One-stage release by double surgical approach for neglected congenital vertical talus: results in a series of walking children in Tanzania

Ilaria Sanzarello, Matteo Nanni, Fabrizio Perna, Francesco Traina, Cesare Faldini

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Abstract

Congenital vertical talus is an uncommon rigid flatfoot deformity present at birth, producing pain and disability if untreated. This study reports results and complications in a series of walking children affected by neglected congenital vertical talus treated by one-stage release through a double surgical approach in a hospital sited in the Tanzanian rural outback. Between 2009 and 2014, nine consecutive congenital vertical talus were observed in five patients (three males and two females) aged between 2 and 4 years. In two children, the deformity was idiopathic, in two it was associated to distal arthrogryposis and in one to Larsen syndrome. The surgical procedure was performed through a posteromedial and a lateral incision and included extensive soft tissue release and reduction of talo-navicular and subtalar joint, pinned with percutaneous Kirschner wires. The talar axis-first metatarsal base angle (TAMBA) was measured preoperatively and at follow-up. Results were summarized using the Adelaar score and the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire. The mean follow-up was 2.6 years (2-4). No major intraoperative complications were observed. The TAMBA passed from 74.4º (range 68-82º) to 20.2º (range 18-24º). No talar osteonecrosis was observed. The results were excellent in three cases, good in five cases and fair in one (Adelaar score). The mean postoperative PODCI score was 48 (range 38-60). None of the patients underwent further surgery. In case of neglected congenital vertical talus and limited health resources, this surgical technique has proved to be a viable option, providing satisfactory results, with low rate of surgical and postsurgical complications.

Original languageEnglish
Pages (from-to)586-590
Number of pages5
JournalJournal of Pediatric Orthopaedics Part B
Volume28
Issue number6
Early online dateJul 24 2019
DOIs
Publication statusPublished - Nov 2019

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Keywords

  • congenital vertical talus
  • extensive release
  • low income country
  • neglected
  • surgical treatment

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