Results of talectomy for inveterate or recurrent clubfoot - 24/11/21

Doi : 10.1016/j.otsr.2021.103146

Virginie Nguyen-Khac ^a,⁎ , Asuka Desroches ^a,^b, Julia Bouchaïb ^c, Jean-Paul Padovani ^a, Philippe Wicart ^a
^a Hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
^b Centre Hospitalier Inter-Communal Robert Ballanger, boulevard Robert Ballanger, 93600 Aulnay-sous-Bois, France
^c Clinique Toutes Aures, 393, avenue des Savels, 04100 Manosque, France

^⁎Corresponding author.

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Abstract

Introduction

The aim of the present study was to define indications for talectomy in congenital paralytic, dystrophic or idiopathic, inveterate or recurrent, clubfoot.

Hypothesis

Talectomy is a valid option for paralytic, dystrophic or idiopathic, inveterate or recurrent, clubfoot.

Patients and methods

A single-center retrospective series comprised 52 clubfeet in 31 patients. Etiology was paralytic in 34 feet (65%) (17 arthrogryposes, 10 myelomeningoceles, 4 encephalopathies, 3 peripheral neuropathies), dystrophic in 6 (12%) and idiopathic in 12 (23%). In 27 feet, there was history of surgery (52%). Mean age at talectomy was 4.7 years. In 45 feet (87%), there were associated procedures (soft-tissue release, tendon surgery, calcaneal or lateral arch osteotomy, tibiocalcaneal fusion) and talectomy was isolated in 7 feet (13%). Mean follow-up was 9 years. Final assessment was based on the modified Ghanem and Seringe classification (G&S) and the Ankle-Hindfoot Scale (AHS).

Results

All feet required at least one complementary procedure, either in the same step or as revision. Revision surgery was performed in 17 cases (33%), including all 7 feet with isolated talectomy (7 calcaneal tendon lengthenings, 10 mid- or hind-foot osteotomies, 6 tibiocalcaneal fusions, one calcaneocuboid fusion, and 2 progressive corrections by external fixator). Finally, 33 feet (63%) had good G&S results, 44 (85%) were pain-free, and 40 (77%) were plantigrade.

Discussion

Talectomy for paralytic or dystrophic inveterate or recurrent clubfoot provided satisfactory medium-term results. Associated to other procedures, it achieves a pain-free plantigrade foot in most cases. Tibiocalcaneal fusion has an analgesic effect. Talectomy may, however, not be indicated in idiopathic clubfoot, given the patients’ high functional demand and the existence of alternative treatments.