SLR - December 2022 - Yunkyung Jessica Lee, DPM
Title: Minimally Invasive Method in Treatment of Idiopathic Congenital Vertical Talus: Recurrence is UncommonReference: Cummings JL, Hosseinzadeh P. Minimally Invasive Method in Treatment of Idiopathic Congenital Vertical Talus: Recurrence is Uncommon. J Pediatr Orthop. 2022 Oct 1;42(9):503-508.
Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Yunkyung Jessica Lee, DPM
Residency Program: Eastern Virginia Medical School, Norfolk, VA
Podiatric Relevance: Treatment strategies for the pediatric population dealing with foot and ankle pathology are continuously evolving. Congenital vertical talus (CVT) is a rare disorder of the foot, manifested as a severe, rigid rocker-bottom flatfoot. It is defined as a foot deformity in which the calcaneus is in equinus, talus is plantarflexed, and the navicular is irreducibly in a dorsal dislocation. Correction of the vertical talus can be quite difficult and challenging to maintain. The purpose of the current study was to evaluate a more recent alternative and less invasive surgical method to treat congenital vertical talus.
Methods: This study was performed to assess patients with idiopathic CVT who underwent minimally invasive surgery performed by a single surgeon. Dobbs Method, developed after the Ponseti method, was utilized which consisted of serial casting, reduction, pinning of the talovnavicular joint and then Achilles tenotomy. The talar axis-first metatarsal base angle (TAMBA) and talocalcaneal angles on anterior-posterior and lateral radiographs were reviewed pre-operatively, 2 weeks postoperatively, 1 year postoperatively, and at the most recent follow up. Recurrence of the talonavicular and pes valgus deformities were considered if the TAMBA was > 30 degrees in a previously treated foot and anterior-posterior talocalcaneal angle was > 40 degrees.
Results: A total of 35 patients (47 feet) were included in the final analysis with an average follow-up time of 45 months. Preoperatively, the average lateral TAMBA was 74±18 versus 12±8 after the first minimally invasive procedure which resulted in an average correction of 62 ± 18 degrees. Those who experienced recurrence of talonavicular deformity had an average lateral TAMBA of 53 ± 23 and occurred in patients who received treatment at an age > 1 year. There was a statistical significance between age at the time of receiving treatment and recurrence of the talonavicular deformity in patients > 12 months (P = 0.041). Pes valgus recurrences were equal among < 1 year old patients and those > 1 years old. The total number of recurrences of the talonavicular deformity was present in 4 feet (9%), with no cases requiring additional surgery for correction.
Conclusion: This study provides confirmation of the early study from 2006 which was published by Dobbs et al. All patients were able to achieve correction of measured angles following the initial surgery. There were 3 recurrences in the 2006 study versus 4 cases of recurrence in the current study which implies that the Dobbs Method holds long-term CVT surgical correction in the pediatric community with low complication rates. The study has suggested that intervention after 12 months of age has been correlated with an increase in recurrence of CVT. Some limitations of the study include incorporating clinical exam findings in every patient such as ankle range of motion, a short-term follow up period, as well as having a control group. Minimally invasive technique in congenital vertical talus sheds a new light on surgical treatment options but will definitely require more research and supportive data to confirm its true success in the pediatric world.