Surgical correction of congenital vertical talus in infants / 中华骨科杂志

ABSTRACT

Objective To investigate the surgical treatment of congenital vertical talus (CVT). Methods Ten feet in six patients (4 girls and 2 boys) with CVT were reviewed. Four of the feet were associated with neuromuscular disorders(Ⅱ), five with malformation syndromes. one foot was idiopathic. The age at surgery ranged from 13 to 39 months with an average of 16.5 months. All were operated with a single-stage soft tissue procedures by using double of posterior and dorsal incisions. Elongation of tendo Achillis and capsulotomy of the ankle and subtalar joints were performed through a straight posterior incision. The dorsal approach was made over the anterior inferior ankle crease from the tip of fibula to talonavicular joint laterally. The extensor digitorum longus and peroneal tendons were lengthened, whereas the peroneus tertius was always tenotomized. The calcaneocuboid capsule, subtalar capsule, and talonavicular capsule also were released. The tibilis anterior tendon was placed through a drill hole in the neck of the talus. One K-wire was passed through the navicular and then retrograde across the talonavicular joint to maintain the reduced position. The other K-wire drove from the heel pad across the subtalar joint. A cast was applied with the ankle in slight plantarflexion for 3 months. Then special shoe was applied for 12 months. Results Six cases (10 feet) were available for follow-up from 6 to 33 months (mean, 23.1 months). The postoperative clinical outcome was evaluated by using a version of Adalaar score. All patients got good cosmetic appearance of the feet and the medial longitudinal arch of feet, had no prominent talar head, and had no the ankle and subtalar motion loss. The presence of mild hindfoot valgus on weight-bearing was noted in only two feet. Seven of ten feet were wearing special shoes. Radiographically, two parameters-talar and calcaneal axis-first metatarsal base angles (TAMBA and CAMBA) were measured from the lateral view of the feet. Preoperative and final follow-up radiographs were obtained. None had avascular necrosis of the talus. TAMBA changed from 66?(range, 50?-98?) to 1.6?(range, -11?-16?), CAMBA changed from 26.1?(range, 14?-60?) to -5.45?(range, -13?-3?). Conclusion Operative reduction has been advocated as the only effective treatment for CVT. It is the best choice to use a single-stage soft tissue surgery for infants with CVT. It is concluded that the results of this procedure are satisfactory.