SURGICAL TREATMENT OF CONGENITAL VERTICAL TALUS

Abstract

Congenital vertical talus is a rare deformity. Many different surgical procedures have been described, and there is debate about whether the correction should be done in one or two stages. We review the results of single stage surgical correction of congenital vertical talus.

Between 1992 and 2000, five boys and seven girls were treated, ranging in age from eight months to two years. In six children both feet were involved, so there was a total of 18 feet. One child had spina bifida, four had arthrogryposis multiplex congenita and three had syndromes and chromosomal abnormalities. Four cases were idiopathic.

Dorsolateral and medial incisions were used. Through the dorsolateral the sinus tarsus, calcaneocuboid and talonavicular joints were released and the extensors lengthened. Through the medial incision the navicula was reduced onto the talus, the tibialis posterior and talonavicular capsule were reefed and the tendo Achillis lengthened. The talonavicular and calcaneocuboid joints were pinned. The tibialis anterior was re-routed through the talar neck. Plasters were changed after two weeks and serial plasters were applied for four to six months.

Follow-up ranged from one to seven years. Results were assessed clinically and radiologically, using the Adelaar 10 point scoring system. There were no wound complications or cases of avascular necrosis of the talus. Further surgery was required to correct cavus in two feet, to correct forefoot abduction in two, and to correct hindfoot valgus in one. Results were rated good in 12 feet and fair in six. Radiologically there was notable improvement in the anteroposterior and lateral talocalcaneal and tarso-first metatarsal angles. All patients were ambulant at last follow-up.

In treating congenital vertical talus, good clinical and radiological results can be obtained with single stage correction of the hindfoot and midfoot deformities.