Congenital Vertical Talus

Congenital Vertical Talus Treatment
  • Congenital Vertical Talus is a rare congenital condition caused by neuromuscular or chromosomal abnormalities in neonates that typically presents with a rigid flatfoot deformity.

  • Diagnosis is made with forced plantar flexion lateral radiographs that show persistent dorsal dislocation of the talonavicular joint.

  • Treatment is usually serial manipulation and casting followed by surgical release and talonavicular reduction and pinning at age 6-12 months.

  • कंजेनिटल वर्टिकल टैलस एक दुर्लभ जन्मजात स्थिति है, जो नवजात शिशुओं में न्यूरोमस्कुलर या क्रोमोसोमल असामान्यताओं के कारण होती है जो आमतौर पर एक कठोर फ्लैटफुट विकृति के साथ प्रस्तुत होती है।

  • निदान जबरन forced plantar flexion latera रेडियोग्राफ़ के साथ किया जाता है ।

  • उपचार आमतौर पर serial manipulation and casting( प्लास्टर ) होता है जिसके बाद सर्जिकल रिलीज ।

  • Incidence

    • rare, 1:150,000 births

  • Demographics

    • M:F ratio of 2:1

  • Anatomic location

    • 50% bilateral

  • Pathoanatomy

    • rigid foot deformity

      • irreducible dorsolateral navicular dislocation

      • vertically oriented talus

      • calcaneal eversion with attenuated spring ligament

  • Genetics

    • a positive family history is present in up to 20% of patients

    • HOXD10 gene mutation (transcription factor)


    • soft tissue contractures

      • मांसपेशियों के सुकुड़ने के कारण उनके कार्य में बदलाव आना displacement of peroneal longus and posterior tibilais tendon so they function as dorsiflexors rather than plantar flexors

      • contracture of the Achilles tendon

  • Physical exam

    • rigid rockerbottom deformity

      • fixed hindfoot equinovalgus

        • due to contracture of the Achilles and peroneal tendons

      • rigid midfoot dorsiflexion

        • secondary to the dislocated navicular

      • forefoot abducted and dorsiflexed

        • due to contractures of the EDL, EHL and tibialis anterior tendons

    • prominent talar head

      • can be palpated in medial plantar arch on exam

        • produces a convex plantar surface


    • gait abnormality

      • patient may demonstrate a "peg-leg" or a calcaneal gait due to poor push-off power

      • limited forefoot contact, excessive heel contact

    • neurologic deficits

      • a careful neurologic exam needs to be performed due to frequent association with neuromuscular disorders

  • Radiographs

    • recommended views

      • AP, oblique and lateral foot

    • findings

      • lateral

        • vertically positioned talus & dorsal dislocation of navicular

          • line along long axis of talus passes below the first metatarsal-cuneiform axis

            • before ossification of navicular at age 3, the first metatarsal is used as a proxy for the navicular on radiographic evaluation

      • AP

        • talocalcaneal angle > 40° (20-40° is normal)

  • MRI

    • neuraxial imaging should be performed to rule out neurologic disorder

    • alternative views

      • forced plantar flexion lateral radiograph is diagnostic

        • shows persistent dorsal dislocation of the talonavicular joint

          • oblique talus reduces on this view

          • Meary's angle > 20° (between line of longitudinal axis of talus and longitudinal axis of 1st metatarsal)

      • forced dorsiflexion lateral

        • reveals fixed equinus

Treatment उपचार

    • serial manipulation and casting

      • indications

        • indicated preoperatively to stretch the dorsolateral soft-tissue structures

        • foot is manipulated into inversion and plantarflexion

      • typically still requires closed vs open pinning of the talonavicular joint with percutaneous achilles tenotomy


    • surgical release and talonavicular reduction and pinning

      • indications

        • indicated in most cases

        • performed at 6-12 months of age

      • technique

        • involves pantalar release with concomitant lengthening of peroneals, Achilles, and toe extensors

        • talonavicular joint is reduced and pinned while reconstruction of the plantar calcaneonavicular (spring) ligament is performed

        • concomitant tibialis anterior transfer to talar neck

    • minimally invasive correction

      • indications

        • new technique performed in some centers to avoid complications associated with extensive surgical releases

      • technique

        • principles for casting are similar to the Ponseti technique used clubfoot

        • serial casting utilized to stretch contracted dorsal and lateral soft tissue structures and gradually reduced talonavicular joint

        • once reduction is achieved with cast, closed or open reduction is performed and secured with pin fixation

        • percutaneous achilles tenotomy is required to correct the equinus deformity

    • talectomy

      • indicated in resistant case

    • triple arthrodesis

      • as salvage procedure