Advertisement

Journal of Children's Orthopaedics

, Volume 6, Issue 6, pp 491–496 | Cite as

The talar axis–first metatarsal base angle in CVT treatment: a comparison of idiopathic and non-idiopathic cases treated with the Dobbs method

  • Oliver EberhardtEmail author
  • Francisco Fernandez Fernandez
  • Thomas Wirth
Original Clinical Article

Abstract

Purpose

Congenital vertical talus (CVT) appears as an idiopathic or non-idiopathic deformity. In this study, we analysed the talar axis–first metatarsal base angle (TAMBA) values of idiopathic and non-idiopathic CVT cases treated with the Dobbs method.

Materials and methods

Between January 2007 and July 2012, 20 cases of CVT were treated, starting with a manipulation, casting and a minimally invasive surgical approach. We analysed retrospectively the TAMBA values in idiopathic and non-idiopathic CVT. As a new indicator for the mobility in the talonavicular complex, we used the difference of the TAMBA in neutral position and the TAMBA in plantarflexion. TAMBA measurements of CVT successfully treated with the Dobbs method were compared to TAMBA values of CVT unsuccessfully treated using a minimally invasive approach.

Results

Out of 20 CVT, 14 were successfully treated with the Dobbs method. Of these 14, five feet were non-idiopathic and nine feet were idiopathic. Six feet did not have complete correction following the Dobbs protocol, and were associated with arthrogryposis or caudal regression syndrome. The initial TAMBA in idiopathic feet ranged from 70 to 110° (mean 88°). The TAMBA in non-idiopathic feet ranged from 75 to 128° (mean 105). Feet successfully treated with the Dobbs method had an initial TAMBA between 74 and 110° (mean 87°). Feet unsuccessfully treated with the Dobbs method had an initial TAMBA between 95 and 128° (mean 118°).The measurement difference between the TAMBA in neutral and plantarflexion positions in cases unsuccessfully treated with the Dobbs method were smaller compared to values of feet successfully treated with the Dobbs method. These differences were statistically significant (p < 0.0001).

Conclusion

In our series, the success of the Dobbs method in CVT treatment depended on the flexibility in the talonavicular complex. The TAMBA value and TAMBA difference (TAMBA neutral minus TAMBA plantarflexion) express the flexibility in the talonavicular joint and could be predictive for the success of a minimally invasive treatment. Only in a few cases is the success of the Dobbs method limited. These feet are associated with a TAMBA greater than 120° in neutral position and, particularly, a TAMBA difference smaller than 25°.

Keywords

Vertical talus Minimally invasive treatment Reversed Ponseti technique Flatfoot Pes calcaneovalgus 

Notes

Conflict of interest

None.

References

  1. 1.
    Drennan JC (1995) Congenital vertical talus. J Bone Joint Surg Am 77:1916–1923Google Scholar
  2. 2.
    Greenberg AJ (1981) Congenital vertical talus and congenital calcaneovalgus deformity: a comparison. J Foot Surg 20:189–193Google Scholar
  3. 3.
    Hamanishi C (1984) Congenital vertical talus: classification with 69 cases and new measurement system. J Pediatr Orthop 4:318–326CrossRefGoogle Scholar
  4. 4.
    Ogata K, Schoenecker PL, Sheridan J (1979) Congenital vertical talus and its familial occurrence: an analysis of 36 patients. Clin Orthop Relat Res 139:128–132Google Scholar
  5. 5.
    Dobbs MB, Purcell DB, Nunley R, Morcuende JA (2006) Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Joint Surg Am 88:1192–1200CrossRefGoogle Scholar
  6. 6.
    Eberhardt O, Fernandez FF, Wirth T (2011) Die Behandlung des Talus verticalis mit der Methode nach Dobbs. Z Orthop Unfall 149:219–224Google Scholar
  7. 7.
    Bhaskar A (2008) Congenital vertical talus: treatment by reverse ponseti technique. Indian J Orthop 42:347–350CrossRefGoogle Scholar
  8. 8.
    Alaee F, Boehm S, Dobbs MB (2007) A new approach to the treatment of congenital vertical talus. J Child Orthop 1:165–174CrossRefGoogle Scholar
  9. 9.
    Giannestras NJ (1970) Recognition and treatment of flatfeet in infancy. Clin Orthop Relat Res 70:10–29Google Scholar
  10. 10.
    Silk FF, Wainwright D (1967) The recognition and treatment of congenital flat foot in infancy. J Bone Joint Surg Br 49:628–633Google Scholar
  11. 11.
    Seimon LP (1987) Surgical correction of congenital vertical talus under the age of 2 years. J Pediatr Orthop 7:405–411CrossRefGoogle Scholar
  12. 12.
    Clark MW, D’Ambrosia RD, Ferguson AB (1977) Congenital vertical talus: treatment by open reduction and navicular excision. J Bone Joint Surg Am 59:816–824Google Scholar
  13. 13.
    Zorer G, Bagatur AE, Dogan A (2002) Single stage surgical correction of congenital vertical talus by complete subtalar release and peritalar reduction by using the Cincinnati incision. J Pediatr Orthop B 11:60–67Google Scholar
  14. 14.
    Wirth T, Schuler P, Griss P (1994) Early surgical treatment for congenital vertical talus. Arch Orthop Trauma Surg 113:248–253CrossRefGoogle Scholar
  15. 15.
    Napiontek M (1995) Congenital vertical talus: a retrospective and critical review of 32 feet operated on by peritalar reduction. J Pediatr Orthop B 4:179–187CrossRefGoogle Scholar
  16. 16.
    Chalayon O, Adams A, Dobbs MB (2012) Minimally invasive approach for the treatment of non-isolated congenital vertical talus. J Bone Joint Surg Am 94:e73CrossRefGoogle Scholar

Copyright information

© EPOS 2012

Authors and Affiliations

  • Oliver Eberhardt
    • 1
    Email author
  • Francisco Fernandez Fernandez
    • 1
  • Thomas Wirth
    • 1
  1. 1.Olgahospital StuttgartStuttgartGermany

Personalised recommendations