Orthopedics and Pediatric Orthopedics Clinic, Medical University of Lodz, Lodz, Poland.
J Orthop Surg Res. 2023 Apr 18;18(1):306. doi: 10.1186/s13018-023-03708-6.
Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal dislocation of the navicular on the head of the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and etiology of vertical talus is unknown. Dobbs et al. (J Bone Joint Surg Am 88(6):1192-200, 2006) described a minimally invasive alternative which allowed to avoid the need for extensive soft tissue release procedures in treatment of congenital vertical talus. Eleven congenital vertical talus feet (group 5 according to Hamanishi) in eight children (four boys and four girls) constituted the study material. Upon the diagnosis, the patients' age ranged from 5 to 26 months old (the mean - 14.6). The treatment involved serial manipulation and casting according to the reverse Ponseti method (from 4 to 7 casts) followed by a minimally invasive approach consisting in temporary stabilization of the talonavicular joint with the use of K-wire and Achilles tenotomy according to the Dobbs technique. Then patients continued the shoe and bar program for 2 years. The X-ray measurements on lateral radiographic included the talocalcaneal angle, tibiotalar angle and talar axis-first metatarsal base angle whereas AP radiographic images-the talocalcaneal angle and talar axis-first metatarsal angle. The Wilcoxon test was used to compare dependent variables. The final clinical assessment made during the last follow-up (the mean: 35.8 months, the range: 25-52) revealed that neutral position of the foot and normal range of motion were observed in ten cases and recurrence of foot deformity in one case. The last X-ray examination showed normalization all of radiological parameters, except for one case, and examined parameters were statistically significant. The minimally invasive technique described by Dobbs should be the first option in treatment of congenital vertical talus. It allows to reduce the talonavicular joint, brings good results and preserves foot mobility. The attention should be put on early diagnosis.
先天性垂直距骨是一种罕见的足部畸形。距骨和跟骨后足呈外翻和跖屈，中足背屈，前足外展，这是由于跗骨的舟骨和跟骨前部分的楔骨在距骨头上固定的背侧脱位。垂直距骨的流行病学和病因尚不清楚。Dobbs 等人（J Bone Joint Surg Am 88(6):1192-200, 2006）描述了一种微创替代方法，可以避免在治疗先天性垂直距骨时需要广泛的软组织松解术。这项研究的材料包括 8 名儿童（4 名男孩和 4 名女孩）的 11 只先天性垂直距骨足（Hamanishi 分类为 5 组）。在诊断时，患者的年龄从 5 至 26 个月（平均 14.6 个月）不等。治疗包括根据反向 Ponseti 方法（4 至 7 个石膏）进行连续手法复位和石膏固定，然后采用微创方法，根据 Dobbs 技术，用 K 线暂时固定距跟关节，并进行跟腱切断术。然后患者继续穿矫形鞋和支具治疗 2 年。侧位 X 线测量包括距跟角、距骨跟骨角和距骨第一跖骨基底角，而前后位 X 线图像则测量距跟角和距骨第一跖骨角。采用 Wilcoxon 检验比较了依赖变量。最后一次随访（平均 35.8 个月，范围 25-52 个月）时进行的临床评估发现，10 例患者足部处于中立位，运动范围正常，1 例患者出现足部畸形复发。最后一次 X 射线检查显示，除 1 例外，所有影像学参数均恢复正常，且检查参数均具有统计学意义。Dobbs 描述的微创技术应是治疗先天性垂直距骨的首选方法。它可以缩小距跟关节，效果良好，保留了足部的活动度。应注意早期诊断。
