Efficacy of Reverse Ponseti Technique in treating Congenital Vertical Talus

Abstract

Introduction- Historically treatment of Congenital Vertical Talus involved extensive surgery, with major              complications. Here, we describe our experience with reverse Ponseti technique. Materials and methods - 3 cases (5 feet) of congenital vertical talus (CVT) both isolated and                nonisolated, were  treated by serial manipulation and casting by Reverse Ponseti technique. An average of 10 plaster cast applications were required to correct the deformity. Once the talus and navicular were aligned based on the reduction of radiographic parameter Talar Axis first Metatarsal Base Axis angle(TAMBA), percutaneous fixation of the talo-navicular joint with a Kirschner wire, and percutaneous tendoachilles tenotomy under anesthesia was performed following which a cast was applied for 6 weeks, then changed to brace and later Ankle Foot Orthosis once child starts walking. Results The mean follow-up period for the three cases was 11 months. At the end of the serial cast correction by reverse ponseti all 3 patients (5 feet) were supple and plantigrade but still using braces. The mean talar axis 1st metatasal base angle (TAMBA) angle was 73.75 before casting and this improved to 24.5deg. Conclusion- Although our follow-up period is small, we would recommend early casting by reverse Ponseti technique for CVT. TAMBA is a reliable radiological             parameter for the assessment follow up of CVT. This early casting method can prevent extensive surgery in the future, but a close follow up is necessary to detect recurrence.