Lateral Column Shortening with Talonavicular Fusion and Adductor Hallucis Lengthening in the Management of Neglected and Relapsed Congenital Talipes Equinovarus: A Retrospective Analysis of 22 Cases

Abstract

Manish Bajaj*, Gaurav Jain, Anshul Meena

Background: Neglected and relapsed Congenital Talipes Equinovarus (CTEV) presents significant challenges in pediatric orthopedic surgery. While the Ponseti method has revolutionized initial management, many patients still require surgical intervention for persistent or recurrent deformities. This study evaluates the efficacy of combined lateral column shortening, talonavicular fusion, and adductor hallucis lengthening in managing resistant deformities.

Methods: A retrospective analysis was conducted on 22 patients (34 feet) with neglected or relapsed CTEV who underwent lateral column shortening with cuboid wedge resection, talonavicular fusion, and adductor hallucis lengthening between 2015 and 2022. Patients had a minimum follow-up of 24 months. Clinical assessment included morphological evaluation, functional outcomes, and radiographic analysis using standardized measurements. Paired t-tests and chi-square analysis were employed (p<0.05 considered significant).

Results: Mean patient age at surgery was 8.4 ± 3.2 years. Mean follow-up duration was 34.6 ± 8.4 months. Preoperative talus-first metatarsal angle (AP view) averaged 35.2° ± 8.6°, improving to 18.3° ± 6.4° postoperatively (p<0.001). Calcaneus-fifth metatarsal angle improved from 29.1° ± 7.2° to 14.5° ± 5.8° (p<0.001). Successful forefoot correction was achieved in 91.2% of feet (31/34). AOFAS scores improved from 38.6 ± 11.2 to 82.4 ± 9.7 (p<0.001). Overall complication rate was 29.4% (10/34 feet). Four feet (11.8%) experienced delayed union, managed with extended immobilization. Three feet (8.8%) developed wound dehiscence requiring multiple dressings. One patient (2.9%) developed deep infection managed with debridement and antibiotics. One foot (2.9%) required reoperation for inadequate correction. Talonavicular fusion union was achieved in 100% of cases at mean 8.4 ± 2.1 weeks.

Conclusion: Combined lateral column shortening with talonavicular fusion and adductor hallucis lengthening represents an effective single-stage surgical intervention for neglected and relapsed CTEV despite a moderate complication rate consistent with published literature. The procedure consistently achieves significant radiographic and functional correction. Careful postoperative management and surveillance can effectively address complications.