Talectomy in the treatment of the myelomeningocele patient.

This paper is an analysis of a series of 11 pediatric myelomeningocele patients in whom 20 talectomies were performed for correction of rigid equinovarus of paralytic vertical talus deformities. In most of the patients talectomy achieved a satisfactory correction of the foot deformity with maintenance of the correction for up to 5 years of follow-up in this study. Failure of the procedure related to two factors: (1) severe external rotational contracture of the hips in patients with high spinal lesions; (2) incomplete removal of the talus because of extensive scarring and fibrosis due to prior infection or surgery. Correction of the external rotational deformity of the hip or a derotational supramalleolar osteotomy of the tibia can prevent the first cause of failure. An intra-operative X-ray of the foot can prevent the latter.