Serial Casting for Neuromuscular Flatfoot and Vertical Talus in an Adolescent With Hereditary Spastic Paraplegia

Abstract

Individualized multiphase serial casting requires further investigation with patients such as those with hereditary spastic paraplegia.

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

“…Through a dorsal approach, he tenotomized the extensor digitorum longus, peroneus tertius, extensor hallucis longus, and tibialis anterior as well as performed a capsulotomy of the talonavicular joint. Excellent cosmetic results were reported but functional outcomes, 19,2015 including the ability to dorsiflex toes or ankles, were not described. The advantage of the minimally invasive approach that we utilized in the current study is that it relies on serial casting to gradually stretch the dorsolateral soft tissues so that, unlike with Seimon's approach, tenotomies of the dorsolateral tendons are not necessary and in most cases the talonavicular joint is fully reduced with casting alone.…”

“…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.…”

“…T 19,2015 manipulation and casting followed by percutaneous talonavicular joint pinning and percutaneous Achilles tenotomy to correct hindfoot equinus, followed by shoe-and-bar bracing once casting is complete and the pin is removed 17,18,27 . All of the isolated vertical tali in this study were reduced with the above treatment protocol.…”