Naviculectomy combined with 'à la carte' soft-tissue releases: is it a practical solution for congenital vertical talus in adolescence?

Neglected congenital vertical talus in adolescents often necessitates extensive soft-tissue dissection, leading to increased surgical trauma and worsening outcomes. We propose that excising the navicular bone can shorten the foot's medial column and loosen the ligaments around the talonavicular joint, thus improving reduction. This study aimed to evaluate whether naviculectomy and 'à la carte' soft-tissue releases could enhance the outcomes in these patients or not. A retrospective case series study was conducted on 15 adolescent patients (average age 10.67 years) with neglected congenital vertical talus from June 2020 to 2025, with a median follow-up of 24 months. All cases were idiopathic, neglected, virginal feet that had not undergone any manipulative casting before. Clinical assessments followed Zorer et al .'s criteria, and pain levels were evaluated using the visual analog scale (VAS). There were 11 boys and 4 girls. The median Zorer score increased from 2 preoperatively to 11 postoperatively, with a mean difference of 10 ( P  < 0.001), reflecting marked functional recovery. The median VAS score showed significant improvement at the final follow-up from 7 to 2 ( P  < 0.001). Significant improvement was observed in all radiographic measurements. Naviculectomy combined with 'à la carte' soft-tissue releases could be a practical, effective solution for adolescents with neglected congenital vertical talus in terms of pain relief, clinical, and radiological improvement while reducing complications associated with extensive surgical soft-tissue releases on short-term outcomes.