New Technique for the Single Stage Management of Congenital Vertical Talus by Percutaneous Tenotomies, Open Talonavicular Reduction and Percutaneous K-Wire Fixation
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- Category: Vol. 83, September 2015
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New Technique for the Single Stage Management of Congenital Vertical Talus by Percutaneous Tenotomies, Open Talonavicular Reduction and Percutaneous K-Wire Fixation, MOHAMED M. HEGAZY, SHERIF M. ISMAIL, AHMAD S. HASSAN and IBRAHEM S. HANTERA
Abstract
Background: Management of Congenital Vertical Talus (CVT) may depend upon the age of initial presentation. Early management may involve a trial of single stage correction, a two-stage correction, or the addition of subtalar arthrodesis. These procedures are associated with a high complication rates.
Methods: A prospective cohort of 20 feet (11 patient) with CVT all under 30 months of age of both idiopathic and teratologic variety is presented. The condition was treated by a novel technique utilizing percutaneous tenotomies of the tibialis anterior, extensor digitorum, extensor hallucis longus, peroneal longus and brevis tendons, along with the Achillis tendon. This was combined with a minimal midfoot incision to allow for reduction and K-wire fixation of the talonavicular and calcaneocuboid joints, followed by plication of the spring ligament. Patients then were casted in an above knee cast for 8 weeks. Following which, a below knee orthotic with medial arch support was applied for one year.
Results: Minimum follow-up period was for twenty months. Results were evaluated using the 10-point system developed by Adelaar et al., initial correction was achieved in all cases with significant improvement of radiological parameters (p<0.05). There were two cases of relapse (in a bilateral case diagnosed as Escobar syndrome).
Conclusion: The described technique appears to give initial promising results. The recurrence rate is statistically related to later age of management and to teratologic varieties. However, this rate still appears to be lower than reported complication rate associated with the more extensive open surgical techniques.
Level of Evidence: Level IV case series study.