Vertical talus is one of the most severe congenital foot deformities. It is detected in one child out of 10 thousand newborns and is characterized by a vertical position of the talus. The cause of the deformation is chromosomal mutations, often combined with other congenital malformations, such as neurofibromatosis or myelodysplasia. At the CONSTANTA Clinic in Yaroslavl, the Dobbs method is used to treat this pathology. It, combined with highly qualified orthopedists treating vertical ramus, guarantees the effectiveness of therapy and complete cure.
Clinical picture
The pathology is localized in the talonavicular joint. The head of the talus is inclined towards the sole, and the scaphoid is shifted to the dorsal side. The valgus and equinus position of the heel region, the curvature, and the abduction of the anterior section form a “rocking chair”-type convexity toward the sole in cases of severe pathology. This is a clear visual sign by which the diagnosis of congenital vertical talus in children can be made even without x-rays. The pathology is also characterized by pronounced flat feet and hyperextension to the dorsal side.
Diagnostics
The disease is diagnosed by an orthopedist-traumatologist as a result of a medical examination and x-ray. On photographs in frontal and lateral projections, a rigid dislocation of the head of the talus is clearly indicated. During the initial consultation, the degree of deformation is determined, treatment measures are prescribed, and their cost is accurately calculated.
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- photograph of a straight and lateral view of children's feet with maximum dorsiflexion;
- x-rays in the same projections;
- a short video recording of a baby walking in one direction and back.
Symptoms of hallux limitus/hallux rigidus
Pain
. At the early stage of the disease (hallux limitus), pain in the joint occurs only periodically - under heavy loads. But the longer you ignore the problem, the more frequent and severe the attacks become. Soon pain becomes an indispensable companion when walking. And in the later stages it does not disappear, even when the patient’s legs are at rest.
About limited mobility
in the joint in the early stages of arthrosis (hallux limitus) is minimal. But with severe arthrosis (hallux rigidus), it becomes more and more difficult to move the finger - first of all, to lift it. Ultimately, arthrosis leads to the almost complete inability to move a finger.
Lameness
appears inevitably due to pain. With severe arthrosis of the 1st metatarsophalangeal joint, patients involuntarily begin to shift weight to the outer edge of the foot when walking. This, in turn, leads to the formation of painful calluses in the area of the 4th and 5th metatarsals and under the main phalanx of the first toe.
Joint deformity
. Due to the presence of bone spines (exostoses), thickening of the metatarsal head is observed. The deformation becomes more noticeable over time.
Inflammation
.
When arthrosis worsens, swelling is periodically observed, the skin turns red, and the temperature rises. Diagnosis of the disease in the clinic does not take much time. The podiatrist examines the foot and takes x-rays. With arthrosis, x-rays clearly show narrowing of the joint space and bone exostoses.
Treatment method
Treatment measures must begin immediately after the pathology is identified. Their goal is to restore the normal shape and functionality of the foot. This is achieved by strengthening muscle tissue and ligaments, which are easily corrected in childhood. Thanks to the elasticity of the child’s tissues, it is possible to restore the correct anatomy of the talonavicular joint without resorting to major surgery.
Clinic Constant. Information for parents of young patients.
Treatment of vertical ram in our Clinic includes:
- Staged casting Dobbs therapy involves manual correction with holding the legs in the desired position. Over the course of several weeks, the pediatric orthopedist applies 5-6 plaster casts to the child from the fingers to the upper thigh with the knees bent at a right angle. This will stretch the soft tissue and normalize the anatomy of the joint.
- Surgical intervention: joint fixation, achillotomy During a low-traumatic operation under the control of electronic optics, the joint is fixed in an anatomically correct position using Kirschner wires. The Achilles tendon is lengthened through a percutaneous Achilles tendon.
- Application of postoperative plaster A plaster cast fixes the foot in the middle position for 8 weeks
- Removing the fixing pins After removing the pins, the high plaster bandage is changed to a short one (up to the knee) to be worn for a month. With it, the child can move around with assistance.
- Wearing braces After removing the final cast, you must use special orthopedic shoes (braces) for 3 months according to the established regulations, gradually reducing the wearing time. This will consolidate the therapeutic effect and prevent the foot from returning to the wrong position.
Healing takes more than one month. The result depends on the persistence of adults. It is necessary to strictly follow medical instructions and regularly show the child to specialists. Our Clinic, for its part, guarantees highly qualified medical care. Correction of the vertical ram is carried out by leading pediatric orthopedists CONSTANTS: MD. M.A. Vavilov – President of the Russian Ponseti Association and Ph.D. M.V. Gromov. Having extensive experience in practical work with children and parents, they easily find contact with young patients.
Arthrosis of the ankle joint
Surgical treatment may be indicated for patients with severe osteoarthritis or in cases where conservative treatment is ineffective. There are several different options for surgical treatment of osteoarthritis.
Arthroscopy . Arthroscopic procedures include synovectomy and debridement (cleaning of the joint), removal of loose intra-articular bodies, excision of osteophytes (bone spines) and chondroplasty (cartilage replacement). The high effectiveness of arthroscopic interventions in the treatment of osteoarthritis of the ankle joint has been confirmed in many studies. In patients with widespread degenerative joint disease, arthroscopy can achieve long-term positive effects. Arthroscopy may also be effective in patients with focal osteochondral lesions of the talus.
