SLR - May 2021 - Rachel Egdorf-Gerber
Reference: Hafez M, Davis N. Outcomes of a Minimally Invasive Approach for Congenital Vertical Talus With a Comparison Between the Idiopathic and Syndromic Feet. J Pediatr Orthop. 2021 Apr 1;41(4):249-254.Level of Evidence: Level 4- case series
Scientific Literature Review
Reviewed By: Rachel Egdorf-Gerber, DPM
Residency Program: AMITA Health St. Joseph Hospital – Chicago, IL
Podiatric Relevance: Congenital Vertical Talus (CVT) is a rare condition that can be treated by podiatric surgeons. Due to the rarity of the condition, few studies include multiple patients and have a long term follow up component. This study looks at minimally invasive treatment work for idiopathic and syndromic congenital vertical talus utilizing radiologic, clinical and patient reported outcomes.
Methods: All patients with idiopathic or syndromic CVT treated within a 10 year period that had radiographs and notes available were included in this retrospective study. Preoperative, immediate post-operative and the latest radiographs were evaluated. The talus axis first metatarsal base angle (TAMBA) and talocalcaneal (TC) angle on all radiographs were recorded. All feet were also evaluated clinically and patients completed the Roye patient reported outcomes questionnaire (scores between 10 & 40, lower scores equivalent with better function). Treatment consisted of weekly manipulation and casting, followed by surgery. Surgical correction included talonavicular (TN) joint reduction and fixation with a K wire and percutaneous Achilles tenotomy.
Results: Thirty feet in 21 patients were evaluated, 13 of these were idiopathic and 17 were syndromic. The mean follow up was 77 months (14-123 months). Patients had an average of 5 lower limb casts (2-12 casts) before closed reduction with wire fixation was completed in 29 feet and open reduction of the TN was necessary in one foot. On radiographs, the anterioposterior (AP) TC corrected by average of 20 degrees and the AP TAMBA corrected by average of 28 degrees. On lateral radiographs, the TC corrected by average of 14 degrees and TAMBA corrected by average of 34 degrees. Recurrence occurred in 16 percent (five feet in three patients); all of which were in syndromic cases (29 percent recurrence rate in syndromic cases). Fourteen of the 21 patients completed the Roye questionnaire with the average score being 11 for idiopathic patients and 22 for syndromic cases. There was no significant difference in ROM between the idiopathic and syndromic groups.
Conclusions: This is the largest group of CVT patients in published literature. All radiographic angles were improved by an average of 14-34 degrees postoperatively Recurrence in this study (16%), is similar to previously reported literature and should be a complication discussed with the patient and parents in detail before surgery. Idiopathic CVT cases had a lower rate of recurrence, compared to syndromic cases. The Roye patient reported outcome scores were satisfactory in all patients, however patients with idiopathic CVT once again had better scores than the syndromic cases. These differences between the idiopathic and syndromic groups may both be due to associated conditions in syndromic feet causing complications and recurrence. Overall 29 of the 30 feet were corrected with manipulation, casting, and minimally invasive CVT treatment. This suggests minimally invasive treatment is an appropriate option for patients with CVT and that supplementary procedures such as tibialis anterior tendon transfers and anterolateral releases are not necessary.