Outcomes of a Minimally Invasive Approach for Congenital Vertical Talus With a Comparison Between the Idiopathic and Syndromic Feet

Abstract

Background: Congenital vertical talus (CVT) is a rare congenital foot disorder. Approximately half of the affected children have associated neuromuscular syndromes which may further complicate the treatment. The traditional treatment involved extensive soft tissue and bony reconstructions. The minimally invasive method (Dobbs method/reverse Ponseti) has changed the treatment of CVT. There is significant variation of the reported outcome of this method in the current literature. In this study we report the outcome of this minimally invasive technique for treatment of CVT and compare the results of treatment in syndromic and idiopathic patients. Methods: Idiopathic and syndromic patients treated from CVT with minimally invasive method from 2006 till 2016 were included in this retrospective study. We reviewed the patients’ notes, radiographs and collected parents reported outcome questionnaire (Roye score) in addition to clinical examination to comprehensively report the treatment outcome. Results: A total of 21 patients 30 feet were included in this study. The average age of commencing treatment was 6 months (1 to 17 mo). The mean follow-up was 6.5 years (1 to 11 y). Correction of the deformities and abnormal angles were achieved in all feet. Five of the 17 syndromic feet had recurrence while no recurrence was reported in any if the 13 idiopathic feet. At the time of the index procedure no supplementary procedures were required. The average arc of motion for foot ankle dorsiflexion and plantar flexion was 30 degrees. Patients with idiopathic CVT had a mean the Roye score of 11 while syndromic patients had a mean score of 22. Conclusion: The minimally invasive method is a valuable option for treatment of CVT. Idiopathic patients had no recurrence and better functional scores compared syndromic patients. There was no requirement for supplementary procedures such as tibialis anterior transfer or anterolateral release at the time of the initial surgery. Level of Evidence: Level IV—case series.

An Algorithmic Approach to the Congenital Vertical Talus

“…34 Hafez and Davis published their series of 21 patients aged 1-17 months with a mean 6.5-year follow-up treated with the minimally invasive method. 35 The five syndromic patients had lower functional scores and 29% recurrence, all occurring in the first postoperative year. None of the idiopathic feet had a recurrence, and no patients required adjunct procedures such as tibialis anterior tendon transfer or anterolateral soft tissue releases.…”

What is New in Pediatric Orthopaedic Foot and Ankle

“…Correction can be obtained nearly universally, including patients with teratologic CVT. Nevertheless, recurrence is common in the teratologic feet 47,48. This suggests treatment for CVT should be similar to that of clubfoot and should include preoperative casting followed by a less invasive surgical procedure to obtain reduction of the navicular on the talus.…”

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

“…As the navicular is not yet ossified in younger patients, we used the TAMBA to monitor for both severity and recurrence of talonavicular deformity. In conjunction with past studies, we defined recurrence of talonavicular deformity as a lateral TAMBA measuring >30 degrees in a previously corrected foot and persistent pes valgus as an AP talocalcaneal angle >40 degrees 21,22…”

“…Early results from the Dobbs Method have shown lower complication rates with better functional outcomes compared with more extensive surgical treatments 21. Although early results of this technique are encouraging, more research is needed to confirm the previously reported advantages of this new treatment method.…”