2017, Number 1
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ABSTRACTBackground: Congenital vertical talus (CVT) is a rare deformity that occurs at birth and is characterized by fixed dorsal dislocation of the navicular on the head of the talus. The traditional treatment has consisted of the extensive soft tissue release with poor results and a high rate of complications. Recently, a minimally invasive technique (Dobbs method) has been described with encouraging results. We systematically reviewed the literature to: 1) determine the efficacy of the method in patients with isolated and teratological CVT, 2) determine the recurrence rate and complications, and 3) identify risk factors for recurrence of the deformity. Methods: Using databases available from Ovid, PubMed and Cochrane Library, we collected all papers on patients with diagnosis of CVT treated with Dobbs method. Studies published in Spanish, English or German since June 2006 (initial description of the method) were included for the analysis until October 1, 2016. Results: 161 patients (84 teratological, and 77 idiopathic patients) were analyzed. Mean age was 3.8 months (range, two days to nine years). Mean number of casts was 6.8 (range, five to 10). In all cases the initial correction of the deformity was achieved. No patient presented complications related to casting, Achilles tenotomy or talo-navicular realignment through the mini-approach. Mean follow-up was 31.4 months. Thirty-two feet (20%) presented recurrence of the deformity. Patients with teratological CVT had a higher rate of recurrence compared to idiopathic CVT (23% versus 17%). Conclusions: Treatment of congenital vertical talus with Dobbs method is safe and effective. Patients with syndromic or neurological associations have an increased risk of relapse and should be monitored to diagnose this complication early. Initial reports with this technique are encouraging, however long-term studies are needed to confirm if these results are maintained over time.
Jacobsen ST, Crawford AH. Congenital vertical talus. J Pediatr Orthop. 1983; 3(3): 306-310.
Alaee F, Boehm S, Dobbs MB. A new approach to the treatment of congenital vertical talus. J Child Orthop. 2007; 1(3): 165-174.
Ogata K, Schoenecker PL, Sheridan J. Congenital vertical talus and its familial occurrence: an analysis of 36 patients. Clin Orthop Relat Res. 1979; (139): 128-132.
Dobbs MB, Schoenecker PL, Gordon JE. Autosomal dominant transmission of isolated congenital vertical talus. Iowa Orthop J. 2002; 22: 25-27.
Dobbs MB, Gurnett CA, Pierce B, Exner GU, Robarge J, Morcuende JA et al. HOXD10 M319K mutation in a family with isolated congenital vertical talus. J Orthop Res. 2006; 24(3): 448-453.
Lloyd-Roberts GC, Spence AJ. Congenital vertical talus. J Bone Joint Surg Br. 1958; 40-B(1): 33-41.
Dodge LD, Ashley RK, Gilbert RJ. Treatment of congenital vertical talus: a retrospective review of 36 feet with long-term follow-up. Foot Ankle. 1987; 7: 326-332.
Zorer G, Bagatur AE, Dogan A. Single stage surgical correction of congenital vertical talus by complete subtalar release and peritalar reduction by using the Cincinnati incision. J Pediatr Orthop B. 2002; 11(1): 60-67.
Mazzocca AD, Thomson JD, Deluca PA, Romness MJ. Comparison of the posterior approach versus the dorsal approach in the treatment of congenital vertical talus. J Pediatr Orthop. 2001; 21(2): 212-217.
Dobbs MB, Purcell DB, Nunley R, Morcuende JA. Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Joint Surg Am. 2006; 88(6): 1192-1200.
Ponseti IV. Congenital clubfoot. Fundamentals for treatment. Oxford: Oxford University Press; 1996.
Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital clubfoot. J Bone Joint Surg Am. 1980; 62(1): 23-31.
Bhaskar A. Congenital vertical talus: treatment by reverse Ponseti technique. Indian J Orthop. 2008; 42(3): 347-350.
Eberhardt O, Fernandez FF, Wirth T. Treatment of vertical talus with the Dobbs method. Z Orthop Unfall. 2011; 149(2): 219-224.
David MG. Simultaneous correction of congenital vertical talus and talipes equinovarus using the Ponseti method. J Foot Ankle Surg. 2011; 50(4): 494-497.
Eberhardt O, Fernandez FF, Wirth T. The talar axis-first metatarsal base angle in CVT treatment: a comparison of idiopathic and non-idiopathic cases treated with the Dobbs method. J Child Orthop. 2012; 6(6): 491-496.
Aslani H, Sadigi A, Tabrizi A, Bazavar M, Mousavi M. Primary outcomes of the congenital vertical talus correction using the Dobbs method of serial casting and limited surgery. J Child Orthop. 2012; 6(4): 307-311.
Chalayon O, Adams A, Dobbs MB. Minimally invasive approach for the treatment of non-isolated congenital vertical talus. J Bone Joint Surg Am. 2012; 94(11): e73.
Aydın A, Atmaca H, Müezzinoğlu ÜS. Bilateral congenital vertical talus with severe lower extremity external rotational deformity: treated by reverse Ponseti technique. Foot (Edinb). 2012; 22(3): 252-254.
Wright J, Coggings D, Maizen C, Ramachandran M. Reverse Ponseti-type treatment for children with congenital vertical talus: comparison between idiopathic and teratological patients. Bone Joint J. 2014; 96-B(2): 274-278.
Yang JS, Dobbs MB. Treatment of congenital vertical talus: comparison of minimally invasive and extensive soft-tissue release procedures at minimum five-year follow-up. J Bone Joint Surg Am. 2015; 97(16): 1354-1365.
Chan Y, Selvaratnam V, Garg N. A comparison of the Dobbs method for correction of idiopathic and teratological congenital vertical talus. J Child Orthop. 2016; 10(2): 93-99.
Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006; 88(5): 986-996.
Ponseti IV. Relapsing clubfoot: causes, prevention, and treatment. Iowa Orthop J. 2002; 22: 55-56.
DeRosa GP, Ahlfeld SK. Congenital vertical talus: the Riley experience. Foot Ankle. 1984; 5: 118-124.
Kodros SA, Dias LS. Single-stage surgical correction of congenital vertical talus. J Pediatr Orthop. 1999; 19(1): 42-48.
Hootnick DR, Dutch WM Jr, Crider RJ Jr. Ischemic necrosis leading to amputation following surgical correction of congenital vertical talus. Am J Orthop (Belle Mead NJ). 2005; 34(1): 35-37.
Adelaar RS, Williams RM, Gould JS. Congenital convex pes valgus: results of a nearly comprehensive release and a review of congenital vertical talus at Richmond Crippled Children’s Hospital and the University of Alabama in Birmingham. Foot Ankle. 1980; 1(2): 62-73.
Morris C, Doll HA, Wainwright A, Theologis T, Fitzpatrick R. The Oxford ankle foot questionnaire for children: scaling, reliability and validity. J Bone Joint Surg Br. 2008; 90(11): 1451-1456.
Daltroy LH, Liang MH, Fossel AH, Goldberg MJ; Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America. The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. J Pediatr Orthop. 1998; 18(5): 561-571.
Gates PE, Campbell SR. Effects of age, sex, and comorbidities on the pediatric outcomes data collection instrument (PODCI) in the general population. J Pediatr Orthop. 2015; 35(2): 203-209.