What is a congenital vertical talus?

A vertical talus or a congenital vertical talus is a rare deformity of the foot that is usually present at birth. It is an extreme type of flatfoot that may affect one or both feet. The talus is small bone in the ankle which points forward in a horizontal direction and sits between the tibia and fibula bones of lower leg and the heel bone to form the ankle joint complex. In a foot with congenital vertical talus, the talus points towards the ground in a vertical direction. The consequences of this is a stiff and rigid foot with no arch that is frequently called a rocker bottom foot. The problem can occur by itself or could be part of a wider syndrome such as arthrogryposis or spina bifida. There is also a less severe form of this deformity called oblique talus which is halfway between the horizontal and vertical forms of the talus. This type is much more flexible and only shows up when weightbearing.

A congenital vertical talus is usually diagnosed at birth, but it can sometimes be picked up on ultrasound during the pregnancy. An examination of the foot will generally show the problem and is used to determine just how rigid it is. There is generally no pain initially, but if it is left untreated the foot will remain deformed and with later weightbearing it will generally become symptomatic. An x-ray will clearly pick up the talus in a more vertical position. Some experts consider a congenital vertical talus to be a mild form of a clubfoot.

Generally, some surgery is usually needed to correct the congenital vertical talus deformity. However, the orthopaedic surgeon may want to try a period of stretching or casting to try and improve the flexibility and position of the foot. While in only a few cases will this do away with the need for surgery altogether it is more likely to reduce the amount and extent of surgery that is needed and lead to a better outcome from surgery. Casting is required over a number of visits and changed weekly to keep moving the foot into a more corrected position. If there is not enough of an improvement with this approach then surgery will likely be needed. The extent of the surgery will demand on how much the casting changed the foot and how rigid the deformity is. If the foot is rigidly deformed, then the surgery will need to be more extensive and is usually done just prior to one year of age. The whole point of the surgery is to correct the position of the bones within the foot. To do this generally needs some tendons and ligaments to be lengthened to allow the bones of the foot to be moved. Those bones are then held in place with pins and put in a cast. These pins usually get removed after 4 to 6 weeks. A special shoe or brace may need to be worn for a period of time after than to maintain correction.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.