Bilateral Congenital Vertical Talus in Association with Beals Contractural Arachnodactyly: A Case Report.

CASE: Congenital vertical talus (CVT) is a rare rigid flatfoot disorder with a rocker-bottom flatfoot appearance. It is characterized by hindfoot valgus and equinus, with associated midfoot dorsiflexion and forefoot abduction. We describe a patient who was born with dysmorphic features and subsequently was diagnosed with Beals contractural arachnodactyly. After the diagnosis of bilateral CVT was made, it was treated with a single-stage open reduction. There was a unilateral recurrence, which was treated with revision surgery. The patient had an excellent functional outcome. CONCLUSION: CVT often requires surgical management and may recur. To our knowledge, this is the first reported case of CVT associated with Beals contractural arachnodactyly.

Management of foot deformity in children.

This study describes the management of foot deformity in children. Severe congenital clubfeet treated using posteromedial release without talocalcaneal joint release were flexible and functional. Talectomy may be necessary for congenital clubfeet with arthrogryposis multiplex congenita. The diagnosis and severity of vertical talus were defined based on stress radiographs. For the deformity with spina bifida, a combination of talocalcaneal joint fusion and precise correction by soft tissue release and tendon transfer was performed. This combined surgery is effective, particularly in patients with equino-varus feet.

Subtalar Joint Distraction Arthrodesis to Correct Calcaneal Valgus in Pediatric Patients with Tarsal Coalition: A Case Series.

Subtalar joint middle facet coalitions commonly present in children who have a painful, rigid, pes planovalgus foot type. The middle facet coalition allows rearfoot forces to be distributed medially through the coalition, and this can result in arthritis or lateral tarsal wedging. The senior author has used a wedged bone graft distraction subtalar joint arthrodesis to correct calcaneal valgus and restore the talar height in these patients. The tight, press-fit nature of the tricortical iliac crest allograft provides stability and can negate the need for internal fixation. We retrospectively reviewed 9 pediatric subtalar joint distraction arthrodesis procedures performed on 8 patients during a 6-year period. All patients began weightbearing at 6 weeks after surgery. All patients had osseous union, and no complications developed that required a second surgery. The clinical outcomes, assessed at a mean of 25.5 (range, 6.3 to 75.8) months postoperatively, were satisfactory. The mean American Orthopaedic Foot and Ankle Society score was 90.1 (range, 79 to 94), on a 94-point scale. The wedged distraction arthrodesis technique has not been previously described for correction of pediatric patients with lateral tarsal wedging, but it is an effective option and yields successful outcomes.

[The inborn flat-valgus deformity of the foot in children].

To optimize the diagnosis and treatment for the inborn flat-valgus deformity of the foot (IFVDF), the results of treatment of 78 children, ageing from 1 mo to 12 yrs old, were analyzed. Algorithms of diagnosis and treatment were elaborated. Operative treatment on soft tissues for IFVDF was indicated in the cases of inefficacy or insufficient efficacy of conservative therapy in the age after 1 year old, when a child starts to walk by himself. The proposed method of operative treatment permits to achieve good results and it is less traumatic in comparison with the existing methods. Better results are noted while application of the method in children, ageing from 1 to 4 yrs old.

Rigid pediatric pes planovalgus: conservative and surgical treatment options.

Rigid pediatric pes planovalgus refers to a condition of the foot in which the medial longitudinal arch height is abnormally decreased along with a significant loss of midfoot and hindfoot motion in the pediatric patient. Known causes for this condition are well documented and consist of congenital vertical talus, tarsal coalitions, and peroneal spastic flatfoot without coalition. This article outlines conservative and surgical treatment of rigid pediatric pes planovalgus.

A familial case of trichorhinophalangeal syndrome type I.

Trichorhinophalangeal type I (TRPS I) is a rare autosomal dominant disorder characterized by variable clinical expression of sparse and slow-growing hair, pear-shaped nose, elongated philtrum, and bone deformities, including cone-shaped epiphyses of the phalanges and short stature. We describe three members of a family who consulted us because of slow-growing scalp hair with craniofacial and radiological features typical of TRPS I.

Single stage surgical correction of congenital vertical talus by complete subtalar release and peritalar reduction by using the Cincinnati incision.

