Reverse Ponseti-type treatment for children with congenital vertical talus

Abstract

Children with congenital vertical talus (CVT) have been treated with extensive soft-tissue releases, with a high rate of complications. Recently, reverse Ponseti-type casting followed by percutaneous reduction and fixation has been described, with excellent results in separate cohorts of children with CVT, of either idiopathic or teratological aetiology. There are currently no studies that compare the outcome in these two types. We present a prospective cohort of 13 children (21 feet) with CVT of both idiopathic and teratological aetiology, in which this technique has been used. Clinical, radiological and parent-reported outcomes were obtained at a mean follow-up of 36 months (8 to 57). Six children (nine feet) had associated neuromuscular conditions or syndromes; the condition was idiopathic in seven children (12 feet). Initial correction was achieved in all children, with significant improvement in all radiological parameters. Recurrence was seen in ten feet. Modification of the technique to include limited capsulotomy at the initial operation may reduce the risk of recurrence. The reverse Ponseti-type technique is effective in the initial correction of CVT of both idiopathic and teratological aetiology. Recurrence is a problem in both these groups, with higher rates than first reported in the original paper. However, these rates are less than those reported after open surgical release.

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.…”

A comparison of the Dobbs method for correction of idiopathic and teratological congenital vertical talus

“…The results from this method of correction in both idiopathic and those with associated neuromuscular or genetic conditions have been excellent [ 12 , 13 ]. As the Dobbs method is a less invasive approach, it appears to avoid the risks associated with more extensive soft tissue releases [ 13 , 14 ].…”

Child with a Lower Extremity Trouble

“…Güncel yaklaşım; idiopatik ve teratolojik etiolojiye rağmen reverse ponseti tekniğiy-le seri alçılama, bu esnada perkütan redüksiyon ve fiksasyon uygulaması sayesinde mükemmel sonuçlar bildirilmiştir. [36] Dobbs metoduyla limitli cerrahi ve seri alçıla-ma tekniğide benzer bir yöntemdir ve mükemmel sonuçlar bildirilmiştir. [ …”