SLR - June 2023 - Dy Chin, DPM, MS
Title: Comparison of Different Surgical Techniques in Correction of Congenital Vertical Talus Deformity: A Systematic Review and Meta-Analysis of the LiteratureReference: Cummings JL, Rivera AE, Tippabhatla A, Hosseinzadeh P. Comparison of Different Surgical Techniques in Correction of Congenital Vertical Talus Deformity: A Systematic Review and Meta-Analysis of the Literature. J Pediatr Orthop. 2023 May-Jun 01;43(5):317-325. doi: 10.1097/BPO.0000000000002369. Epub 2023 Feb 20. PMID: 36808104.
Level of Evidence: Level III
Reviewed By: Dy Chin, DPM, MS
Residency Program: Baylor Scott & White, Temple, TX
Podiatric Relevance: Congenital Vertical Talus (CVT) is a rare foot deformity that affects infants and children, characterized by a rigid flatfoot with the talus in a plantar flexed position, hindfoot valgus and forefoot abduction. The standard treatment for CVT is a surgical correction, which involves soft tissue release, bony correction, and tendon transfer. The authors of this paper did a systematic review and meta-analysis for the five most commonly used methods for surgical correction of this deformity. They compared the Two-Stage Coleman-Stelling Technique, the Direct Medial Approach, the Single-Stage Dorsal (Seimon) Approach, the Cincinnati Incision, and the Dobbs Method.
Methods: Using PRISMA guidelines, two team members of the study conducted a systematic search reviewing 212 articles, of which 31 studies were eligible based on their inclusion and exclusion criteria. A total of 580 feet were used in this meta-analysis. There were 4 studies in which the Coleman-Stelling technique was used as the corrective surgical procedure, 8 studies that used the Direct Medial Approach, 5 studies each supporting the Single-Stage Dorsal (Seimon) Approach and Cincinnati Incision, and 9 studies that used the Dobbs Method. Their main evaluation for primary outcomes were recurrence of deformity and reoperation rate; other criteria included ankle arc of motion and a clinical scoring algorithm using the Adelaar scoring system.
Results: The reported incident of radiographic recurrence of talonavicular subluxation for all studies included in the article was 19.3% with 45 cases (7.8%) requiring reoperation. Recurrence of the deformity was seen highest in children treated with the Direct Medial Approach (29.3%) and lowest in the Single-Stage Dorsal Approach (11%)(P<0.05). Reoperation rate was significantly lower in the Single-Stage Dorsal Approach (2%) compared to the other methods (P<0.05). There was no significant difference in the reoperation rate between the other methods. The highest clinical score was seen in the Dobbs Method cohort (8.36) which also demonstrated the largest ankle arc of motion.
Conclusions: This study finds that all five surgical techniques are effective in achieving correction of the deformity, but the Single-Stage Dorsal (Seimon) Approach and the Dobbs Method have fewer complications and shorter duration of treatment compared to the other techniques. The Two-Stage Coleman-Stelling Technique is effective but requires a prolonged treatment period, while the Direct Medial Approach has lower risk of complication. Overall, the study concludes that the choice of surgical technique for correction of CVT should be based on individual patient’s condition and the surgeon’s experience and preference. This study provides valuable information for clinicians and researchers when determining treatment of such condition.