Surgical treatment of symptomatic accessory navicular bone (os tibiale externum) in pediatric patients. A systematic review

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Objective: A symptomatic accessory navicular bone can cause foot pain and, in some instances, a painful flatfoot with functional limitations. Treatment is generally conservative, but in selected patients, surgical management may be necessary. The purpose of this study was to analyze a series of selected papers to identify the best surgical treatment for symptomatic accessory navicular bone. Methods: A literature search was performed in MEDLINE database, Chocrane Library and Scopus database. The research was performed following the PRISMA guidelines. Articles published from 1998 to 2023 reporting clinical outcomes of pediatric patients affected by accessory navicular bone surgically treated were included. Results: From an initial pool of 76 studies, 8 were included in this review. These encompassed 228 patients (294 feet), with an average age at surgery of 12.4 years; 147 patients were female (64.5%) and 81 male (35.5%). The follow-up ranged from 10 months to 12 years. Most cases involved type II os tibiale externum (246 feet). Treatments varied: 57 simple excisions, 62 Kidner procedures, 22 excisions with suture anchor stabilization, 31 percutaneous drillings, 37 subtalar arthroereisis alone, 35 combined with Kidner procedure, and 50 with medial soft tissue reconstruction. Conclusions: While a definitive surgical treatment of choice for symptomatic accessory navicular cannot be indicated, simple excision without detachment of the tibialis posterior tendon appears to be a valid treatment option for resolving this syndrome. Associated procedures may be performed when a flexible flatfoot is present and symptoms persist.

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