Minimally Invasive Approach for the Treatment of Non-Isolated Congenital Vertical Talus

Abstract

Serial manipulation and casting followed by limited surgery, consisting of percutaneous tenotomy of the Achilles tendon and a small medial incision to either palpate the talonavicular joint or perform capsulotomies of the talonavicular joint and the anterior aspect of the subtalar joint to ensure accurate reduction and pin fixation, result in excellent short-term correction of the deformity while preserving subtalar and ankle motion in patients with rigid congenital vertical talus associated with neuromuscular and/or genetic syndromes.

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

“…As sample size limitations precluded an examination of the possible interaction between the treatment group and the underlying syndrome and/or neuromuscular condition, we were unable to statistically determine whether the underlying etiology impacts treatment outcomes. However, because vertical talus, like many musculoskeletal disorders, is genetically and etiologically heterogeneous, the underlying cause is likely to affect outcomes, as studies (including ours) suggest 10,19,20,22,23,25 .…”

“…In some of the more rigid non-isolated vertical tali in which serial casting does not achieve full correction, then a selective capsulotomy of the anterior subtalar joint completes the correction 10 . Following the first description of this minimally invasive method for the treatment of congenital vertical talus 17,18 , many centers replicated a high success rate for achieving initial clinical and radiographic correction for both isolated and non-isolated vertical tali 10,[19][20][21][22][23][24][25][26]32 . However, the follow-up was less than two years in those studies, and none had a comparison cohort treated with traditional surgical techniques.…”

“…Indeed, primary muscle abnormalities have been found on muscle biopsies in some cases 9 . Although both isolated and non-isolated vertical tali pose treatment challenges, it is generally accepted that non-isolated cases are more rigid and less responsive to treatment 10,11 . The challenge in treating vertical talus is how to best achieve the desired outcome of a mobile, plantigrade, painfree, and functional foot.…”

“…A minimally invasive technique for correcting vertical talus that relies primarily on serial casting was introduced almost ten years ago 17,18 . Multiple centers have reproduced the effectiveness of this technique in achieving initial correction (both radiographically and clinically), while maintaining excellent motion in the foot and ankle, for patients with both isolated and non-isolated vertical talus 10,[19][20][21][22][23][24][25][26] . In the present study, we compare the long-term outcomes of clinical and radiographic correction, foot function, and foot and ankle flexibility in patients with vertical talus (isolated and non-isolated) treated with either the minimally invasive method 17 or extensive soft-tissue release surgery.…”

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

“…Department of Orthopedics, Shohada Hospital, Tabriz University of Medical Science, Tabriz, Iran e-mail: Dr_Aslani73@yahoo.com surgery that has been successful for both isolated vertical talus and syndromic vertical talus [12,13]. This was a less invasive method in correcting the vertical talus, and it has been proved that the method produces more favorable results in the long term than extensive surgical methods [14].…”