Reverse Ponseti-type method plus mini-invasive approach for congenital vertical talus in young children

Abstract

Objective To explore the clinical efficacies and surgical of reverse Ponseti-type method plus mini-invasive approach for children with congenital vertical talus. Methods Between July 2012 and December 2015, 11 consecutive patients with a total of 18 feet with congenital vertical talus were retrospectively reviewed after undergoing reverse Ponseti method plus mini-invasive approach. There were 8 boys and 3 girls with an average age of 10.9 (3.9-31.2) months. Serial manipulations and casting were followed by percutaneous Achilles tenotomy, casting or other limited procedures if necessary. They were evaluated clinically and radiographically at the time of presentation, immediately postoperatively and at the time of the latest follow-up. Also Adelaar scoring system and subtalar and ankle range of motion were used for evaluating clinical effects at the latest follow-up. Results All 18 feet achieved initial correction both clinically and radiographically during an average follow-up period of 27 (12-57) months. However, 2 patients with 4 feet had recurrent deformity within 6 months of initial procedure and underwent serial manipulations and casting followed by pinning of talonavicular joint without an extensive soft-tissue release. According to the Adelaar scoring system, the outcomes were excellent (n=2), good (n=15) and fair (n=1). There was neither wound necrosis nor stiffness of ankle & subtalar joints. At the final evaluation, the mean ankle dorsiflexion was (20.89±9.28)° and the mean plantar flexion (18.50±6.89)°. Significant differences existed (P<0.05) in all radiographic parameters, including AP-TCA (anteroposterior-talocalcaneal angle) [(31.60±27.77)° vs (49.65±13.00)°], AP-TAMBA (anteroposterior-talus axial-first metatarsal base angle) [(12.79±2.48) vs (42.90±18.01) ]; L-TCA (lateral-talocalcaneal angle) [(44.57±6.71) vs (55.22±11.20) ], L-TAMBA (lateral-talus axial-first metatarsal base angle) [(9.40±2.83) vs (55.63±13.36)] and L-TICAA (lateral-tibiocalcanean angle) [(67.14±5.71) vs (119.51±17.52) ] as compared with preoperative values at the latest follow-up. Conclusions In the terms of clinical appearance, foot function and radiographic measured results, reverse Ponseti-type method plus mini-invasive approach offers early excellent outcomes for congenital vertical talus. Key words: Congenital vertical talus; Microtraumatic operation; Efficacy