Congenital Vertical Talus
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
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
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