Functional Outcomes of Talectomy in Pediatric Feet

Abstract

Background: Historically, talectomy has been predominantly performed to operatively treat severely rigid equinovarus feet. A limited number of investigators have studied functional outcomes in pediatric patients posttalectomy. We aimed to assess the outcomes of pediatric patients undergoing talectomy using the American Orthopaedic Foot & Ankle Society (AOFAS) score and a subjective survey of patients’ and their caregivers’ satisfaction. Methods: We performed a retrospective cohort study that included 31 patients with nonidiopathic severely rigid talipes equinovarus, in a single center, using consecutive sampling. All medical records of those patients were reviewed, and relative data were extracted. The AOFAS score was used to measure the outcomes during the last visit (April 2020). Satisfaction was evaluated in a binary manner by questioning the patients and their caregivers if they would undergo the same surgery again for the same result. Results: Thirty-one patients were included. Myelomeningocele was the primary diagnosis in 13 patients (41.9%), and arthrogryposis was diagnosed in 11 patients (35.5%). Twenty-two patients had bilateral procedures. The mean age at the time of surgery was 6.0 ± 3.0 years, and the mean follow-up was 6.0 ± 1.0 years. Plantigrade feet following the primary surgery were achieved in 88.5% of cases. Postoperatively, braces were well tolerated in 86.5% of patients. Deformity recurrence was observed in 21.2% of patients, and 17.3% of patients required subsequent surgeries. Patients with arthrogryposis had significantly higher AOFAS scores than those with myelomeningocele and other diagnoses ( P = .017). Further, patients who tolerated braces had higher AOFAS scores than those who did not tolerate braces ( P = .006). However, patients who developed hindfoot varus and dorsal bunion postoperatively had lower AOFAS scores ( P = .054 and P = .006, respectively). Patients who had recurrent deformities or required further surgeries also had lower AOFAS scores ( P = .025 and P = .015, respectively). Although 17.3% of patients were not able to comment about their satisfaction due to their general medical condition, 63.5% of patients reported that they were satisfied. Furthermore, 75.0% of caregivers were satisfied with the outcomes and their children’s functional status posttalectomy. Conclusion: The observed outcomes of primary and salvage talectomies demonstrate the general overall effectiveness of this operative intervention as an end-stage treatment for pediatric patients with severely rigid talipes equinovarus. Level of Evidence: Level III; retrospective cohort study.

Disability and Quality of Life After Talectomy for Arthrogryposis Multiplex Congenita

“…Some studies suggest that mild residual deformities may not limit walking ability or affect the comfort of the patient, 8,11,14,18 whereas others recommend surgical correction because these residual deformities are painful and severely reduce functionality. 1,15,17 In our study, when the foot was plantigrade, the presence of only forefoot supination among postoperative residual deformities after talectomy decreased functional scores. The presence of hindfoot varus, midfoot adductus, and dorsal bunion did not affect functional scores.…”

“…It is known that many residual deformities occur in the long term after the removal of the talus. 1,2,4,7,8,11,[13][14][15]17,18 It remains controversial which of these postoperative residual deformities are amenable to surgical correction and which, if corrected, are likely to result in better function. Some studies suggest that mild residual deformities may not limit walking ability or affect the comfort of the patient, 8,11,14,18 whereas others recommend surgical correction because these residual deformities are painful and severely reduce functionality.…”

“…The aim of talectomy is to provide a stable and plantigrade In the literature, residual or recurrent deformity, tibiocalcaneal fusion, and osteoarthritis have all been reported following talectomy in patients with AMC. 1,[3][4][5]13,18 Outcomes studies of talectomy have generally focused on whether the foot is plantigrade and on the presence of residual deformities. 3,13,15,18 The effect of residual deformity after talectomy on functional status of patients has not been adequately clarified.…”