ABSTRACT
PURPOSE: We performed clinical and radiological evaluation of surgical outcomes of congenital vertical talus. MATERIALS AND METHODS: Fifteen surgically treated feet in 9 patients (6 bilateral and 3 unilateral) which were followed-up for at least 2 years were included. Mean patient age at the time of surgery was 10.9 months. The surgical technique was a one-stage correction using the Kumar technique with a Cincinnati skin incision. In 7 feet we also transferred half of the tibialis anterior to the talar neck (the Grice technique). Radiologic parameters (talo-calcaneal angle, talo-first metatarsal angle, tibio-talar angle, tibio-calcaneal angle) were analyzed pre- and postoperatively and at the last follow-up, and clinical outcomes by the Laaveg-Ponseti score. RESULTS: Talus orientation was improved in all patients. All radiologic parameters showed statistically significant improvement by the last follow-up. The mean Laaveg-Ponseti score at the last follow-up was 16 for patient satisfaction, 16 for function, and 24 for pain. There was no recurrence, however one case of talar neck fracture occurred during the tibialis anterior transfer. CONCLUSION: One-stage surgical correction for congenital vertical talus at an early age provides satisfactory functional and cosmetic results.
Subject(s)
Humans , Follow-Up Studies , Foot , Metatarsal Bones , Neck , Patient Satisfaction , Recurrence , Skin , TalusABSTRACT
[Objective]To evaluate the application value of minimally invasive release operation about congenital vertical talus(CVT).[Method]All operation were operated with single method by author.Firstly,Achilles tendon,capsulotomy of the ankle and subtalar joint were released through a small straight posterior inside of Achilles tendon end point.Secondly,astragaloscaphoid and subtalar front joint were released bluntly through a straight posterior incision.Thirdly,based on circs subtalar joint were released through calcaneocuboid articulation outside foot.Then one K-wire were passed through the body of talus from its axis,and passed through instep after reposition of astragaloscaphoid joint.Two K-wires was passed through calcaneus to talus from planta.[Result]Eight cases were available for follow-up from 17 to 36 months(mean,28 months),follow-up results was evaluated by using a version of Adelaar and Kodros score,there were excellent result in 1 foot,good in 5,fair in 2.The presence of hindfoot valgus and forefoot abduce were noted in one foot,forefoot pronation was appeared in one foot.Two parameters-talar and calcaneus axis-first metalarsal base angles,calcaneus talus angles of eutopic and lateral radiograph were basally normal.[Conclusion]Operative reduction has been advocated as the only effective treatment for CVT,it is the best choice to use minimally invasive release operation for infant.
ABSTRACT
Congenital vertical talus is dufficult to correct and tends to recur. Reduction of the deformed talon-avicular joint is rarely possible by conservative means alone and consequently surgical reduction is usually necessary. The technique of Kumar, Cowell and Ramsey(TAL, capsular release, open reduction of navicular, and K-wire fixation) was combined with or without tendon transfer using Tibialis anterior(Grice operation) in 11 feet of seven children(bilateral in four) under the age of four(2 girls and 5 boys), and followed them for average 41 months. Three of them were combined with cerebral palsy, syringomyelia, and multiple joint stiffness with camptodactyly. In preoperative radiograms, all of their tali are so distorted plantarward and medially as to be almost vertical. The talus was in an equinus position also but to a lesser degrees. The forefoot was dorsiflexed at the midtarsal joint and the navicular lay on the dorsal aspect of the talar head. Seven feet are corrected normally after operation, but four feet were recurred and soft tissue releasing techniques combined with extraarticular subtalar arthrodesis or triple arthrodesis were planned after their skeletal maturity.