SLR - December 2022 - Chloe F. Sakow, DPM, MPH
Title: Talectomy for Arthrogrypotic Foot Deformities: A Systematic ReviewReference: Chergui, S., Al-Ali, H., Marwan, Y., Abu Dalu, K., Dahan-Oliel, N., Hamdy, R. C. “Talectomy for arthrogrypotic foot deformities: A systematic review”. Foot and Ankle Surgery. 10 October 2022. https://doi.org/10.1016/j.fas.2022.10.002
Level of Evidence: Level III
Reviewed By: Chloe F. Sakow, DPM, MPH
Residency Program: Regions Hospital/HealthPartners Institute – St. Paul, MN
Podiatric Relevance: One of the most common congenital joint contracture syndromes, arthrogryposis multiplex congenita (AMC), can involve extensive ankle and hindfoot deformities, most notably equinovarus and clubfoot deformities. There is little literature regarding the treatment of rigid cavovarus and equinovarus AMC contractures and there are no current guidelines on talectomy as a possible treatment in the pediatric population.
Methods: Articles were found using Embase and Medline, with screening conducted separately by two separate independent observers. Quality assessment of the included articles was conducted using the adapted tool “Methodological index for non-randomized studies” (MINORS). A descriptive analysis due to the heterogeneity of the study was conducted rather than a meta-analysis.
Results: 187 unique articles were found and the final analysis included 8 retrospective case series and one case report, with 232 total feet in the studies. 77 out of 234 talectomies were primary, the remainder being salvage talectomies after failed intervention. The indications in 8 studies were rigid persistent clubfoot and 1 study being vertical talus. Post-talectomy 4/7 studies immobilized the operative feet for 12 weeks or longer. 167 (71.98%) of the 232 feet had satisfactory clinical results, with radiographic bony tibiocalcaneal fusion in 27 (32.93%) out of 82 feet. 55 (92.62%) of patients were stiff and showed no significant motion at the tibiotalar joint. 113 (92.62%) had a functional gait post-op, with 41 (36.28%) able to ambulate without walking aids. Recurrence of deformity was noted in 39 feet (16.81%), with revision surgery performed in 31 (13.36%) with the most common being wedge tarsectomy (38.71%) followed by talar excision (25.81%). Four studies reported implication rates, with total skin necrosis of the lateral foot observed in 52 talectomies treated with a myocutaneous patch.
Conclusions: Arthrogrypotic feet are stiff and resistant to treatment, with literature reporting mixed reviews on serial casting, soft tissue release, and triple arthrodesis as treatment options. Talectomy is a reliable primary or salvage procedure with satisfactory results and low recurrence, the principle being a talectomy leads to laxity of the soft tissues allowing deformity correction without tension. In this study we cannot ascertain how age of talectomy influences outcomes. Additionally, there is no standard severity classification for arthrogryposis foot deformity, making it difficult to quantify the degree of radiographic and functional improvements. Other factors that may impact talectomy success, such as post-op casting and long-term night splinting were not routinely measured. Overall, for severely rigid deformities secondary to arthrogryposis, talectomy can be considered for achieving a plantigrade foot.