Differences in Talar Morphology Between Patients With Clubfoot and Nonclubfoot Patients from Fetus to Adulthood: A Systematic Review.

Background: The talus plays a central role in understanding the pathophysiology and natural history of clubfoot deformity. The morphology, severity, natural history, and functional implications of talar dysplasia in patients with clubfoot are poorly understood. Flat-top talus is a common finding in patients with a history of clubfoot that can lead to limited ankle dorsiflexion and painful anterior ankle impingement. The aim of this review was to assess the morphological differences between clubfoot and non-clubfoot tali.

Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE/PubMed, Embase, and Scopus for articles reporting on talar morphology in patients with clubfoot. Our primary outcomes collected were demographic data of included patients and variables describing talar morphology.

Results: The clubfoot talus is dysplastic in multiple dimensions. The prevalence of talar flattening appears to increase in early life and stabilizes during childhood. Differences in talar length and transverse talar neck angle between clubfoot and nonclubfoot tali virtually disappear by adolescence. The current literature suggests that differences in talar morphology in patients with clubfoot are both of an innate and an acquired nature. Despite the lack of longitudinal studies, some studies show a potential correlation between the presence or development of a flat-top talus and increased clubfoot severity.

Conclusion: Talar dysplasia in patients with clubfoot, including flat-top talus, remains poorly understood, and further studies are necessary to inform treatment guidelines for flat-top talus.

Level of evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.