Treatment of congenital vertical talus by reverse Ponseti technique

Abstract

Background Congenital vertical talus (CVT), also known as congenital convex pes valgus, is a rigid flatfoot deformity characterized by fixed hindfoot equinus and an irreducible talonavicular dislocation. This deformity can either be idiopathic and isolated or can occur with other conditions such as neural tube defects (myelomeningocele and spina bifida occulta), neuromuscular disorders like cerebral palsy and anterior horn cell disease, and in chromosomal aberrations like Down’s syndrome. The use of serial manipulation and plaster cast treatment followed by minimal surgical interventions has provided good early results in the treatment of idiopathic CVT. The method of cast correction of a vertical talus is based on a specific way of manipulating the foot so as to gradually reduce the talonavicular joint. The principles are similar to those used in the Ponseti method of clubfoot correction. Aim of the study To evaluate the management and the outcome of patients with CVT managed with reverse Ponseti technique, and minimal surgical intervention. Patients and methods This prospective study included 25 feet in 17 patients with CVT, comprising eight patients with bilateral and nine with unilateral involvement. The study was done at the new Children Hospital Cairo University between January 2013 and December 2015. The follow-up period ranged from 10 to 14 months, with an average period of 11.6 months. Inclusion criteria were patients diagnosed to have idiopathic CVT and no age limit, and exclusion criteria were previous operative release and cases associated with neuromuscular disorders or syndromes. Results Three (12%) cases were classified as excellent, 12 (48%) cases were classified as good, eight (32%) cases were classified as fair, and two (8%) cases were classified as poor. Conclusion Favorable results were obtained using the reverse Ponseti method of closed manipulation and then limited open reduction and fixation with a pin in the talonavicular joint and percutaneous Achilles tenotomy. There were also fewer complications compared with extensive operative treatments, by avoiding more extensive surgery.