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Background: The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Ponseti for the treatment of clubfoot deformity, followed by pinning of the talonavicular joint and percutaneous tenotomy of the Achilles tendon in patients with idiopathic congenital vertical talus.
Methods: The cases of eleven consecutive patients who had a total of nineteen feet with an idiopathic congenital vertical talus deformity were retrospectively reviewed at a minimum of two years following treatment with serial manipulations and casts followed by limited surgery consisting of percutaneous Achilles tenotomy (all nineteen feet), fractional lengthening of the anterior tibial tendon (two) or the peroneal brevis tendon (one), and percutaneous pin fixation of the talonavicular joint (twelve). The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic measurements obtained at these times were compared. In addition, the radiographic data at the final evaluation were compared with normal values for an individual of the same age as the patient.
Results: Initial correction was obtained both clinically and radiographically in all nineteen feet. A mean of five casts was required for correction. No patient underwent extensive surgical releases. At the final evaluation, the mean ankle dorsiflexion was 25° and the mean plantar flexion was 33°. Dorsal subluxation of the navicular recurred in three patients, none of whom had had pin fixation of the talonavicular joint. At the time of the latest follow-up, there was a significant improvement (p < 0.0001) in all of the measured radiographic parameters compared with the pretreatment values, and all of the measured angles were within normal values for the patient's age.
Conclusions: Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographically at a minimum two years, in patients with idiopathic congenital vertical talus.
Here are my lecture notes on congenital vertical talus:
Quote:
Congenital vertical talus
Rare. Dorsal dislocation of navicular on talus (may be a form of clubfoot).
Cause unknown – but intrauterine position, genetic and neuromuscular conditions have been implicated. May be isolated deformity of part of another syndrome (eg arthrogryposis multiplex congenita; neurofibromatosis; nail-patella syndrome).
Rocker bottom appearance to foot; talus is prominent talus head in plantar medial side of foot; dorsal creasing in the MTJ region; rigid STJ; forefoot is abducted and dorsiflexed.
On x-ray, the dorsal dislocation of the navicular off the head of the talus onto the talar neck is seen
Posterior tibial tendon is more dorsally located --> acts as a dorsiflexor
Two types:
1. Dislocation of talonavicular joint, subluxation of subtalar joint, normal calcaneocuboid joint (more flexible)
2. Dislocation of talonavicular joint, subluxation of subtalar joint and calcaneocuboid joint, ankle joint equinus (more rigid)
Initially treatment at birth is manipulation and casting – later treatment is surgical. Prognosis is often not good without surgery.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
I have a 14 year old female patient who has bilateral anterior knee pain. Tip toe test shows no reformation of the medial arch and no calcaneal inversion. She is max pronated and supination resistance is hard. There is excessive medial buldging and she has previously not been able to tollerate neutral type casted orthoses. Her STJ ROM is normal and the forefoot in not plantarflexed on rearfoot (as you mention above).
Whilst I haven't yet taken x-ray, I am certain this is a structural type flat foot deformty abd have considered a vertical talus as a cause.
Have you any thoughts on this and on what orthoes may work?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
The Following User Says Thank You to Craig Payne For This Useful Post:
With all the reseach with congenital foot deformities, casing is really only effective if commenced in really early stages (like first coupel of months of life). Past that, ossification of bones means taht surgery is required.. Robcox, if this was a congenital vertical talus, you'd see it without an X-ray, it's quite pronounced. Think those old rocker bottom feet in old people with abducted forefeet and huge lumps under the MLA.
Cheers!
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Adrian Misseri
B.Pod.,M.Hlth.Sci.(Pod.)
You know.. we could just cut it off.....?
The Following User Says Thank You to Adrian Misseri For This Useful Post:
OBJECTIVE: Congenital vertical talus is a rare condition but a well-known cause of severe rigid flatfoot in children. The aim of this study was to evaluate the mid-term clinical and radiological results of one-stage surgical correction in children with congenital vertical talus.
METHODS: Five feet in three children diagnosed with congenital vertical talus who had undergone surgical correction were followed up for a mean period of seven and half years. During this period they were clinically evaluated for subjective complaints and objective findings focused on the range of movement at the ankle joint, position of the hindfoot, and weight-bearing ability of the treated extremity. They were also evaluated on the basis of radiographs of foot and ankle made in standard projections.
RESULTS: All the children had a good functional range of movement and normally shaped foot. The range of movement remains restricted and decreased during the follow-up period without causing any functional disability. All radiological measurements were within normal limits. There was no evidence of necrosis of talus.
CONCLUSION: We recommend operative treatment for congenital vertical talus by the end of first year of age. The range of movement remains restricted and seems to decrease during follow-up, which had a little effect on the functional outcome of the ankle joint
Congenital Vertical Talus
Linear Mode
