Minimally Invasive Method in Treatment of Idiopathic Congenital Vertical Talus: Recurrence is Uncommon

Abstract

Background: Historically, treatment for congenital vertical talus (CVT) has included open reduction of the talonavicular joint and extensive soft tissue release. In 2006, a new minimally invasive method consisting of serial manipulation and casting followed by percutaneous fixation of the talonavicular joint and percutaneous Achilles tenotomy was introduced. Although the early results of this new technique are promising, more research is needed to verify that the talonavicular correction is maintained with time. Methods: We conducted a retrospective chart review of all patients with idiopathic CVT who underwent minimally invasive correction by a single surgeon at a tertiary care institution. Radiographic evaluation of the preoperative, immediate postoperative, 1 year postoperative and latest follow-up appointments were performed. Complications and clinical outcomes were recorded. Radiographic recurrence of the deformity was defined as lateral talar axis-first metatarsal base angle > 30 degrees. Statistical analysis was performed on the maintenance of radiographic correction and factors associated with recurrence. Results: Forty seven feet in 35 patients were included in the study with average follow-up of 45 months. The average preoperative lateral talar axis-first metatarsal base angle was 74 ± 18 compared with 12 ± 8 after initial surgical intervention. In addition, radiographic correction of all other measured angles was achieved in every child following the initial surgery. Radiographic recurrence of talonavicular deformity was seen in 4 feet (9%). No cases of recurrence required a second corrective surgery during the follow-up period. There was a significant association between patient age at the time of treatment and recurrence of talonavicular deformity with patients older than 12 months being more likely to experience recurrence (P = 0.041). Conclusions: In this large series, we found that correction of talonavicular deformity can be achieved and maintained in a large majority of children with idiopathic CVT who undergo treatment with this minimally invasive technique and recurrences are uncommon. Treatment with this technique should be initiated as soon as a diagnosis of CVT is confirmed and the patient is medically stable to decrease the likelihood of experiencing recurrence of talonavicular deformity.

Comparison of Different Surgical Techniques in Correction of Congenital Vertical Talus Deformity: A Systematic Review and Meta-Analysis of the Literature

“…There was a total of 9 studies (145 patients, 219 feet) meeting our inclusion criteria in which the Dobbs Method was utilized 6,31–37,42. Results are shown in Table 6.…”

“…There was a total of 9 studies (145 patients, 219 feet) meeting our inclusion criteria in which the Dobbs Method was utilized. 6,[31][32][33][34][35][36][37]42 Results are shown in Table 6. Radiographic recurrence of the deformity was noted in 21.5% of the patients, with 14% requiring reoperation.…”

Pé talo vertical: tratamento pelo método Dobbs – “Ponseti invertido”

“…A indicação do tratamento com o método Dobbs é endossada pela literatura mais recente, que evidenciou sua eficácia com seguimento médio de 45 meses, com poucas recorrências em casos idiopáticos [3][4][5] . Apesar de uma maior idade ao início do tratamento estar associada a uma maior probabilidade de recorrência, constatou-se também que a aplicação dessa técnica causou melhora significativa em crianças acima dos 18 meses.…”

Children’s orthopaedics

“…The early results of this are promising, and a group from Saint Louis (Missouri, USA) have published their medium-term follow-up to verify if the improvement is maintained over time. 2 This paper is, as one might expect, a retrospective review of all patients with idiopathic congenital vertical talus under the care of a single-surgeon tertiary centre who underwent a minimally invasive correction according to a relatively standard protocol. Preoperative radiographs were compared with postoperative, one-year follow-up, and final follow-up films; complications and clinical outcomes were recorded.…”