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

Abstract

Introduction The traditional treatment for congenital vertical talus, which involves serial casting and extensive soft-tissue releases, has been associated with severe stiffness and other complications in adolescents and adults. Our hypothesis is that favorable results will be obtained using the Dobbs method of serial manipulation, casting, and limited surgery for vertical talus correction, even in older children and syndromic cases. Therefore, the present study aimed at evaluating the Dobbs method in such cases. Materials and methods We treated 15 feet of 10 patients (aged from 1 month to 9 years) using manipulation and serial casting or the reverse Ponseti method followed by percutaneous Achilles tenotomy and limited open reduction of the talonavicular joint. All patients were evaluated both clinically and radiologically in a mean follow-up period of 2 years. Results After 2 years, all patients had plantigrade and flexible feet with good radiographic correction. The mean talocalcaneal angle before (70.5°± 10.5) and after (31°± 5.2) treatment and the talar axis metatarsal base angle before (60°± 11.4) and after (15°± 6.7) treatment were significantly improved (P \ 0.001). Discussion Recent research has shown that manipulation and serial casting followed by limited surgery (Dobbs method) was successful in treating idiopathic congenital vertical talus. Our results also showed that this method resulted in an excellent outcome in both idiopathic and syndromic congenital vertical talus, even in older children.

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.…”

“…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.…”

The 2017 ABJS Nicolas Andry Award: Advancing Personalized Medicine for Clubfoot Through Translational Research

“…6A) resulting in functional anterograde feet (Fig. 6B), patients with complex clubfoot [61], and patients who previously were treated with extensive surgery [7] but had severe relapse [31]. While these patients are more difficult to treat, often undergoing more casting to correct and having a higher risk of recurrence, their outcomes can be excellent and their treatment rewarding.…”

The Foot and Ankle: Congenital and Developmental Conditions

“…It is a rare condition, with an incidence of 1 in 10,000 births [ 53 ]. It may be slightly more common in males and is often bilateral [ 54 ].…”