Long-term results of pediatric treatment of congenital vertical talus

Abstract

Objective To review long-term results of congenital vertical talus treated with classical techniques and a minimally invasive treatment approach offered by M. Dobbs. Material and methods Review of 30 pediatric cases (54 feet) with severe congenital convex pes valgus was performed over the period of 11 years. Patient ages ranged from 1 month to 13 years at the start of treatment. The 54 primary operations performed included triple arthrodesis (n = 2), open talus reduction according to S.J. Kumar, K.R. Cowell, D.L. Ramsey (n = 5), Coleman open reduction of the talus and screw fixation (n = 6), serial casting and percutaneous fixation of the talonavicular joint with a Kirschner wire and a percutaneous Achilles tendon tenotomy (n = 41). Reduction of the talus was produced under vision and followed by capsuloplasty of 23 feet. C-arm was used for closed correction in the rest of the cases. Results A minimally invasive Dobbs approach that consisted in serial casting, minimal surgery followed by bracing was shown to provide favorable outcomes in 21 patients (41 feet) treated at early childhood. Recurrent deformity with the oblique talus developed in 3 cases (4 feet) during growth of an average 6.1 years despite satisfactory primary correction and required further interventions. However, open reduction has become a rare procedure in the patient cohort with introduction of Dobbs practice at our hospital. There are more reports of successful primary treatment with Dobbs method in the national literature with no long-term follow-ups available in our country. Conclusions Kumar and Coleman operative interventions are reserved for unrecognized or recurrent cases following Dobbs manipulations. Triple arthrodesis as a definitive procedure can be used in a late detection of the condition or poor outcomes.

Keywords

• congenital convex pes valgus
• vertical talus
• Dobbs method
• foot deformity