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Le pied bot convexe congénital: étude diagnostique et thérapeutique de 71 cas

Congenital vertical talus. A diagnostic and therapeutic study of 71 cases

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Summary

We have studied 71 feet with Congenital Vertical Talus in 51 patients. The condition is characterised by two fixed deformities, equinus of the hindfoot with a vertical talus and dislocation of the mid tarsal joint due to malposition of the navicular with respect to the head of the talus. The forefoot is usually everted, but lay in inversion in 25% of our cases.

The deformity must be recognised within a few weeks of birth, and the diagnosis is facilitated by radiographs taken in extreme dorsiflexion and plantarflexion. The radiographic appearances allow classification of the deformity into three groups which aid in the choice of the correct management.

Treatment is by operation. We have performed 48 open reductions, followed by lengthening of the Achilles tendon six weeks later. Our results can be equally divided into good, fair and poor. We have excised the talus on three occasions only, but we feel that this operation may well be useful in the presence of marked deformity of the talus, particularly in the older child.

Résumé

Le pied bot convexe congénital est défini par un équin irréductible de l'astragale et par une luxation dorsale irréductible du scaphoïde sur la tête de l'astragale.

A côté de la pronation classique de l'avant pied, il existe une supination de l'avant pied dans un quart des cas.

Parmi les 51 enfants de cette série, 20 avaient une atteinte bilatérale et 34 avaient des troubles neurologiques et/ou des malformations associés.

Le diagnostic doit être fait dans les premières semaines de la vie pour permettre un traitement précoce.

Il est essentiellement radiologique et repose surtout sur des clichés dynamiques de profil en équin et en talus forcé.

La classification radiologique en 3 groupes de Pouliquen et Rigault a un intérêt pronostic et permet de poser des indications thérapeutiques en tenant compte de l'âge de l'enfant.

Le traitement est essentiellement chirurgical. Il repose surtout sur le «Rechaussement-reposition» dont nous avons 48 cas, suivi d'un temps postérieur systématique, 6 semaines plus tard. Les résultats sont bons, moyens et mauvais, chacun, dans un tiers des cas. Les indications de l'astragalectomie réalisée seulement dans 3 cas devraient à notre avis être élargies au pied dont les déformations de l'astragale sont trop importantes, surtout si l'enfant est âgé.

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Authors and Affiliations

  1. Service d'Orthopédie Traumatologie Infantile de l'Hôpital des Enfants Malades, 149, rue de Sèvres, F-75743, Paris Cedex, France

    O. Badelon, P. Rigault & J. P. Padovani

  2. Service d'Orthopédie Traumatologie Infantile de l'Hôpital Raymond Poincaré, F-92380, Garches, France

    J. C. Pouliquen

  3. Centre Hélio-Marin de Roscoff, F-29211, Perharidy, France

    J. Guyonvarch

Authors
  1. O. Badelon
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  2. P. Rigault
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  3. J. C. Pouliquen
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  4. J. P. Padovani
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  5. J. Guyonvarch
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Badelon, O., Rigault, P., Pouliquen, J.C. et al. Le pied bot convexe congénital: étude diagnostique et thérapeutique de 71 cas. International Orthopaedics 8, 211–221 (1984). https://doi.org/10.1007/BF00269918

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