Surgical correction of congenital vertical talus by one-stage peritalar reduction and tibialis anterior transfer

ABSTRACT

Twenty-eight feet of 16 children with true congenital vertical talus [CVT] were treated surgically by one-stage peritalar reduction and tibialis anterior transfer to the neck of the talus. The male to female ratio was 31. Fifty percent [8 patients with 15 feet] were isolated CVT and the remaining [8 patients with 13 feet] were CVT associated with other congenital anomalies mostly arthrogryposis. Patients with the neurological disorders were not included. Familial occurrence was encountered in 4 children [7 feet] of the same family. The mean age at operation was 19.1 +/- 7.1 months [range 6-36]. All patients were operated by the author and were available for clinical and radiological follow-up for a mean of 9 +/- 5.3 years [range 2-16]. A modified scoring system with 32 points for clinical and 8 points for radiological parameters was utilized for assessment of the final outcome. Nine feet [32.1%] had excellent results, 15 [53.6%] good, 3 [10.7%] fair and one [3.6%] poor. The mean score for all patients was 31.9 +/- 2.8 points. All patients and their parents, except one, were satisfied by their functional results and appearance of the feet. Radiologically there was a statistically significant improvement of the measured angles at the final follow-up compared to the preoperative angles. Unsatisfactory results occurred in 4 feet [14.3%]; in 3 due to partial recurrence of the deformity; these were associated with arthrogryposis. The fourth had overcorrection. No talar avascular necrosis was encountered in this study. Early treatment of CVT by simultaneous correction of all the anomalies during the same sitting led to very satisfactory medium term results: