Single Stage Surgical Correction of Congenital Vertical Talus by Complete Subtalar Release and Peritalar Reduction by Using the Cincinnati Incision*

Purpose Congenital vertical talus (CVT) appears as an idiopathic or non-idiopathic deformity. In this study, we analysed the talar axis-first metatarsal base angle (TAM-BA) values of idiopathic and non-idiopathic CVT cases treated with the Dobbs method. Materials and methods Between January 2007 and July 2012, 20 cases of CVT were treated, starting with a manipulation, casting and a minimally invasive surgical approach. We analysed retrospectively the TAMBA values in idiopathic and non-idiopathic CVT. As a new indicator for the mobility in the talonavicular complex, we used the difference of the TAMBA in neutral position and the TAMBA in plantarflexion. TAMBA measurements of CVT successfully treated with the Dobbs method were compared to TAMBA values of CVT unsuccessfully treated using a minimally invasive approach. Results Out of 20 CVT, 14 were successfully treated with the Dobbs method. Of these 14, five feet were non-idiopathic and nine feet were idiopathic. Six feet did not have complete correction following the Dobbs protocol, and were associated with arthrogryposis or caudal regression syndrome. The initial TAMBA in idiopathic feet ranged from 70 to 110°(mean 88°). The TAMBA in non-idiopathic feet ranged from 75 to 128°(mean 105). Feet successfully treated with the Dobbs method had an initial TAMBA between 74 and 110°(mean 87°). Feet unsuccessfully treated with the Dobbs method had an initial TAMBA between 95 and 128°(mean 118°).The measurement difference between the TAMBA in neutral and plantarflexion positions in cases unsuccessfully treated with the Dobbs method were smaller compared to values of feet successfully treated with the Dobbs method. These differences were statistically significant (p \ 0.0001). Conclusion In our series, the success of the Dobbs method in CVT treatment depended on the flexibility in the talonavicular complex. The TAMBA value and TAMBA difference (TAMBA neutral minus TAMBA plantarflexion) express the flexibility in the talonavicular joint and could be predictive for the success of a minimally invasive treatment. Only in a few cases is the success of the Dobbs method limited. These feet are associated with a TAMBA greater than 120°in neutral position and, particularly, a TAMBA difference smaller than 25°.

Section: Discussionmentioning

confidence: 99%

The talar axis–first metatarsal base angle in CVT treatment: A comparison of idiopathic and non-idiopathic cases treated with the Dobbs method

Eberhardt

Fernández

Wirth

2012

“…Previous surgical methods have been associated with some complications, including wound necrosis, talar necrosis, under-correction of the deformity, joint stiffness, and pseudoarthrosis. Many of these patients need multiple operations following the primary surgical treatments, such as subtalar and triple arthrodesis, in their future life [18][19][20][21][22][23]. Also, there is significant controversy about the number and location of ideal incisions to surgically correct the vertical talus, as well as about correcting the deformities in one or two stages.…”

Section: Discussionmentioning

confidence: 99%

“…Recent research has indicated excellent vertical talus correction with serial casting followed by a minimally invasive surgery. In the short follow-up time of patients with congenital vertical talus, treatment with serial casting and minimally surgery has excellent results in the correction of deformity [21][22][23][24]. Eberhardt et al show that the Dobbs method is successful in vertical talus treatment [25].…”

Section: Discussionmentioning

confidence: 99%

Primary outcomes of the congenital vertical talus correction using the Dobbs method of serial casting and limited surgery

Aslani¹,

Sadigi²,

Tabrizi³

et al. 2012

Introduction The traditional treatment for congenital vertical talus, which involves serial casting and extensive soft-tissue releases, has been associated with severe stiffness and other complications in adolescents and adults. Our hypothesis is that favorable results will be obtained using the Dobbs method of serial manipulation, casting, and limited surgery for vertical talus correction, even in older children and syndromic cases. Therefore, the present study aimed at evaluating the Dobbs method in such cases. Materials and methods We treated 15 feet of 10 patients (aged from 1 month to 9 years) using manipulation and serial casting or the reverse Ponseti method followed by percutaneous Achilles tenotomy and limited open reduction of the talonavicular joint. All patients were evaluated both clinically and radiologically in a mean follow-up period of 2 years. Results After 2 years, all patients had plantigrade and flexible feet with good radiographic correction. The mean talocalcaneal angle before (70.5°± 10.5) and after (31°± 5.2) treatment and the talar axis metatarsal base angle before (60°± 11.4) and after (15°± 6.7) treatment were significantly improved (P \ 0.001). Discussion Recent research has shown that manipulation and serial casting followed by limited surgery (Dobbs method) was successful in treating idiopathic congenital vertical talus. Our results also showed that this method resulted in an excellent outcome in both idiopathic and syndromic congenital vertical talus, even in older children.

“…Some authors have recommended the addition of a tibialis anterior tendon transfer to the head or neck of the talus at the time of open reduction to add a dynamic corrective force [40-42, 47, 48]. Correction of vertical talus through an open reduction can be associated with significant short-term complications, including wound necrosis [1], undercorrection of the deformity [34], stiffness of the ankle and subtalar joint [49], and the eventual need for multiple operative procedures such as subtalar and triple arthrodesis [47]. Long-term outcomes are likely to be complicated by a significant amount of degenerative arthritis as is seen in many patients with clubfoot treated with extensive soft-tissue releases [50].…”

Section: Traditional Surgical Treatmentmentioning

confidence: 99%

A new approach to the treatment of congenital vertical talus

Alaee

Boehm

Dobbs

2007

Congenital vertical talus is an uncommon foot deformity that is present at birth and results in a rigid flatfoot deformity. Left untreated the deformity can result in pain and disability. Though the exact etiology of vertical talus is unknown, an increasing number of cases have been shown to have a genetic cause. Approximately 50% of all cases of vertical talus are associated with other neuromuscular abnormalities or known genetic syndromes. The remaining 50% of cases were once thought to be idiopathic in nature. However, there is increasing evidence that many of these cases are related to single gene defects. Most patients with vertical talus have been treated with major reconstructive surgeries that are fraught with complications such as wound necrosis, talar necrosis, undercorrection of the deformity, stiffness of the ankle and subtalar joint, and the eventual need for multiple operative procedures. Recently, a new approach to vertical talus that consists of serial casting and minimal surgery has resulted in excellent correction in the short-term. Longer follow-up will be necessary to ensure maintenance of correction with this new technique. A less invasive approach to the correction of vertical talus may provide more favorable long-term outcomes than more extensive surgery as has been shown to be true for clubfoot outcomes.