Clinical efficacies of mini-invasive procedure for congenital vertical talus in young children

Abstract

Objective To assess the clinical efficacies of patients with congenital vertical talus (CVT) undergoing mini-invasive procedure (MIP) and incorporating early treatment of manipulation and serial casting. Methods From June 2011 to June 2015, the clinical records of 16 CVT infants (30 feet) were retrospectively reviewed. They underwent manipulation and serial casting plus MIP. Casting was applied for 12 weeks postoperatively and followed by wearing plantar flexion position orthosis for 23 hours daily over 3 months, 20 hours subsequently until walking age and then nightly until 4 years old. All of them were available for clinical and radiological follow-ups. And the Adelaar scoring system was utilized for assessing clinical outcomes and Hamanishi system for analyzing radiological parameters. Results The average follow-up period was 43.2 (12-63.6) months. All cases achieved good appearances and arches without obvious dysfunctions. Profiles of subtalar joint and ankle dorsiflexion: preoperative/postoperative 10° (0° to 20°)/22.5 (5° to 35°) (P<0.01) and plantar flexion: preoperative / postoperative -10° (-20° to 0°)/22.5 (5° to 35°) (P<0.001). The outcomes were excellent (83.7%), good (10%) and fair (3.3%). All could walk with normal shoes. Radiology showed one case of ischemic necrosis of talus head. Radiologically there was a statistically significant postoperative improvement of measured angles as compared to preoperative values (P<0.001). All radiological parameters were within normal ranges. Conclusions Manipulation and serial casting plus MIP (close reduction or small-incision open reduction of talonavicular joint) for CVT yield excellent outcomes. And mini-invasiveness and little scarring offer better long-term ankle functions and using orthosis prevents the recurrence of deformities. Key words: Vertical talus, congenital; Manipulation, orthopedic; Minimally surgical procedures