Background: The treatment of idiopathic congenital vertical talus
has traditionally consisted of manipulation and application of casts followed
by extensive soft-tissue releases. However, this treatment is often followed
by severe stiffness of the foot and other complications. The purpose of this
study was to evaluate a new method of manipulation and cast immobilization,
based on principles used by Ponseti for the treatment of clubfoot deformity,
followed by pinning of the talonavicular joint and percutaneous tenotomy of
the Achilles tendon in patients with idiopathic congenital vertical talus.
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.