Efficacy of subtalar arthroereisis and Kidner procedure for adolescent flexible flatfoot with painful accessory navicular: A systematic review and meta-analysis.

Abstract

<h4>Background</h4>Flexible flatfoot with painful accessory navicular poses a significant therapeutic challenge in adolescents, with no consensus on optimal surgical management. This meta-analysis evaluates the efficacy of subtalar arthroereisis (STA) combined with the Kidner procedure for this condition.<h4>Methods</h4>We systematically searched 6 databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang) up to (insert date). Eight studies involving 249 participants met inclusion criteria. Standardized mean differences (SMDs) with 95% confidence intervals were calculated for radiographic parameters (Meary's angle, talus-first metatarsal angle [T1MT], talonavicular coverage angle [TCA]), pain (visual analog scale), and function (American Orthopaedic Foot & Ankle Society Score [AOFAS]). Heterogeneity and publication bias were assessed using I² statistics and Egger's test.<h4>Results</h4>The combined procedure significantly improved all measured outcomes: Meary's angle (SMD -3.71, 95% confidence interval, -4.90 to -2.51), T1MT (SMD -2.63, -3.69 to -1.57), TCA (SMD -2.65, -4.29 to -1.01), visual analog scale (SMD -4.36, -5.17 to -3.54), and AOFAS (SMD 4.85, 4.25-5.44). Compared to STA alone, the combination showed superior correction of T1MT (SMD -0.35, -0.66 to -0.04) but no significant differences in other parameters (AOFAS: SMD 0.80, -0.45 to 2.05; TCA: SMD -0.68, -1.67 to 0.31).<h4>Conclusion</h4>STA with Kidner procedure effectively corrects deformity and improves function in adolescent flexible flatfoot with accessory navicular. While superior to STA alone in T1MT correction, most outcomes were comparable between approaches. These findings support the combined technique as a viable surgical option for this challenging condition.