Recent Trends in Treatment of Congenital Vertical Talus
Mohab Essam Abo Alyazid Elkilany;
Abstract
Congenital vertical talus is a rare anomaly characterized by dorsal dislocation of the talonavicular joint with the talus locked in vertical position.
Clinically, the foot has a rocker bottom appearance with convex plantar surface, the forefoot is abducted, and the hind foot is in marked valgus and equines. The child has an awkward and clumsy gait with distortion of the shoes due to fixed valgus deformity of the heel.
CVT can be diagnosed radiologically by antroposterior, lateral radiographs and lateral radiograph in plantar flexion. The x-rays shows dorsal talonavicular dislocation with vertical position of the talus which could not be reduced with plantar flexion of the foot.
Treatment options of CVT vary according to the age of the patient.
Conservative treatment alone has little role in treatment of CVT. It only helps in lengthening of tight soft tissues for limiting the surgical procedures.
The exact surgery indicated is determined by the age of the child and the severity of the deformity. Children 1 to 4 years old generally are best treated by open reduction and realignment of the talonavicular and subtalar joints. Occasionally, in children 3 years of age or older who have a severe deformity, navicular excision is required at the time of open reduction. Children 4 to 8 years old can be treated by open reduction and soft tissue procedures combined with extraarticular subtalar arthrodesis. Children 12 years old or older are best treated by triple arthrodesis for permanent correction of the deformity.
65
Recently, a new method of treatment depend on serial casting and manipulations of the foot in inversion and equines followed by minimal surgical intervention including Achilles lengthening, lengthening of contracted dorsal foot tendons and open reduction of the talonavicular joint through minimal incision.
A few modifications were applied to the technique originally described by Dobbs.
These modifications included the manipulation technique and the postoperative period as regard the use of the bar brace and stretching exercises. Those modifications , resulted in excellent short-term correction of the deformity while preserving subtalar and ankle motion in patients with rigid congenital vertical talus associated with neuromuscular and/or genetic syndromes.
Clinically, the foot has a rocker bottom appearance with convex plantar surface, the forefoot is abducted, and the hind foot is in marked valgus and equines. The child has an awkward and clumsy gait with distortion of the shoes due to fixed valgus deformity of the heel.
CVT can be diagnosed radiologically by antroposterior, lateral radiographs and lateral radiograph in plantar flexion. The x-rays shows dorsal talonavicular dislocation with vertical position of the talus which could not be reduced with plantar flexion of the foot.
Treatment options of CVT vary according to the age of the patient.
Conservative treatment alone has little role in treatment of CVT. It only helps in lengthening of tight soft tissues for limiting the surgical procedures.
The exact surgery indicated is determined by the age of the child and the severity of the deformity. Children 1 to 4 years old generally are best treated by open reduction and realignment of the talonavicular and subtalar joints. Occasionally, in children 3 years of age or older who have a severe deformity, navicular excision is required at the time of open reduction. Children 4 to 8 years old can be treated by open reduction and soft tissue procedures combined with extraarticular subtalar arthrodesis. Children 12 years old or older are best treated by triple arthrodesis for permanent correction of the deformity.
65
Recently, a new method of treatment depend on serial casting and manipulations of the foot in inversion and equines followed by minimal surgical intervention including Achilles lengthening, lengthening of contracted dorsal foot tendons and open reduction of the talonavicular joint through minimal incision.
A few modifications were applied to the technique originally described by Dobbs.
These modifications included the manipulation technique and the postoperative period as regard the use of the bar brace and stretching exercises. Those modifications , resulted in excellent short-term correction of the deformity while preserving subtalar and ankle motion in patients with rigid congenital vertical talus associated with neuromuscular and/or genetic syndromes.
Other data
| Title | Recent Trends in Treatment of Congenital Vertical Talus | Other Titles | الطرق الحذيثة لعلاج التشوه الخلقي الرأسي في عظمة العقة | Authors | Mohab Essam Abo Alyazid Elkilany | Issue Date | 2015 |
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