CONGENITAL VERTICAL TALUS - PROCEDURE AND RESULTS OF A ONE-STAGE SURGICAL-CORRECTION

Purpose of the study The aim of this study was to emphasize the anatom ical particularities of congenital vertical talus. We propose a one st age operative procedure adapted to the deformities. Materials and meth ods A retrospective study of 24 childrens with congenital vertical tal us was conducted. An etiology was observed in 58 per cent of cases and 42 per cent were considered as idiopathic. From a radiological analys is of 39 feet, we precise the anatomical particularities. We used ante roposterior and lateral X-ray and lateral stress views with maximal pl antar and dorsal flexion. Most of the lesions were localized in the mi dtarsal joint. The irreducibility of the talonavicular dislocation is the predominant lesion. it is usually associated with a desorientation of the cubocalcaneal joint. The articular surfaces are desorganised w ith a dorsal orientation. There is a variable amount of equinus deform ity in the hindfoot. However the talocalcaneal divergence angle is nea rly normal. The forefoot is most of the times in eversion but sometime s in inversion. Procedure All childrens were treated initially by phys iotherapy. We recommend operative treatment for them between one to tw o years old. After a soft tissue release, the talonavicular dislocatio n and the hind foot equinus deformity is reduced simultaneously. The s ubtalar joint is respected and not opened. Retracted tendons may be an obstacle to the reduction. They must be lenghtened if necessary espec ially the Achilles tendon, the peronei, the extensors and the tibialls anterior. Reduction is maintained by a K wire transfixing the midtars al joint. Results Clinical results were difficult to evaluate. Out of 24 operated feet, a satisfactory outcome had been achieved in 15 feet. All were plantigrad and 18 had a good cosmetically aspect. The only b ad result concerned an old case which was not operated by this techniq ue. Discussion and conclusion Conservative treatment is usuary unsucce ssful in congenital vertical talus. Numerous procedures have been advo cated for the surgical correction of this deformity. Some authors advi sed excision of the navicular, full open peritalar release or extraart icular talocalcaneal arthrodesis. These are often extensive procedures and most are performed in two stages. Recently, one stage operative p rocedure was proposed. It allows a good correction with the respect of the subtalar joint and a lower risk of talus avascular necrosis. Furt herwere it is more adapted to the deformity with a less extensive scar and a better respect of the anatomy.