Untitled

Abstract

Talectomy is recommended as a primary or salvage procedure for management of rigid or recurrent equinovarus deformity in arthrogryposis. Twenty-one feet (11 children) that had undergone talectomy were reviewed at a mean follow-up of 11.1 years (range, 2-24). Fourteen (73.7%) feet were satisfactory at final review, whereas five (26.3%) had an unsatisfactory result. Attention to technical details and accurate positioning of calcaneus in the ankle mortise are the two important prerequisites to guarantee a satisfactory long-term result. Fusion of the tibiocalcaneal articulation in optimal position, either spontaneous or induced, is a favorable sign, as it ensures lasting correction of the deformity. The role of a tight and fibrotic tibialis anterior in causing recurrence of severe forefoot adduction and supination is discussed.

Treatment of Foot Deformities in Arthrogryposis Multiplex Congenita

“…Most authors agreed that this method was effective, especially in cases of recurrent deformity, with the rate of satisfactory results reported to be as high as 70% 23,24,30,31,38 . Mild recurrent equinus or forefoot adduction was observed after some talectomies, but these recurrences rarely caused trouble in everyday living and did not constitute an indication for further operative treatment 23,24,30,31 . Poor outcomes after talectomy generally were considered to be the result of operative technical errors.…”

“…This goal of treatment remains true today; however, there are important recent developments-specifically, the need to consider patient satisfaction and the need to limit the number and extent of operative interventions. D'Souza et al underlined that, in cases of arthrogrypotic clubfoot, the presence of mild equinus and mild forefoot deformity are still compatible with a good result 23 . Cassis and Capdevila included patients' opinions in the final assessment of treatment and reported that a pain-free foot with the possibility of wearing standard shoes and overall patient satisfaction were enough to merit a good result despite the presence of mild residual deformity (up to 5°of equinus on clinical examination) 24 .…”

“…In studies of primary talectomy with more than five years of follow-up, satisfactory outcomes were achieved in only about half of the patients. Specifically, Hsu et al reported a satisfactory outcome for nine of fifteen feet 30 , D'Souza et al reported a satisfactory outcome for eleven of twenty-one feet 23 , and Green et al reported a satisfactory outcome for nineteen of thirty-four feet 31 . In conclusion, neither primary soft-tissue releases nor primary talectomies have proved to be superior, and final longterm results after both techniques are far from satisfactory.…”

“…In the past, as a result of disappointing results following soft-tissue releases and frequent recurrences of the deformity, complete excision of the talus (talectomy, astragalectomy) via a lateral approach gained popularity both as a primary procedure and as a secondary salvage procedure for the treatment of arthrogrypotic clubfeet 5,6,[22][23][24][25]30,31,38,39 (Fig. 4).…”

“…Poor outcomes after talectomy generally were considered to be the result of operative technical errors. To avoid such outcomes, complete excision of the talus, possibly in one piece, should be performed; otherwise, if a large fragment remains in the ankle mortise, the fragment will grow with time, leading to recurrent deformity 23,30 . Small residual, osteocartilaginous talar pieces are not disabling and do not require treatment 24 .…”