Osteotomy of the tibia . In some cases, osteoarthritis of the ankle joint is caused by deformities of the tibia, which lead to improper distribution of loads in the ankle joint. In such cases, osteotomy eliminates deformity and optimizes load distribution. It is indicated primarily for young patients with varus or valgus deformity of the lower limb and associated minimal or moderate osteoarthritis of the ankle joint.
Arthrodesis of the ankle joint . Arthrodesis of the ankle joint (tibiotalar arthrodesis) is one of the most predictable interventions for relieving pain caused by severe degenerative damage to the joint. Arthrodesis can be performed openly or arthroscopically. In this case, all remnants of cartilage covering the articular surfaces are removed, and the articular ends of the bones are fixed to each other with a plate and/or screws in order to create conditions for their fusion. The probability of forming a bone block created in this way with both methods reaches 80-90%, and the choice of a specific method of joint arthrodesis is determined by such factors as the severity of the deformity, the condition of the vessels and skin of the limb, and the quality of the bone tissue. The main disadvantage of ankle arthrodesis is the loss of dorsiflexion and plantarflexion. Most patients tolerate this quite well, but this in turn accelerates the development of degenerative changes in other joints of the foot, in particular in the subtalar joint. In order to ensure maximum mobility of the remaining joints of the foot after arthrodesis of the ankle joint, the latter is fixed in a special position.
Rice. Arthrodesis (closure) of the ankle joint.
Total ankle replacement . During this operation, the damaged articular surfaces of the tibia and talus are replaced with artificial components. This operation is ideal for elderly and senile patients with a normal body mass index, in advanced stages of osteoarthritis, minimally severe deformities, a satisfactory range of motion and good quality of soft tissue in the surgical area. Its effectiveness in relieving pain is similar to arthrodesis, and the advantage is maintaining mobility of the ankle joint and thereby reducing the load on the remaining joints of the foot. The main disadvantage of ankle replacement is that the artificial joint is a mechanical device and wears out over time, gradually leading to the need for replacement. The need for revision of the prosthesis due to its wear usually occurs earlier than the need for similar revisions after knee or hip replacement, however, according to modern research, the survival rate of ankle joint prostheses at 8-10 years after surgery reaches 85-90%.
Rice. Total ankle replacement.
Subtalar arthrodesis . Arthrodesis of the subtalar joint is the most effective treatment method and the method of choice in cases where conservative treatment of arthrosis of this joint is ineffective. The operation involves removing the articular cartilage and subchondral bone of the articular surfaces that form the subtalar joint and fixing them with staples or screws. If the shape of the articular surfaces does not allow for close contact between them, bone grafting is performed using auto- or allo-bone, which fills existing defects, thereby creating conditions for the formation of bone fusion. The principle inherent in arthrodesis of any joint (getting rid of pain at the cost of loss of movement) is also true for this operation. The scope of the operation can be expanded by simultaneous arthrodesis of the talonavicular and calcaneocuboid joints. This operation will be called “three-joint arthrodesis.” It is most often used to correct hindfoot deformities.
Rice. Subtalar arthrodesis.
Debridement and microfracture . This method is most often used to treat small (less than 1.5 cm in diameter) cartilage defects of the talus. Unstable fragments of cartilage are removed arthroscopically, and the bone base is processed and many holes (microfractures) are formed in it using an awl or drill to stimulate bleeding and the subsequent formation of a fibrin bundle. The fibrin bundle fills the defect and then transforms into fibrocartilage. The operation is effective in approximately 90% of cases of cartilage damage.
If the articular cartilage is not damaged, and the damage is located under it, it is possible to drill out the defect from the side of the bone, and not from the side of the articular surface, the latter remaining intact (the so-called “retrograde tunneling”).
Osteochondral transplantation (cartilage transplantation) . This is the replacement of the damaged articular surface with grafts consisting of bone and cartilage tissue.
Options for such transplantation are osteochondral auto- or allotransplantation (OCAT), as well as autochondrocyte implantation (ACI). Such operations are usually indicated in cases of ineffectiveness of previously performed debridement and microfracture, as well as in cases of significant osteochondral damage.
During OHAT, a cylindrical block consisting of cartilage and bone is taken from the condyle or trochlea of the femur and transplanted into a bone bed formed of the same shape in the area of the osteochondral defect.
IAC involves taking the patient’s own chondrocytes, culturing them in the laboratory, and then implanting the thus enlarged cell mass into the defect area and covering it with a patch of periosteum or collagen matrix.
Comfort and care for patients Clinics
Taking care of the convenience of children and parents, we offer:
- comfortable living conditions in wards equipped with children's functional furniture;
- responsiveness and competence of the staff, always ready to help and answer all questions;
- a memorable toy for the baby as a gift from the doctor after each appointment and operation;
- the service of a Personal Manager who takes upon himself the solution of organizational issues. To order a service, call: +7 (4852) 37-00-85 or write by email. mail
Cost of treatment
You can receive medical assistance in the treatment of vertical ramus at the CONSTANTA Clinic in Yaroslavl at your own expense (the approximate cost is indicated below, may vary depending on the volume of surgical intervention and the complexity of the operation) or FREE OF CHARGE (at the expense of a charitable foundation).
We provide free treatment for young patients with musculoskeletal problems with financial support from Rusfond.
CONSTANTA Clinic through the eyes of a child! Treatment of vertical ram Anesthesia for operations in children Treatment of children with the support of the Charitable Foundation