Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure)
CPT4 code
Name of the Procedure:
Reconstruction (advancement) of Posterior Tibial Tendon with Excision of Accessory Tarsal Navicular Bone (Kidner Procedure)
Summary
In layman's terms, this procedure involves repairing and repositioning the posterior tibial tendon in the foot and removing an extra bone near the inner ankle known as the accessory tarsal navicular bone. This extra bone can cause pain and problems with walking.
Purpose
The procedure addresses issues related to flatfoot deformity caused by a dysfunctional posterior tibial tendon and the presence of an accessory navicular bone. The goal is to relieve pain, improve foot function, and restore normal walking patterns.
Indications
- Flatfoot deformity
- Persistent pain along the inner side of the foot or ankle
- Swelling or tenderness at the site of the accessory navicular bone
- Difficulty walking or standing for extended periods
Preparation
- Fasting for at least 8 hours before the procedure
- Adjusting or stopping certain medications as advised by the doctor
- Pre-surgical imaging tests like X-rays or MRI to evaluate the foot structure
Procedure Description
- Administration of anesthesia (general or regional).
- A small incision is made over the inner side of the foot.
- The accessory navicular bone is exposed and carefully removed.
- The posterior tibial tendon is then repaired or repositioned (advanced) to its proper place.
- The incision is closed with sutures, and a sterile dressing is applied.
Tools/Equipment:
- Scalpel
- Surgical scissors
- Retractors
- Sutures
- Sterile drapes
Duration
The procedure typically takes about 1-2 hours.
Setting
The procedure is performed in a hospital or an outpatient surgical center.
Personnel
- Orthopedic surgeon or podiatric surgeon
- Operating room nurses
- Anesthesiologist
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Blood clots
- Tendon re-rupture or failure to heal properly
- Pain at the incision site
Benefits
- Pain relief
- Improved foot stability and function
- Better walking ability
- Recovery of normal or near-normal foot shape
Recovery
- Immobilization of the foot in a cast or boot for several weeks
- Keeping the foot elevated to reduce swelling
- Physical therapy to regain strength and flexibility
- Avoiding weight-bearing activities until the doctor advises otherwise
- Follow-up appointments to monitor healing progress
Expected recovery time is typically 6-12 weeks, with gradual return to normal activities.
Alternatives
- Conservative treatments like physical therapy, orthotic devices, and anti-inflammatory medications
- Less invasive surgical options if applicable
- Pros and cons: Conservative treatments may not fully resolve the issue but are less risky. Other surgeries may vary in invasiveness and effectiveness.
Patient Experience
During the procedure, the patient won't feel pain due to anesthesia. Post-surgery, there might be discomfort managed with pain medication. Care includes rest, elevation, and following post-op care instructions to ensure smooth recovery.