Die Talektomie mit Verschiebung des Fußes nach ventral und des Innenknöchels nach lateral

Summary

Goal of Surgery

Achievement of a functional, painless lower limb through elimination of a severe foot deformity.

Improved dorsiflexion of the foot.

Indications

Severe and untreated clubfoot.

Severe fracture-dislocation of talus (Hawkins III).

Contraindications

Circulatory insufficiencies.

Osteoarthritis of ankle and subtalar joints.

Positioning and Anaesthesia

Supine, leg in external rotation and knee flexed.

General or regional anaesthesia.

Surgical Technique

Removal of the talus through a medial approach after osteotomy of the medial malleolus. Anterior displacement of the foot and lateral displacement of the medial malleolus creating a joint between calcaneus and tibia and medial wall of calcaneous and medial malleolus. In instances of osteoporosis the osteotomy of the medial malleolus will be modified.

Postoperative Management

Below knee cast for 3 weeks. Followed by partial weight bearing in a cast. Full weight bearing without cast after 6 weeks.

Possible Complications

Incomplete removal of talus.

Poor articular contact.

Injury to nerves and vessels.

Results

14 talectomies, mean follow-up 42 months. 8 patients had a standard procedure and were assessed according to the criteria of Morris: 6 excellent, 1 good and 1 poor result. 6 patients underwent a modified procedure (see Figure 6): 2 excellent and 4 good results.