A novel anterior talar osteotomy for equinus deformity with posterior tilt of the talus trochlea: the mid- and long-term outcomes

A substantial proportion of patients equinus patients exhibit posterior tilt of the talus trochlea, soft tissue procedures solely, such as Achilles tendon lengthening, may not enough to correct deformity or lead to tibiotalar joint incongruence, while triple arthrodesis is a joint-sacrificing procedure. Therefore, we introduce a novel anterior talar osteotomy to correct equinus deformity while maintaining tibiotalar joint congruence. A total of 12 patients (mean age of 26.83 ± 8.83 years) were included in this study. 50 healthy individuals were enrolled as controls to assess the morphology of the talar trochlea and determine the presence of posterior tilt in the patient cohort. Both postoperative imaging and clinical outcomes were collected during follow-up to evaluate the efficacy of the procedure. The average follow up duration was 80.92 ± 18.36 months. Preoperative imaging revealed a talus trochlea–neck angle on X-ray (TTNAx) of 53.58 ± 9.93°, a talar neck depth of 0.05 ± 0.04, and a TTNA on CT (TTNAct) of 51.89 ± 9.34°. These values differed significantly from those of the 50 healthy controls: 30.58 ± 3.13°, 0.30 ± 0.04 and 25.57 ± 2.00°, respectively. Postoperatively, TTNAx improved to 38.00 ± 4.20° and talar neck depth to 0.10 ± 0.05. The Foot and Ankle Disability Index (FADI) activity score improved from 43.67 ± 12.23 to 91.92 ± 4.89, and the FADI sports score improved from 6.58 ± 3.55 to 23.92 ± 3.65. The overall good and excellent rate was 75%. All osteotomies healed successfully, with no cases of avascular necrosis of the talus observed. For equinus patients presenting with posterior tilt of talar trochlea, anterior talar osteotomy could effectively correct the deformity, while preserving subtalar joint function and maintaining tibiotalar joint congruence. This joint-sparing approach is particularly recommended for young, active patients. Level IV- Case Series.