Seventeen feet of 12 patients with congenital vertical talus, which were treated with a single-stage surgical correction of complete subtalar release and peritalar reduction by using the Cincinnati incision, were reviewed. Five of the feet were associated with neuromuscular disorders, four with neural tube defects, and eight were idiopathic. All patients were operated on by the same surgeon and all were available for clinical and radiographic follow-up averaging 42.9 months (range 19-81) from the time of surgery. There were no wound complications or avascular necrosis of the talus. None required subsequent reoperation. At final follow-up, results were based on clinical and radiographic outcomes and included five excellent, eight good, two fair, and two poor. All families were satisfied with the results and appearance of the feet. Radiographically, there was a significant improvement in the anteroposterior and lateral talocalcaneal and talo-first metatarsal angles, and at follow-up, the group averages for each of these angles were within the normal ranges. In the treatment of congenital vertical talus, good clinical and radiographic outcomes can be obtained, with a low incidence of complications, using this single-stage surgical correction procedure.

Single-stage surgical correction of congenital vertical talus.

Forty-one patients (55 feet) with congenital vertical talus (CVT) were reviewed. Thirty of the feet were associated with neural tube defects, 10 with neuromuscular disorders, five with congenital malformation syndromes, and none with chromosomal aberrations. Ten of the feet were idiopathic. All were treated with a single-stage surgical correction as described, by using the Cincinnati incision, and performed by the same surgeon. Thirty-two patients (42 feet) were available for clinical and radiographic follow-up averaging 7 years (range, 2-12) from the time of surgery. There were no wound complications or avascular necrosis of the talus. In 10 feet, subsequent reoperation was necessary. At final follow-up, results were based on the clinical and radiographic outcomes and included 31 good and 11 fair. All patients and families were satisfied with the results and appearance of the feet. There were no bony prominences or skin problems. The presence of mild pain was noted in only three feet. Radiographically, there was a significant improvement in the anteroposterior (AP) and lateral talocalcaneal and talo-first metatarsal angles, and at follow-up, the group averages for each of these angles were within the normal range. In treating CVT, good clinical and radiographic results can be obtained with a low incidence of complications using this single-stage surgical correction of the hindfoot and midfoot deformities.

Contracted valgus flat foot caused by tarsal synostosis in the adolescent.

Contracted valgus flat foot in the adolescent is frequently caused by tarsal synostosis or synchondrosis which are often not revealed in common radiographic views, and which may instead by clearly shown by CT scan. These synostoses are prevalently symptomatic during adolescence, when by ossifying they block the subtalar joint in valgus; they are less symptomatic between 20 and 40 years of age. Pain returns during the fifth decade due to the occurrence of secondary arthrosis of the nearby joints.

[Caudal regression syndrome]. / Beitrag zum caudalen Regressionssyndrom.

It is reported about a young girl with congenital agenesis of the os sacrum, a congenital platfoot and a luxation of the left hip. These congenital malformations can be found in children born to diabetic mothers.

Congenital convex pes valgus. The condition and its treatment.

The congenital convex pes valgus deformity has been presented in reference to its etiology, pathologic anatomy, diagnosis, and treatment. It is imperative that this deformity be diagnosed immediately and treatment instituted rapidly to achieve a functional plantigrade and asymptomatic foot.

Congenital convex pes valgus.

This paper will review the recent literature on congenital convex pes valgus. Many articles have been written on the subject, and there is no agreement as to the correct treatment of this difficult deformity. This manuscript will describe the deformity and suggest that combining various forms of previous treatments may result in a better correction than individual modalities alone.

[Calcaneus displacement osteotomy in pediatric flatfoot]. / Calcaneus-Verschiebeosteotomie beim kindlichen Knickfuss.

Severe unstable pes valgus that can no longer be treated conservatively can be corrected and stabilized by corrective osteotomy of the calcaneus. An important advantage of calcaneus osteotomy is the conservation of the subtalar joint. Calcaneus displacement osteotomy requires less effort from the surgeon, and the correction is more effective than wedge osteotomy of the calcaneus.

Congenital vertical talus. The results of staged operative reduction.

Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet.

Congenital convex pes valgus.

Congenital convex pes valgus is a rigid flatfoot deformity that may or may not be symptomatic. The authors describe the anatomical, clinical, and radiographic appearance and various methods of treatment. It may be asymptomatic in children, but early detection is important because delay in reduction can adversely affect results. Failure to diagnose and treat properly may lead to disabling deformity.