A new approach to the treatment of congenital vertical talus

Abstract

Congenital vertical talus is an uncommon foot deformity that is present at birth and results in a rigid flatfoot deformity. Left untreated the deformity can result in pain and disability. Though the exact etiology of vertical talus is unknown, an increasing number of cases have been shown to have a genetic cause. Approximately 50% of all cases of vertical talus are associated with other neuromuscular abnormalities or known genetic syndromes. The remaining 50% of cases were once thought to be idiopathic in nature. However, there is increasing evidence that many of these cases are related to single gene defects. Most patients with vertical talus have been treated with major reconstructive surgeries that are fraught with complications such as wound necrosis, talar necrosis, undercorrection of the deformity, stiffness of the ankle and subtalar joint, and the eventual need for multiple operative procedures. Recently, a new approach to vertical talus that consists of serial casting and minimal surgery has resulted in excellent correction in the short-term. Longer follow-up will be necessary to ensure maintenance of correction with this new technique. A less invasive approach to the correction of vertical talus may provide more favorable long-term outcomes than more extensive surgery as has been shown to be true for clubfoot outcomes.

Primary outcomes of the congenital vertical talus correction using the Dobbs method of serial casting and limited surgery

“…Previous surgical methods have been associated with some complications, including wound necrosis, talar necrosis, under-correction of the deformity, joint stiffness, and pseudoarthrosis. Many of these patients need multiple operations following the primary surgical treatments, such as subtalar and triple arthrodesis, in their future life [18][19][20][21][22][23]. Also, there is significant controversy about the number and location of ideal incisions to surgically correct the vertical talus, as well as about correcting the deformities in one or two stages.…”

Treatment of Congenital Vertical Talus: Comparison of Minimally Invasive and Extensive Soft-Tissue Release Procedures at Minimum Five-Year Follow-up

“…T 19,2015 manipulation and casting followed by percutaneous talonavicular joint pinning and percutaneous Achilles tenotomy to correct hindfoot equinus, followed by shoe-and-bar bracing once casting is complete and the pin is removed 17,18,27 . All of the isolated vertical tali in this study were reduced with the above treatment protocol.…”

Skeletal Muscle Abnormalities and Genetic Factors Related to Vertical Talus

“…Treatment of vertical talus can be long, difficult, and fraught with complications. A new approach emphasizing serial casting rather than extensive soft tissue releases has been used successfully to achieve initial correction of the deformity [1,10,11], although the long-term results are not known.…”