This Article Full Text Full Text (PDF) CME: Take the activity for this article: CME 2: April, May, June 2006 (publication date July 5, 2006; expiration dat... [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in JBJS Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dobbs, M. B. Articles by Morcuende, J. A. Search for Related Content PubMed PubMed Citation Articles by Dobbs, M. B. Articles by Morcuende, J. A. Related Collections Pediatrics Social Bookmarking             What's this?

Early Results of a New Method of Treatment for Idiopathic Congenital Vertical Talus

¹ Department of Orthopaedic Surgery, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO 63110. E-mail address for M.B. Dobbs: dobbsm{at}wudosis.wustl.edu
² Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242

Investigation performed at Washington University School of Medicine, St. Louis, Missouri, and University of Iowa Hospitals and Clinics, Iowa City, Iowa

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: The cases of eleven consecutive patients who had a total of nineteen feet with an idiopathic congenital vertical talus deformity were retrospectively reviewed at a minimum of two years following treatment with serial manipulations and casts followed by limited surgery consisting of percutaneous Achilles tenotomy (all nineteen feet), fractional lengthening of the anterior tibial tendon (two) or the peroneal brevis tendon (one), and percutaneous pin fixation of the talonavicular joint (twelve). The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic measurements obtained at these times were compared. In addition, the radiographic data at the final evaluation were compared with normal values for an individual of the same age as the patient.

Results: Initial correction was obtained both clinically and radiographically in all nineteen feet. A mean of five casts was required for correction. No patient underwent extensive surgical releases. At the final evaluation, the mean ankle dorsiflexion was 25° and the mean plantar flexion was 33°. Dorsal subluxation of the navicular recurred in three patients, none of whom had had pin fixation of the talonavicular joint. At the time of the latest follow-up, there was a significant improvement (p < 0.0001) in all of the measured radiographic parameters compared with the pretreatment values, and all of the measured angles were within normal values for the patient's age.

Conclusions: Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographically at a minimum two years, in patients with idiopathic congenital vertical talus.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

Related articles in JBJS:

Early Results of a New Method of Treatment for Idiopathic Congenital Vertical Talus. Surgical Technique

Matthew B. Dobbs, Derek B. Purcell, Ryan Nunley, and Jose A. Morcuende
JBJS 2007 89: 111-121. [Abstract] [Full Text]  

This article has been cited by other articles:

				W. N. Sankar, J. Weiss, and D. L. Skaggs Orthopaedic Conditions in the Newborn J. Am. Acad. Ortho. Surg., February 1, 2009; 17(2): 112 - 122. [Abstract] [Full Text] [PDF]

				D. J. Sucato and Y.-J. Kim What's New in Pediatric Orthopaedics J. Bone Joint Surg. Am., May 1, 2007; 89(5): 1141 - 1150. [Full Text] [PDF]

				M. B. Dobbs, D. B. Purcell, R. Nunley, and J. A. Morcuende Early Results of a New Method of Treatment for Idiopathic Congenital Vertical Talus. Surgical Technique J. Bone Joint Surg. Am., March 1, 2007; 89(2_suppl_1): 111 - 121. [Abstract] [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2006 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.