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

Abstract

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. We treated 15 feet of 10 patients (aged from 1month to 9years) 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 2years. After 2years, 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). 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.