Wack Christina, Bannow Laura, Fernandez Fernandez Francisco, Wirth Thomas, Eberhardt Oliver
Center for Orthopaedics and Trauma Surgery, Philipps University Marburg, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35037, Marburg, Germany.
Orthopaedic Department, Olgahospital, Klinikum Stuttgart, Kriegsbergstrasse 62, 70174, Stuttgart, Germany.
Arch Orthop Trauma Surg. 2025 Apr 24;145(1):261. doi: 10.1007/s00402-025-05853-5.
Treating vertical talus using the minimally invasive method according to Dobbs is becoming increasingly more common and appears to reduce the need for extensive surgery. In this paper, we report on the long-term findings for treating these idiopathic and non-idiopathic deformities.
Twenty-three vertical talus deformities were treated between 11/2007 and 12/2014. Treatment was primarily carried out using the minimally invasive Dobbs method with reverse Ponseti casting. Patient data, treatment data, surgical methods, relapse rates, functional results and weight-bearing imaging results were documented over the course of the study. The talar axis-first metatarsal base angle (TAMBA) was used to assess the severity of the deformity. Long-term clinical findings and imaging were presented.
Nineteen vertical talus deformities were examined over an average follow-up period of 10.4 years. A minimally invasive primary correction was performed on 74% using the Dobbs method. More extensive surgical measures were necessary in 26,3%. The relapse rate was 26.3%. In the group with idiopathic deformities the average long-term range of motion of the ankle joint was 17.5° dorsiflexion and 36° plantarflexion, in the group with non-idiopathic deformities it was 9.2° dorsiflexion and 12.4° plantarflexion. The average preoperative TAMBA for the entire cohort was 65°; postoperatively it was 13°. In the group of feet that underwent a minimally invasive correction procedure, these values were 51° preoperatively and 11° postoperatively. In 79% we achieved excellent and good results according to the radiological classification system of Hamanishi over the long term.
Using the minimally invasive Dobbs method to treat vertical talus significantly reduces the need for extensive surgery and also leads to good, long-term functional results, especially for idiopathic deformities. More extensive arthrolysis to correct the deformity may still be warranted in cases of non-idiopathic deformities. Non-idiopathic deformities, residual pathologies, and changes in foot deformity not related directly to a vertical talus pathology leads to higher long-term reoperation rates.
采用多布斯（Dobbs）微创方法治疗垂直距骨越来越普遍，似乎减少了广泛手术的必要性。在本文中，我们报告了治疗这些特发性和非特发性畸形的长期结果。
2007年11月至2014年12月期间治疗了23例垂直距骨畸形。治疗主要采用多布斯微创方法及反向庞塞蒂（Ponseti）石膏固定。在研究过程中记录了患者数据、治疗数据、手术方法、复发率、功能结果和负重影像学结果。距骨轴线 - 第一跖骨基底角（TAMBA）用于评估畸形的严重程度。展示了长期临床结果和影像学表现。
对19例垂直距骨畸形进行了平均10.4年的随访。74%的患者采用多布斯方法进行了微创一期矫正。26.3%的患者需要更广泛的手术措施。复发率为26.3%。在特发性畸形组中，踝关节长期平均活动范围为背屈17.5°和跖屈36°，在非特发性畸形组中为背屈9.2°和跖屈12.4°。整个队列术前平均TAMBA为65°；术后为13°。在接受微创矫正手术的足部组中，术前这些值为51°，术后为11°。根据滨西（Hamanishi）放射学分类系统，79%的患者长期取得了优良结果。
使用多布斯微创方法治疗垂直距骨显著减少了广泛手术的必要性，并且还能带来良好的长期功能结果，尤其是对于特发性畸形。对于非特发性畸形，可能仍需要更广泛的关节松解术来矫正畸形。非特发性畸形、残留病变以及与垂直距骨病变无直接关系的足部畸形变化导致更高的长期再次手术率。
