Early Results of a New Method of Treatment for Idiopathic Congenital Vertical Talus

Dobbs, Matthew B.; Purcell, Derek B.; Nunley, Ryan; Morcuende, Jose A.
March 2007
Journal of Bone & Joint Surgery, American Volume;Mar2007 Supplement, Vol. 89-A, p111
Academic Journal
BACKGROUND: The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue re- leases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Ponseti for the treatment of clubfoot deformity, followed by pinning of the talonavicular joint and percutaneous tenotomy of the Achilles tendon in patients with idiopathic congenital vertical talus. METHODS: The cases of eleven consecutive patients who had a total of nineteen feet with an idiopathic congenital vertical talus deformity were retrospectively reviewed at a minimum of two years following treatment with serial manipulations and casts followed by limited surgery consisting of percutaneous Achilles tenotomy (all nineteen feet), fractional lengthening of the anterior tibial tendon (two) or the peroneal brevis tendon (one), and percutaneous pin fixation of the talonavicular joint (twelve). The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic measurements obtained at these times were compared. In addition, the radiographic data at the final evaluation were compared with normal values for an individual of the same age as the patient. RESULTS: Initial correction was obtained both clinically and radiographically in all nineteen feet. A mean of five casts was required for correction. No patient underwent extensive surgical releases. At the final evaluation, the mean ankle dorsiflexion was 25° and the mean plantar flexion was 33°. Dorsal subluxation of the navicular recurred in three patients, none of whom had had pin fixation of the talonavicular joint. At the time of the latest follow-up, there was a significant improvement (p < 0.0001) in all of the measured radiographic parameters compared with the pretreatment values, and all of the measured angles were within normal values for the patient's age. CONCLUSIONS: Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographically at a minimum two years, in patients with idiopathic congenital vertical talus.


Related Articles

  • Veleszületett dongaláb Ponseti szerinti kezelésével elért kezdeti eredményeink. GELLÉRT, SOHÁR; CSABA, GOMBÁR; HRISTIFOR, GÁLITY; KÁLMÁN, TÓTH // Magyar Traumatológia, Ortopédia, Kézsebészet, Plasztikai Seb;2012, Vol. 55 Issue 1/2, p67 

    The Ponseti method for treating congenital clubfoot has recently been accepted and widely used worldwide, and in Hungary as well. The purpose of this study is to assess the results of treatments performed by the authors. 18 feet of 13 patients were treated with the Ponseti method between 2007...

  • Results of Clubfoot Management Using the Ponseti Method: Do the Details Matter? A Systematic Review. Zhao, Dahang; Li, Hai; Zhao, Li; Liu, Jianlin; Wu, Zhenkai; Jin, Fangchun // Clinical Orthopaedics & Related Research;Apr2014, Vol. 472 Issue 4, p1329 

    Background: Although the Ponseti method is accepted as the best choice for treatment of clubfoot, the treatment protocol is labor intensive and requires strict attention to details. Deviations in strict use of this method are likely responsible for the variations among centers in reported...

  • Neglected Idiopathic Bilateral Clubfoot Successfully Treated with the Ponseti Method. de Podestá Haje, Davi // Case Connector;2013, Vol. 3 Issue 1, p1 

    The article presents a case study of a patient referred to a public hospital with previously untreated bilateral clubfoot. Foot manipulation and casting were conducted as described by Ponseti. It reveals that the modification of Ponseti technique in neglected cases is possible, performing the...

  • Missed tendo achilles avulsion: the diagnostic pitfalls and challenges of late surgical fixation. Jayasekera, Narlaka; Johnson, Benjamin; Leggetter, Peter; Williams, David H. // Internet Journal of Orthopedic Surgery;2009, Vol. 12 Issue 1, p16 

    We report a case of calcaneal avulsion fracture in a 61-year old woman with history of ipsilateral lower limb weakness following tuberculosis meningitis at 19-years of age. Her fracture was missed at accident and emergency presentation despite pathognomonic plain radiographic features....

  • Manejo del pie equinovaro aducto congénito con técnica de Ponseti. Experiencia en el Hospital General «La Perla». Méndez-Tompson, M.; Olivares-Becerril, O.; Preciado-Salgado, M.; Quezada-Daniel, I.; Vega-Sánchez, J. G. // Acta Ortopedica Mexicana;Jul/Aug2012, Vol. 26 Issue 4, p228 

    The purpose of this paper is to present the experience of the hospital using the Ponseti method in patients with congenital adduct clubfoot. Material and methods: The study was conducted between January 2007 and December 2009. Children of both sexes were included; the Dimeglio classification was...

  • Ultrasonographic Phases in Gap Healing Following Ponseti-Type Achilles Tenotomy. Singh Mangat, Karanjit; Kanwar, Raj; Johnson, Karl; Korah, George // Journal of Bone & Joint Surgery, American Volume;Jun2010, Vol. 92-A Issue 6, p1462 

    Background: The Ponseti technique is well established in the management of clubfoot deformity, and an Achilles tenotomy is frequently performed to facilitate dorsiflexion of the foot. This report describes the ultrasonographic phases of healing of the tendon gap created by the Achilles tenotomy...

  • Correction of Arthrogrypotic Clubfoot With a Modified Ponseti Technique. Harold van Bosse; Salih Marangoz; Wallace Lehman; Debra Sala // Clinical Orthopaedics & Related Research;May2009, Vol. 467 Issue 5, p1283 

    Abstract  Surgical releases for arthrogrypotic clubfeet have high recurrence rates, require further surgery, and result in short, painful feet. We asked whether a modified Ponseti technique could achieve plantigrade, braceable feet. Ten patients (mean age, 16.2 months; range, 3–40...

  • Gait Analysis after Initial Nonoperative Treatment for Clubfeet: Intermediate Term Followup at Age 5. Lori Karol; Kelly Jeans; Ron ElHawary // Clinical Orthopaedics & Related Research;May2009, Vol. 467 Issue 5, p1206 

    Abstract  We conducted gait analysis following initial nonoperative clubfoot treatment to compare lower extremity kinematic (eg, ankle motion) and kinetic (eg, ankle power) characteristics between patients treated as infants with Ponseti casting or French physical therapy. This is a...

  • Successful non-operative management of an Achilles fracture. Haddad, F. S.; Ting, P.; Goddard, N. J. // Journal of the Royal Society of Medicine;Feb1999, Vol. 92 Issue 2, p85 

    The article describes the case history of a 67-year-old woman which demonstrates a successful non-operative management of a fractured Achilles tendon. Radiographs indicated ectopic ossification in the distal and was advised to have this surgically removed. She then suffered an accident and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics