Diagnosis and treatment of congenital vertical talus in children under 3 years old (review)

Congenital vertical ram is a rare pathology, the incidence of it is 1 case per 10 thousand newborns. This anomaly is usually manifested by a severe planovalgus deformity of the foot. Moreover, it is often (in 50% of cases) associated with chromosomal syndromes (arthrogryposis, neurofibromatosis, myelodysplasia, etc.), with spinal, neuromuscular anomalies of development. As a result, it is necessary to focus the attention of pediatric orthopedists and radiologists on the parameters of the diagnosis in order to reduce false diagnoses and unreasonable surgical interventions in children, show options for surgical techniques for the treatment of feet with an inborn vertical position of the talus in children under 3 years. The presented review of domestic and foreign literature demonstrates the main advantages and disadvantages of existing approaches in the treatment of children under 3 years of age with congenital vertical ram. Demonstrate the main advantages and disadvantages of existing approaches in the treatment of this pathology. Analysis of the literature showed that the causes of the formation of the congenital vertical talus are not fully explored. In Russia, up to the present moment, its diagnosis is still difficult. Congenital vertical talus is one of the rare problems in world orthopedic practice in comparison with congenital clubfoot, but doctors who are constantly treating children with deformities of the feet have such patients regularly.

Outcomes of Naviculectomy for Severe Recurrent Clubfoot Deformity

Background: Naviculectomy was originally described for resistant congenital vertical talus deformity but was later expanded to use in rigid cavus deformity. This study reviews the operative outcomes of complete excision of the navicular for recurrent deformity in the talipes equinovarus (TEV) population. Methods: After institutional review board approval, all patients undergoing naviculectomy at a single institution were identified. Clinical, radiographic, and pedobarographic data (minimum 2 years’ follow-up) were reviewed. Results: Twelve patients (14 feet) with TEV from 1984 to 2019 were included. All feet had minimum 1 prior operative intervention on the affected foot (mean age = 4.0 years, range 0.2-14.5), with 8/14 having at least 3 prior operative procedures. Complete navicular excision with concomitant procedures was performed in all patients (mean age = 11.7 years, range 5.5-16.1). Mean clinical follow-up from naviculectomy was 5.1 years (range, 2.2-11.2). During follow-up, 6 patients required subsequent surgery, most often secondary to pain and progressive deformity. One patient underwent elective below-knee amputation of the affected extremity. Of the remaining 11 patients, 7 of 11 reported continued pain and 8 of 11 maintained adequate range of motion at the ankle at the most recent follow-up. Conclusion: Clinical follow-up demonstrated deteriorating results in a large percentage of patients. The high rate of additional procedures and continued pain in the current series suggests that even as a salvage procedure, naviculectomy may not provide adequate results for patients. Level of Evidence: Level IV, case series.

Conjoined twins presenting with foot deformities: insights to management and challenges

Conjoined twins are a rare outcome of conception associated with numerous anomalies involving multiple organ systems. Musculoskeletal abnormalities like vertebral anomalies, sacral agenesis, foot deformities and hip dysplasia have been described in literature. We describe two cases of pyopagus twins with congenital talipes equinovarus and congenital vertical talus deformity which have not been described previously in this type of conjoined twins. The orthopaedist should look actively for such deformities in this patient population and be wary of the difficulties associated with their management.