Early start of Corrective bandages and daily manipulations effective for treating congenital vertical talus

Elia Utrilla Rodríguez et al conducted a study to analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was needed.

CVT treatment is commonly surgical and involves extensive soft tissue releases to allow restoration of the normal anatomical relationships between the bones of the foot. Extensive open surgical procedures are associated with a high rate of complications. The development of effective conservative therapeutic procedures has allowed improved correction and lower rates of surgical intervention, avoiding or reducing the potential long-term complications of surgical treatment.

A retrospective analysis of all children diagnosed with idiopathic vertical talus was carried out during the years 2008–2021. Thirty-two children (46 feet) were finally included.

Children were treated with serial manipulations, muscle stimulation, and corrective bandages. Once clinical correction was achieved, a foot and ankle orthosis (AFO) was applied at night for one year.

Age at the time of initiation of treatment, duration of treatment, and correction or not of the deformity without surgical intervention was recorded as variables of interest. The talocalcaneal angle, TAMBA, and ankle range of motion were measured before treatment, after treatment, and at the end of the follow-up period. Statistics decision tree was used to determine which variable best discriminated whether the patient needed surgery. To complement the tree diagram, a two-step cluster analysis was carried out.

Key findings of the study were:

• After treatment, TAMBA and talocalcaneal angle changed from “vertical” to “oblique” category in 45 and 37 feet, respectively.

• The pathological dorsal flexion of the ankle changed to normal in 37 feet and ankle plantar flexion was normal in 46 feet. These variables showed significant changes between the three measurement moments.

• The results of the statistics decision tree and cluster analysis indicate that “No surgery” was associated with an age equal to or lower than one week when treatment was started and with an ankle plantar flexion range of motion lower than 36°.

The authors concluded that – “In summary, the proposed treatment method consisting of daily manipulation and corrective bandages for CVT in newborns avoid surgery in 23 patients (32 feet). Starting this conservative treatment within the first week of life and having a plantar flexion of the ankle lower than 36° were related to the success of the treatment. Knowing these two variables could help determine the need for future surgical treatment.”

Further reading:

Corrective bandages and daily manipulations for treatment of congenital vertical talus: a thirteen year follow up., Elia Utrilla Rodríguez, Nieves Díaz Ávila et al, International Orthopaedics (2023) 47:1101–1108 https://doi.org/10.1007/s00264-022-05685-7