Naviculectomy for two ambulatory children with intractable congenital vertical talus: redefining the indications of an old technique

Abstract

Congenital vertical talus is a rare and complex foot anomaly. Serial casting with or without minimally invasive surgery is a universal management strategy especially for children in the first year of life. Nevertheless, extensive surgical treatment of late-presenting, neglected and multiple operated children with congenital vertical talus may be required with guarded results. The results of naviculectomy as a more conservative intervention and directed exclusively at ambulatory children with intractable congenital vertical talus have not been reported. We present the radioclinical outcomes of two ambulatory children with intractable congenital vertical talus treated by naviculectomy/midtarsal resection and limited soft tissue release. One child had an isolated congenital vertical talus whereas the other had a nonisolated etiology. Generally, naviculectomy/midtarsal resection revealed a positive benefit-risk profile in children with intractably severe congenital vertical talus on the short-term. We reported favorable results in terms of foot appearance, function and radiology. We believe that a less invasive procedure like naviculectomy/midtarsal resection is an encouraging technique to investigate in children with intractable congenital vertical talus.

An Algorithmic Approach to the Congenital Vertical Talus

“…El-Sobky et al have also described removing the navicular and the medial cuneiform in a 5-year-old child with arthrogryposis with good results at 2 years. 25 Like this author, they avoid talectomy in ambulatory children. 25 Copyright © 2022 JPOSNA® www.jposna.org…”

“…El-Sobky et al also describe attaching the tendon to the plantar medial TNJ capsule in combination with a naviculectomy. 25 Although the efficacy of these transfers has not been studied, the split transfer may be a safer option than a full transfer, as it does not alter muscle balance while providing internal support for the talus. Complete transfer of the tibialis anterior could lead to worsening muscle imbalance and possible development of a cavus foot deformity, as it leaves the peroneus longus unopposed.…”

“…After age 2 to 3 years, the medial column overgrowth may be too significant for a reduction of the TNJ with a minimally invasive or soft tissue-only approach. Naviculectomy can be performed through a medial or dorsal approach 25 (Figures 15 and 16). The tibialis posterior should be carefully detached from the navicular and advanced to the medial cuneiform and residual TNJ capsule plantarmedially.…”

“…15 Dobbs et al reported the first study showing short-term maintenance of good correction in 19 idiopathic congenital vertical talus deformities treated with a reverse-type Ponseti casting followed by minimally invasive surgery of percutaneous Achilles tenotomy and limited open talonavicular joint (TNJ) capsulotomy with pinning. 15 Other surgical options have included one-stage 5,12,[16][17][18][19][20] and two-stage dorsolateral and posterolateral soft tissue releases, 3,21,22 talectomy, 1,23 naviculectomy with and without adjacent removal of the medial cuneiform, [23][24][25] subtalar arthrodesis, and triple arthrodesis. [26][27][28] Currently, surgeons generally perform the minimally invasive Dobbs Technique.…”

Outcomes of Naviculectomy for Severe Recurrent Clubfoot Deformity

“…1,7,17 Historically, combined medial and lateral column procedures were often employed to correct resistant foot deformities secondary to TEV or congenital vertical talus. 7,9 Naviculectomy was originally described as a salvage procedure primarily for cases of resistant congenital vertical talus deformity. 2,3 Mubarak and Dimeglio expanded the use of this procedure in children with rigid cavus deformity.…”