CONGENITAL VERTICAL TALUS

Dr Dhananjaya Sabat MS, DNB, MNAMS

Assistant Professor OrthopedicsMAMC & STC. New Delhi

INTRODUCTIONCongenital convex pes

valgusuncommon disorder of the

foot; 1BIN 10000. 50% B/LManifested as a rigid rocker-

bottom flatfootdefined by an irreducible and

rigid dorsal dislocation of the navicular on the talus.

left untreated, CVT results in a painful and rigid flatfoot with weak push-off power.

should be recognised at birth and treated before the age of 2.

ETIOLOGYIdiopathicGenetic/syndromic: Spina bifida, trisomy,

marfan, DDH Neuromuscular: Congenital myopathies and

distal arthrogryposis

Abnormal variation in muscle fiber size, type I muscle fiber smallness, and abnormal fiber type predominance (Merrill)

.Contracture of the tendo-Achilles, EDL, EHL,

tibialis anterior

CLINICAL PRESENTATIONrigid flatfoot with a rocker-

bottom appearance of the footPersian slipper appearanceCalcaneus in fixed equinus Achilles tendon is very tight The hindfoot is in valgusThe head of the talus is found

medially in the soleThe forefoot is abducted and

dorsiflexed.

Coleman divided CVT into 2 typesType 1 was associated with a calcaneocuboid

dislocationType 2 was not associated with a

calcaneocuboid dislocation. This distinction is important clinically

because the type 1 deformity is stiffer and particular attention must be paid to releasing the calcaneocuboid joint.

IMAGING STUDIESAP: increased talocalcaneal anglePlantarflexed lateral: fixed forefoot

dorsal dislocationDorsiflexed lateral: fixed equinus

of hindfoot

Lateral radiographs of the foot in maximal plantarflexion can reveal if the navicular is reducible; CONGENITAL OBLIQUE TALUS

Because the navicular may not be ossified, the alignment of the first metatarsal to the talus must be evaluated.

Hamanishi described 2 radiographic angles: the talar axis–first metatarsal base angle (TAMBA) and the calcaneal metatarsal base angle (CAMBA). The changing point from a flexible oblique talus to rigid CVT is a TAMBA of approximately 60° and a CAMBA of 20

NONOPERATIVE TREATMENT

Serial casting to stretch the foot in plantarflexion and inversion while counterpressure is applied to the medial aspect of the talus

Reverse Ponseti methodComplete correction rarely

achieved.

SURGICAL TREATMENTsingle-stage surgical

correction Cincinnati approach or

the dorsal approach (Seimon)

Peroneus tertius & an abnormal band of the inferior retinaculum causing a tether from the tibia to the calcaneus: release

Talonavicular joint & calcaneocuboid joint opened

Percutaneus tendo achilles tenotomy

Talonavicular joint is reduced, fixed with K wire

Cast for 2 weeks. f/b brace

COMPLICATIONS

Wound complicationRecurrenceStiffnessAVN talus

LATE PRESENTATIONSTR + navicular excisionSubtalar arthrodesis 21/2-6yrTriple arthrodesis >6yr