Corrective bandages and daily manipulations for treatment of congenital vertical talus: a thirteen year follow-up

Abstract

Purpose To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was needed. Methods A retrospective analysis of all children diagnosed with idiopathic vertical talus was carried out during the years 2008–2021. Thirty-two children (46 feet) were finally included. Children were treated with serial manipulations, muscle stimulation, and corrective bandages. Age at the time of initiation of treatment, duration of treatment, and correction or not of the deformity without surgical intervention were recorded as variables of interest. The talocalcaneal angle, TAMBA, and ankle range of motion were measured before treatment, after treatment, and at the end of the follow-up period. Statistics decision tree was used to determine which variable best discriminated whether the patient needed surgery. To complement the tree diagram, a two-step cluster analysis was carried out. Results After treatment, TAMBA and talocalcaneal angle changed from “vertical” to “oblique” category in 45 and 37 feet, respectively. The pathological dorsal flexion of the ankle changed to normal in 37 feet and ankle plantar flexion was normal in 46 feet. These variables showed significant changes between the three measurement moments. The results of the statistics decision tree and cluster analysis indicate that “No surgery” was associated with an age equal to or lower than one week when treatment was started, and with an ankle plantar flexion range of motion lower than 36°. Conclusions The beginning of this conservative treatment in the first week of life and having a plantar flexion of the ankle lower than 36° were related to the success of the treatment without surgery.

Congenital Vertical Talus: An Updated Review

“…Additionally, the talo-first metatarsal angle (Meary’s angle) on the AP view is often greater than 30 degrees, further signifying hindfoot valgus. On the lateral view, critical radiographic parameters include the tibiocalcaneal angle, kite angle, and Meary’s angle (Figure 2A , 2B ) [ 17 ]. In cases of CVT, the long axis of the talus aligns vertically relative to the first metatarsal, and the calcaneus is affected by severe equinus, thereby increasing the lateral Meary’s, kite, and tibiocalcaneal angles [ 1 ].…”

“…Historically, nonoperative treatment consisted of serial manipulation and casting [ 17 ]. Over the years, studies concluded that serial casting alone was not sufficient, and that combination with surgical treatment resulted in superior outcomes with reduced relapse [ 8 ].…”

“…Additionally, the talo-first metatarsal angle (Meary's angle) on the AP view is often greater than 30 degrees, further signifying hindfoot valgus. On the lateral view, critical radiographic parameters include the tibiocalcaneal angle, kite angle, and Meary's angle (Figure 2A, 2B) [17].…”