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New treatment for congenital vertical talus improves foot appearance, function

Patients received a mean of five casts, and none underwent extensive surgical releases, researchers said.

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A new treatment for idiopathic congenital vertical talus corrected deformity and improved foot function in a two-year retrospective study.

In the study, surgeons combined serial manipulation, casts and limited surgical intervention. Matthew B. Dobbs, MD; Derek B. Purcell, MD; and Ryan Nunley, MD, of the department of orthopedic Surgery, Washington University School of Medicine, St. Louis, Mo., and Jose A. Morcuende, MD, PhD, of the department of orthopedic surgery and rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, published their results in the American edition of the Journal of Bone & Joint Surgery.

The study group comprised 11 patients with 19 vertical tali. The children were treated at St. Louis Children’s Hospital and the University of Iowa Hospitals and Clinics.

Researchers evaluated radiographs at the time of presentation, postoperatively and at the latest follow-up. The patients’ mean age at latest follow-up was 3 years (range, 2.5 years to 6 years), the authors wrote.

To avoid foot stiffness and other complications associated with traditional manipulation and plaster cast immobilization, surgeons used a manipulation and casting technique based on the Ponseti method of treating clubfoot deformity. In manipulating and casting, surgeons used Ponseti’s methods, but applied the forces in the opposite direction. They augmented the manipulation and casting by pinning the talonavicular joint and performing percutaneous tenotomy of the Achilles tendon, according to the study.

Surgeons performed percutaneous tenotomy on all 19 feet, did fractional lengthening of the anterior tibial tendon (two feet) or peroneal brevis tendon (one foot), and percutaneous pin fixation of the talonavicular joint (12 feet).

Outcomes showed clinical and radiographic correction in all 19 feet. Surgeons used a mean of five casts on each treated foot. None of the patients required extensive surgical releases.

The new treatment method produced “excellent” results, the authors said. On the Adelaar scoring system, five patients had excellent results, six had good results and none had fair or poor results, researchers said.

“All parents were satisfied with the appearance of the foot,” they said. “No patient required custom shoes or complained of abnormal foot wear, and none had pain. There were no operative complications.”

For more information:

• Dobbs MB, Purcell DB, Nunley R, et al. Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Joint Surg Am. 2006;88:1192-1200.