Comparison of the posterior approach versus the dorsal approach in the treatment of congenital vertical talus

The purpose of this study was to compare retrospectively the results of a s ingle-stage dorsal approach versus the posterior approach for the surgical treatment of congenital vertical talus (CVT) at a single institution. Twent y-four patients (33 feet) with CVT were treated surgically between 1960 and 1998. Eighteen patients (25 feet) underwent a posterior release (group 1), and six patients (eight feet) underwent surgery via the dorsal approach (g roup 2). All patients were evaluated at a minimal follow-up of 3 years. Pre operative and follow-up radiographs were evaluated, and a modified version of the clinical score by Adalaar was used. Group 1 had 45 procedures on 25 feet, whereas group 2 had no repeated or revision operations. The clinical score was 6.75 for group 1 and 8.0 for group 2. Tourniquet time was 123 min utes and 87 minutes for groups 1 and 3, respectively. Twelve group 1 patien ts (48%) had avascular necrosis (AVN) versus none of the group 2 patients. Both groups had similar preoperative and postoperative radiographic measure ments. Both approaches were able to reduce successfully the talonavicular j oint; however, the single-stage dorsal incision group required significantl y less operative time, had better clinical scores, and had fewer complicati ons 3 years after surgery.