Rotatory Dorsal Subluxation of the Navicular: A Complication of Clubfoot Surgery

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One hundred fifty-seven patients with 208 idiopathic clubfeet were operated on by a single surgeon (K.K.) from 1976 through 1987. Retrospective analysis was performed with a mean follow-up of 7.3 years on 126 patients with 168 operated-on feet. Twelve (7.1%) of 168 feet developed dorsal subluxation of the tarsal navicular. Six (6.3%) of 95 patients developed subluxation with the posterior medial incision. Six (8.2%) of 78 patients developed subluxation with the Cincinnati incision. Seven (58%) of these 12 feet required additional surgery. An anatomic model was constructed to demonstrate how rotation of the navicular alone mimics the radiographic appearance of dorsal subluxation of the navicular. The navicular dorsal subluxation is a common complication and is associated with a high rate of additional corrective surgery. We suggest that dorsal subluxation of the navicular should be redefined as a rotatory deformity with the medial border of the navicular rotating superiorly in the coronal plane. Attention to the position and rotation of navicular at the time of internal fixation may prevent this complication.

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