Talectomy yielded good clinical outcomes in pediatric patients with clubfoot deformity
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Results presented at the Pediatric Orthopaedic Society of North America Annual Meeting showed talectomy for treatment of clubfoot deformity yielded good clinical outcomes with correction maintained into adulthood.
Jill E. Larson, MD, and colleagues performed a retrospective review of data from all patients with non-idiopathic clubfoot deformity who underwent talectomy from 1975 to 2010. Of the 625 patients identified with clubfoot deformity, researchers noted 53 feet underwent talectomy.
Of the 31 feet that met full follow-up and inclusion criteria, results showed 18 patients had spina bifida and 13 patients had arthrogryposis.
“A total of 17 feet were recorded as having recurrent deformity. Of those, 11 had residual forefoot adduction or supination,” Larson said in her presentation. “However, only three of these feet had a poor result at final follow-up and only two feet required further surgery to achieve a ‘good’ result.”
Patients with residual or recurrent clubfoot deformity had a worse prognosis at final follow-up, and all patients reported a poor result, according to Larson.
At final follow-up, Larson noted talectomy had an overall success rate of 77.4%, with patients who underwent talectomy before 5 years of age having favorable results. She added the diagnosis of spina bifida or arthrogryposis did not influence recurrence, need for further surgery or final outcome at last visit.
“Ambulatory status as defined by a 3-1-1 on the functional mobility scale resulted in a 2.7- times decreased odds ratio of deformity recurrence and 2.4-times increased odds ratio of having a good outcome at final follow-up,” Larson said.
She also noted patients had fewer total surgeries per foot when talectomy was performed as the primary corrective surgery compared with patients who underwent salvaged talectomy.
“A midterm and long-term subgroup analysis found no statistically significant difference between those patients who had follow-up from 5 to 15 years or those who had greater than 15-year follow-up,” Larson said.
Perspective
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Jill E. Larson, MD, and colleagues reported satisfactory long-term outcomes of talectomy in 31 feet with non-idiopathic clubfoot deformity. The treatment for clubfeet has changed during the past 2 decades, with Ponseti casting being performed as the first step both in idiopathic and non-idiopathic clubfeet. Non-idiopathic clubfeet have a higher rate of relapse after treatment with casting alone and in this series, around 6% required talectomy. Based on the findings of this study and previous studies in the literature, talectomy can be an effective salvage operation to achieve plantigrade feet in these patients.
As other foot procedures in the pediatric population, the results of talectomy can heavily rely on the surgeon’s technique. Talectomy, especially if not done properly, can be associated with future deformities, such as rigid cavus and medial column instability. In my opinion, this procedure should be used as a salvage operation after other methods fail.
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Larson JE, et al. Paper 34. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 12-15, 2021; Dallas (hybrid meeting).
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