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Ankle Joint

Ankle Joint

The ankle is formed by the talocrural joint (crural = leg). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg. The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations...

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Flat Top Talus: Complication of Ponseti Method or Overcorrection?

Shahbaz Khan¹, Mansoor Ali Khan², Muhammad Amin Chinoy²

¹Orthopaedics and Traumatology, Ziauddin University Hospital Karachi, Karachi, PAK.

|March 23, 2021

Summary

Flat-top talus, a complication of idiopathic clubfoot treatment, is linked to the number of Ponseti casts used. Prolonged casting, over three months, increases the risk of this talar dome deformation, independent of tenotomy.

Keywords:

clubfoot flat top talus ponseti ta tenotomy

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Area of Science:

Orthopedics
Pediatric Orthopedics
Foot and Ankle Surgery

Background:

Talar dome deformation, specifically flat-top talus, is a recognized complication following idiopathic clubfoot treatment, including the Ponseti technique.
The etiology and functional implications of this deformation remain incompletely understood.
Idiopathic clubfoot treatment aims to correct foot deformities while minimizing complications such as talar abnormalities.

Purpose of the Study:

To investigate the factors contributing to the development of flat-top talus in children treated with the Ponseti technique for idiopathic clubfoot.
To evaluate the correlation between talar dome deformation and patient demographics, casting parameters, and tenotomy.

Main Methods:

A single-center, cross-sectional study involving 50 children with untreated idiopathic clubfoot who completed the Ponseti casting and bracing protocol.
Weight-bearing lateral ankle X-rays were analyzed to assess talar dome flattening.
Data on age, sex, BMI, number of casts, duration of casting, and tenotomy were collected and correlated with the presence of flat-top talus.

Main Results:

Of the 50 children, 13 (26%) developed flat-top talus.
Children with flat-top talus were treated with casts for a significantly longer duration (median 9 weeks vs. 6 weeks) and required more casts (p=0.005).
No significant association was found between flat-top talus and patient age, BMI, or tenotomy (p=0.340).

Conclusions:

Flat-top talus following the Ponseti technique is primarily associated with the number and duration of casts applied, suggesting a link to manipulation intensity.
Treatment duration exceeding three months may increase the likelihood of developing flat-top talus.
Tenotomy of the tendoachilles does not appear to be a significant factor in the development of flat-top talus.