Abstract
PurposeDeformation of the talus in idiopathic congenital clubfeet is a known problem after treatment. However evidence on types of talus deformation and clinical relevance is rare. The aims of this study were first to define different types of talus deformation, and second, to evaluate the impact of these types on long-term results.MethodsAt a minimum follow-up of ten years 40 idiopathic clubfeet treated by a modified dorsomedial release were analyzed. Based on morphological appearance and the widened range of radius to length ratios (R/L-ratio) in treated clubfeet deformed tali were divided into two groups: tali with decreased R/L-ratios were classified as small-dome talus deformation (SD), tali with increased R/L-ratios were classified as flat-top talus deformation (FT). The impact on degree of arthrosis in the ankle joint, clinical outcome, and ankle range of motion was analyzed.ResultsSmall-dome talus deformation (SD) was found in nine feet. This group showed decreased R/L-ratios and increased talus opening angles, which were linked to an increased range of motion of the ankle joint (p = 0.033). The impact on onset of arthrosis was not significant for this group (p = 0.056). The group of flat top talus deformation (nine feet) showed increased R/L-ratios and decreased talus opening angles, decreased range of motion (p = 0.019), and a significant impact on onset of arthrosis (p = 0.010).ConclusionOur study defines a new subgroup of talus deformation: the small dome talus deformation tends to show a better ankle joint range of motion and a lower risk of arthrosis compared to the classical flat dome talus deformation.
Highlights
Idiopathic congenital clubfoot (ICF) is a complex and relatively common deformity with a prevalence of between 0.6 and 6.8 per 1000 births [1]
Controls Controls Controls Normal shaped talus Small dome talus Flat top talus
Normal shaped talus Flat top talus Small dome talus Flat top talus Normal shaped talus Small dome talus p-value
Summary
Idiopathic congenital clubfoot (ICF) is a complex and relatively common deformity with a prevalence of between 0.6 and 6.8 per 1000 births [1]. The complexity of the deformity is based on the combination of equinus, hindfoot-varus, forefoot-adductus, and cavus deformity of the foot. Clubfoot deformity varies in terms of severity and stiffness [2, 12]. While the cause of idiopathic clubfoot deformity remains unknown, pathologic abnormalities of muscles, soft tissues, nerve abnormalities, and vascular anomalies have been reported [3]. An association to other congenital disorders like developmental dysplasia of the hip has been controversially discussed among the literature [4,5,6].
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