Congenital Vertical Talus
Dorsolateral dislocation of the talocalcaneonavicular joint
Fixed dorsal dislocation of the navicular on the talr head and neck and fixed equinus contracture of the hindfoot resulting in rigid flatfoot deformity. Deep creases on the anterolateral aspect of foot are evident. There is a palpable gap in between the navicular and talar neck dorsally. Exact cause is unknown, often idiopathic or associated with other neuromuscular or genetic disorder. If left untreated, will cause significant disability in future, pain is inevitable. The heel does not purchase the ground, the patient bears weight on the talar head, developing painful callosities, poor gait, and difficulty balancing. Navicular, middle and anterior subtalar facets are often hypoplastic due to positioning. medial soft tissue structures are elongated and dorsallateral soft tissue structures are contracted.
Other known terms : Congenitial convex pes valgus, Reverse Club foot, Congential valgus flat foot, Rocker bottom foot, Talipes convex pes valgus
Incidence is 1 in 10,000, Male prevalence equal to Female, Bilateral presence is 50%
NON OPERATIVE TREATMENT:
- Serial manipulation and Reverse Ponseti casting, to which the foot is manipulated into inversion and plantarflexion
- Typically will require pinning of the talonavicular joint with percutaneous Achilles tenotomy
OPERATIVE TREATMENT:
Reducible : 6-12 months of age
- Pantalar release, lengthening of peroneal tendons, EDL, EHL and Achilles
- Reconstructed spring ligament and pin the talonaviculat joint
- Tibialis anterior is transfered to talar neck
Resistant to treatment:
- Talectomy can be indication
Salvage procedure or case of neglected vertical talus:
- Triple Arthrodesis
Reconstructive surgical options are limited after the age of 3, depending on the severity of deformity, patients will often require a Triple Arthrodesis after the age of 3