatively and at final follow-up using paired t-tests or Wilcoxon signed-rank tests.

RESULTS

Mean age of patients was 31.5 years (range, 10-65) and mean follow-up time was 17.6 months (range, 12-29). EFAS daily-living (9.5→20.9) and sports (6.4→14.4) scores improved significantly (p < 0.001). All radiographic parameters also improved significantly (p < 0.001), including antero‑posterior (AP) Meary (19.5°→-1.3°), lateral Meary (25.1°→4.6°), AP talonavicular coverage (31.4°→3.3°) and lateral talonavicular coverage (17.1°→0.8°) angles.

CONCLUSION

Primary SLC repair using the navicular osteotomy technique, combined with lateral column lengthening and PTT advancement restored talonavicular congruity with clinical and radiographic outcomes comparable to those reported for augmentation and reconstruction.

LEVEL OF EVIDENCE: IV, retrospective case series.