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dear all,

10 yrs old cerebral palsy child , potential walker has,hamstring tightness,
and bil CTEV.

stage one , hamstring release and patella tendon plication was done.

for 2nd stage,

he has rigid BIL.CTEV. We use to do JESS /ILIZAROV at this age group.
(This child is not ideal pt for gradual correction)

but in this child i want do single stage procedure to correct the deformity.

options are PMR, TRIPLE ARTHRODESIS and TALECTOMY.

my plan is talectomy and i can correct the deformity in single stage.

any suggestion,opinion,references regarding this procedure.

Dr.suresh Gandhi
asst.prof .
Dept,Of.Orthopaedics
Saveetha Medical College
Chennai

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I just came across this information! Coughlin, Mann & Saltzman (2007) citing Wilcox and Weiner (1985), suggests that in late childhood (10 years of age?) and adolescence, with a fixed bony deformity more or less like this one, bone osteotomies should be considered before a tripple arthrodesis or a talectomy.

You are correct in your aggressive rationale to opt for talectomy as it will correct the deformity however the position is difficult to mentain orthotically and plantar pressure will not be even, so why risk it?.........sorry for the deviation am just curious??

Foot Ankle Clin. 2004 Dec;9(4):775-85.
Use of talectomy in modern foot and ankle surgery.
Joseph TN, Myerson MS.
Source
The Institute for Foot and Ankle Reconstruction at Mercy, 301 St. Paul Place, Baltimore, MD 21202, USA.
Abstract
Talectomy is a procedure that is undertaken rarely in modern orthopedic surgery; however, it has been performed for many years. Talectomy has been used most commonly in pediatric orthopedics with some degree of success in severe clubfoot deformity, arthrogryposis multiplex congenita, myelomeningocele, tuberculosis, and tumors. In adults, talectomy has been used in salvage procedures that involve nonunion of ankle fusions, failed total ankle arthroplasty, inflammatory arthropathy, neuroarthropathy, failed talar prostheses, failed pantalar fusions, adult neglected clubfoot, posttraumatic avascular necrosis talus, and deformities that are due to sciatic nerve palsy and compartment syndrome. This article consider what place talectomy has in modern adult foot and ankle surgery.
PMID: 15498707 [PubMed - indexed for MEDLINE]