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

Abstract

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°.

A comparison of the Dobbs method for correction of idiopathic and teratological congenital vertical talus

“…Of note, the study which reported no recurrence had a very short follow-up time. Four of the te teratological feet had recurrence, which is lower than other reports of up to 66.7 % recurrence in the teratological group [ 14 , 26 ]. There was no significant difference between the rate of recurrence between the teratological and idiopathic patients.…”

“…They found the talar axis-first metatarsal angle to be significantly smaller in the unsuccessfully treated group compared with those who were successfully treated ( p < 0.0001). The authors found that the flexibility of the talonavicular joint could be a predictor of success in minimally invasive treatment [ 26 ].…”

Treatment of Congenital Vertical Talus: Comparison of Minimally Invasive and Extensive Soft-Tissue Release Procedures at Minimum Five-Year Follow-up

“…In some of the more rigid non-isolated vertical tali in which serial casting does not achieve full correction, then a selective capsulotomy of the anterior subtalar joint completes the correction 10 . Following the first description of this minimally invasive method for the treatment of congenital vertical talus 17,18 , many centers replicated a high success rate for achieving initial clinical and radiographic correction for both isolated and non-isolated vertical tali 10,[19][20][21][22][23][24][25][26]32 . However, the follow-up was less than two years in those studies, and none had a comparison cohort treated with traditional surgical techniques.…”

“…A minimally invasive technique for correcting vertical talus that relies primarily on serial casting was introduced almost ten years ago 17,18 . Multiple centers have reproduced the effectiveness of this technique in achieving initial correction (both radiographically and clinically), while maintaining excellent motion in the foot and ankle, for patients with both isolated and non-isolated vertical talus 10,[19][20][21][22][23][24][25][26] . In the present study, we compare the long-term outcomes of clinical and radiographic correction, foot function, and foot and ankle flexibility in patients with vertical talus (isolated and non-isolated) treated with either the minimally invasive method 17 or extensive soft-tissue release surgery.…”

The pharmacological properties and corresponding mechanisms of farrerol: a comprehensive review

“…Nrf2 regulates the basal and inducible expression of antioxidant genes and other cytoprotective phase II detoxifying enzymes as key transcription factors (Eberhardt et al. 2012 ; Silva-Palacios et al. 2018 ; Chen Y et al.…”