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Reverse Ponseti-type treatment for children with congenital vertical talus: comparison between idiopathic and
J Wright1, D Coggings, C Maizen
1Barts and the London Children's and The Royal London Hospitals, Centre for Orthopaedics, Bart's Health NHS Trust, Whitechapel, London, E1 1BB, UK.
Insights
The reverse Ponseti-type technique effectively corrects congenital vertical talus (CVT) in children. However, recurrence rates are higher than initially reported, suggesting technique modifications may be needed.
Area of Science:
- Pediatric Orthopedics
- Foot and Ankle Surgery
- Congenital Deformities
Background:
- Congenital vertical talus (CVT) treatment traditionally involves extensive soft-tissue releases, often leading to complications.
- Recent studies show promise for reverse Ponseti-type casting with percutaneous fixation in CVT, but outcomes for idiopathic versus teratological etiologies haven't been compared.
Purpose of the Study:
- To compare the clinical, radiological, and parent-reported outcomes of the reverse Ponseti-type technique in children with idiopathic and teratological congenital vertical talus.
Main Methods:
- A prospective cohort study of 13 children (21 feet) with CVT (idiopathic or teratological) treated with reverse Ponseti-type casting and percutaneous fixation.
- Outcomes assessed clinically, radiologically, and via parent-reported measures at a mean follow-up of 36 months.
Main Results:
- Initial correction was achieved in all patients, with significant radiological improvements observed.
- Recurrence was noted in 10 feet across both idiopathic (12 feet) and teratological (9 feet) groups.
- The technique demonstrated effectiveness in initial correction for both CVT etiologies.
Conclusions:
- The reverse Ponseti-type technique is effective for initial correction of congenital vertical talus, regardless of etiology.
- Recurrence remains a concern in both idiopathic and teratological CVT treated with this method, though rates are lower than open surgical release.
- Modifications, such as limited capsulotomy, may be necessary to reduce recurrence rates.
Abstract:
Children with congenital vertical talus (CVT) have been treated with extensive soft-tissue releases, with a high rate of complications. Recently, reverse Ponseti-type casting followed by percutaneous reduction and fixation has been described, with excellent results in separate cohorts of children with CVT, of either idiopathic or teratological aetiology. There are currently no studies that compare the outcome in these two types. We present a prospective cohort of 13 children (21 feet) with CVT of both idiopathic and teratological aetiology, in which this technique has been used. Clinical, radiological and parent-reported outcomes were obtained at a mean follow-up of 36 months (8 to 57). Six children (nine feet) had associated neuromuscular conditions or syndromes; the condition was idiopathic in seven children (12 feet). Initial correction was achieved in all children, with significant improvement in all radiological parameters. Recurrence was seen in ten feet. Modification of the technique to include limited capsulotomy at the initial operation may reduce the risk of recurrence. The reverse Ponseti-type technique is effective in the initial correction of CVT of both idiopathic and teratological aetiology. Recurrence is a problem in both these groups, with higher rates than first reported in the original paper. However, these rates are less than those reported after open surgical release.
