The outcomes of the single-stage, three-incision surgical approach in the treatment of neglected cases of congenital vertical talus: a single centre’s experience

Abstract

Background: Congenital vertical talus (CVT), also known as congenital convex pes valgus, is a rare orthopaedic deformity affecting approximately 1 in 10 000 live births. Neglected CVT (NCVT) cases pose a significant challenge in treatment due to the rigid and severe nature of the deformity, which often resists conservative management and requires extensive surgical intervention. Despite the importance of treating NCVT, the evaluation of their surgical outcomes in Zagazig University Hospital was limited, hence this was the aim of the current study.

Methods: This retrospective study was conducted on children with NCVT who presented to the university hospital during the period March 2019 to January 2023. The surgical technique included a single-stage correction performed through three incisions (medial, lateral and posterior) to provide comprehensive access for soft tissue release, tendon lengthening, and joint stabilisation. In two severe cases, naviculectomy was performed to achieve adequate reduction and medial–lateral arch balance. Preoperative assessment of cases included thorough clinical and radiological assessments. Data was collected, revised, coded and statistically analysed.

Results: The study included 24 feet from 16 children with NCVT, ten males and six females, with half the cases presenting as bilateral deformities. The patients’ mean age was 31.6 ± 3.8 months. Postoperatively, all feet showed satisfactory improvement with successful alignment and restoration of foot mechanics as evidenced by clinical appearance and function as well as radiological parameters. Surgical complications were minimal, with only four feet (17%) experiencing wound ischaemia due to pulling on the skin. No cases of infection or avascular necrosis were noted.

Conclusion: Single-stage surgical correction can be the best option in cases of NCVT that may miss long-term follow-up treatment with more stages. The outcomes highlight the efficacy of this surgical approach in achieving functional and plantigrade feet, even in complex and neglected cases of CVT. Further studies with larger numbers of patients and long-term follow-up are recommended to confirm the current findings and investigate long-term outcomes.

Level of evidence: 2