A treatment developed by a pediatric orthopedic surgeon has shown early success in correcting the foot deformity in children. The treatment for rigid flatfoot//, which once required extensive surgery, can now be corrected with minimal surgery.

Congenital vertical talus (CVT), or "rocker-bottom flat foot," occurs in about 1 in 10,000 live births. Left untreated, the patient would walk on the inside of the ankle rather than the bottom of the foot, resulting in pain and disability. CVT afflicts both healthy children and those with genetic birth defects and neuromuscular disorders.

Matthew B. Dobbs, M.D., who performs surgeries at St. Louis Children's Hospital, developed a treatment for CVT that involves gently manipulating the foot and applying long leg casts weekly for four to six weeks to gradually correct the deformity. After the casting period, Dobbs and his colleagues take an X-ray to determine the success of the correction.

"Much of the correction is achieved with casting alone," says Dobbs, associate professor of orthopaedic surgery at the School of Medicine. "In the cases where we are not able to reach full correction with casting, we reach the rest of the correction with a minimally invasive surgery. This type of surgery is very small compared to the extensive release surgery that has been done in the past."

In the minor surgical procedure, Dobbs inserts a small pin into a joint in the foot where it meets the ankle to hold the correct position for about two months. After the casting treatments or the surgical pinning, CVT patients wear a nighttime brace for several years to prevent recurrence.

Details about the treatment in 11 patients with CVT, or a total of 19 feet, are discussed in the March 2007 issue of The Journal of Bone and Joint Surgery.

His method has caught the attention of pediatric orthopaedic surgeons worldwide, and he is training other surgeons in the United States and inte
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