Definition
Congenital vertical talus is a rigid congenital flatfoot caused by dorsal dislocation of the navicular on the talar head with a vertically oriented talus.
Associations
It may occur in isolation or with:
- Neuromuscular disorders
- Arthrogryposis
- Chromosomal or syndromic conditions
Clinical features
- Rigid rocker-bottom foot
- Hindfoot equinus
- Forefoot dorsiflexion and abduction
- Prominent talar head medially / plantarly
- Deformity does not correct with manipulation
Imaging
Forced plantar-flexion lateral radiograph
This is important in distinguishing vertical talus from flexible oblique talus. In true vertical talus the talonavicular relationship remains dislocated and does not reduce with plantar flexion.
Pathoanatomy
- Dorsolateral dislocation of the navicular on the talar head
- Vertically oriented talus
- Hindfoot equinus
- Contracture of dorsolateral soft tissues
Treatment
Current treatment usually begins with serial manipulation and casting aimed at reducing the talonavicular joint, followed by limited surgery when required:
- Talonavicular reduction and fixation
- Achilles tenotomy / lengthening for residual equinus
The aim is to obtain a plantigrade, flexible, pain-free foot while avoiding extensive soft-tissue release where possible.
Differential diagnosis
- Flexible flatfoot
- Oblique talus
- Calcaneovalgus foot
References
- Orthobullets — Congenital Vertical Talus