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Untreated congenital vertical talus deformity in walking age: minimally invasive method works
Jason L Cummings1, Pooya Hosseinzadeh
1Department of Orthopaedic Surgery, Washington University in St. Louis, Saint Louis, Missouri, USA.
Insights
The Dobbs Method shows promising outcomes for toddlers with congenital vertical talus (CVT) deformity, though recurrence rates warrant consideration. This minimally invasive technique is recommended before extensive surgeries.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
Background:
- Congenital vertical talus (CVT) is a complex foot deformity.
- Limited data exists on the Dobbs Method for toddlers with CVT.
Purpose of the Study:
- To evaluate the efficacy of the minimally invasive Dobbs Method in toddlers (≥18 months) with CVT.
- To assess clinical outcomes, recurrence rates, and patient-reported measures.
Main Methods:
- Retrospective review of 16 children (24 feet) aged 18 months and older treated with the Dobbs Method.
- Analysis of radiographic measurements, surgical complications, and PROMIS questionnaires.
Main Results:
- Initial radiographic correction was observed, but talar-metatarsal-axis-abduction (TAMBA) angles increased significantly by latest follow-up (P=0.0012).
- Radiographic recurrence occurred in 37.5% of feet, with 12.5% requiring revision surgery.
- PROMIS pain and peer relationship scores were comparable to population norms.
Conclusions:
- The Dobbs Method demonstrates successful outcomes in the majority of toddlers with CVT, despite a higher recurrence rate compared to younger patients.
- This minimally invasive approach is a viable option for toddlers before considering extensive soft tissue procedures or salvage options.
Abstract:
There is sparse literature evaluating the outcomes in toddlers with congenital vertical talus (CVT) deformity who undergo treatment with the recently introduced minimally invasive Dobbs Method. We present the first study of this patient cohort to determine the efficacy of this method in patients 18 months of age and older. A list of all patients over 18 months of age who underwent CVT correction at our institution was created. Retrospective chart review was performed, and all follow-up notes were reviewed for clinical outcomes and complications. Eligible patients completed Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires. Statistical analysis was performed using an alpha of 0.05. Sixteen children (24 feet) met all inclusion criteria and were included in the final analysis. Initial radiographic correction of all measured angles was seen, but by the latest follow-up, the average lateral TAMBA had increased from 12.04 degrees immediately postoperatively to 28.8 degrees at the latest follow-up ( P = 0.0012). Radiographic recurrence of deformity was seen in 9 (37.5%) feet and additional unplanned surgery was required in 3 (12.5%) feet. Residual radiographic pes planus was seen in 5 (20.8%) feet. PROMIS pain interference and peer relationship scores were near the population mean. Although the recurrence rate in this patient population seems to be higher than that of younger patients, the majority of toddlers who undergo treatment with this method do experience successful outcomes. We recommend attempting this treatment method in toddlers before performing extensive soft tissue releases or salvage procedures.
