Talectomy for the Treatment of Rigid Nonidiopathic Clubfoot Deformity: Long-term Follow-up.

Abstract

Background: Clubfoot occurs in 30% of patients with myelomeningocele (MM) and is the most frequent foot deformity in patients with arthrogryposis (ART). Patients have high recurrence rates with more conservative interventions and may require talectomy. This study investigated the long-term clinical outcomes of talectomy in patients with MM and ART and identified factors associated with favorable outcomes.

Methods: A retrospective chart review was performed on cases of clubfoott in MM and ART between 1975 and 2010, excluding if follow-up was <5 years or had incomplete charts. A plantigrade, stable, and braceable foot was graded as a good result. Statistical analysis included descriptive statistics, chi-square with continuity correction, Spearman correlation, and Mann-Whitney, with P ​< ​.05 reaching significance.

Results: In total, 944 cases of clubfoot in patients with MM and ART were identified. Of those, 53 underwent talectomy and 31 feet were included in the analysis. Average age on talectomy date was 4.16 ​± ​2.46 years and the mean follow-up since surgery was 15.71 ​± ​8.43 years. "Good results" were found in 24 (77.4%) feet, while 7 feet (22.6%) required additional surgery. Older age at talectomy date was associated with good results at the last clinical visit (P ​= ​.03). Primary talectomies were associated with more subsequent surgeries per foot when compared with salvage talectomies (P ​= ​.03). A Functional Mobility Scale (FMS) of 3-1-1 or higher was associated with a good outcome (P ​= ​.022) and all "poor results" (7 feet, 22.6%) were found in patients with FMS lower than 3-1-1.

Conclusions: Talectomy was performed in 5.6% of cases, demonstrating its rare use in treatment of clubfoot in patients with MM and ART. Nevertheless, these long-term outcomes demonstrate that talectomy surgery may be a good option for the treatment of nonidiopathic clubfoot. Good outcomes are maintained at long-term follow-up, suggesting a satisfactory correction remained until adulthood. Finally, a higher FMS was a predictor of success, suggesting that this procedure should be performed in ambulatory patients.

Key concepts: (1)Talectomy remains a rare procedure, utilized in only 5.6% of clubfoot cases of patients with myelomeningocele or arthrogryposis.(2)"Good" results, defined as a plantigrade, stable, and braceable foot was achieved in 77.4% of patients.(3)Older age at time of talectomy was associated with improved results.(4)A Functional Mobility Scale (FMS) of 3-1-1 or higher was associated with good outcomes and thus may be a predictor of success.

Level of evidence: Level IV.