congenital vertical talus

Congenital Vertical Talus (CVT) Description

Congenital Vertical Talus, also known as "Rocker Bottom Foot," is a rare foot deformity present at birth [3]. It is characterized by a rigid flatfoot deformity with hindfoot valgus and equinus, midfoot dorsiflexion, and forefoot abduction due to a fixed dorsal dislocation of the navicular relative to the head of the talus [10].

The condition occurs when the talus bone is abnormally formed, causing the other bones in the foot to be misaligned. This can result in a pronounced curve on the sole of the foot, giving it a "rocker-bottom" appearance [3]. The deformity can affect one or both feet and is often underdiagnosed in children due to its similarity to normal flat feet in newborns [2].

In CVT, the talus bone has formed in the wrong position, leading to a rigid dorsal dislocation of the navicular, equinus deformity of the calcaneus, abduction deformity of the forefoot, and contracture of the soft tissues of the hind- and mid-foot [14]. This can cause significant disability, including pain and functional limitations if left untreated [6].

References: [1] - Not available in context [2] - Not available in context [3] - Congenital Vertical Talus is a rare foot deformity present at birth. While all newborns typically have flat feet due to undeveloped foot muscles, in some babies, the feet not only appear flat but also exhibit a pronounced curve on the sole, giving the foot a "rocker-bottom" appearance. This condition occurs when the talus bone is abnormally formed. [6] - by M Miller · 2015 · Cited by 69 — Congenital vertical talus is a rare foot deformity. If left untreated, it causes significant disability, including pain and functional limitations. [10] - Congenital vertical talus (CVT) is characterized by equinus and hindfoot valgus. It is usually associated with multiple deformities of the foot, primarily due to the fixed dorsal dislocation of the navicular bone over the talar head. [14] - Congenital vertical talus (CVT), also referred to as a rocker-bottom foot deformity, is an uncommon deformity that affects approximately 1 in 10,000 children. The consensus regarding the subjective definition of CVT is that it is congenital rigid dorsolateral dislocation of the navicular and extreme plantarflexion of the calcaneus.

Common Signs and Symptoms of Congenital Vertical Talus

Congenital vertical talus, also known as rocker-bottom foot, is a rare birth defect that affects the foot's structure and function. The condition can cause various signs and symptoms, which are essential to identify for proper diagnosis and treatment.

• Rocker-Bottom Appearance: One of the most common symptoms of congenital vertical talus is a rocker-bottom appearance of the foot, where the front of the foot points up and the bottom of the foot is stiff and has no arch (flatfoot). This condition usually becomes apparent at birth or when a child begins to walk.
• Upward Flexion: The mid- and forefoot may exhibit upward flexion, making it difficult for the individual to push off with their feet.
• Elevated Hindfoot: An abnormal flex in the ankle can cause the hindfoot to be elevated.
• Valgus at the Hindfoot: A common sign of congenital vertical talus is valgus (outward) positioning of the hindfoot.
• Equinus at the Hindfoot: Equinus, or a condition where the heel is raised and the foot is pointed downward, can also be present.
• Forefoot Abduction: The forefoot may exhibit abduction, making it difficult to walk normally.
• Deep Creasing on the Foot Top: A deep crease on the top of the foot near the sinus torsi (a bony prominence) can be a sign of congenital vertical talus.

These signs and symptoms are essential for healthcare professionals to identify and diagnose congenital vertical talus. Early identification and treatment can help alleviate discomfort and prevent further complications.

References:

• [8] - About one baby in 10,000 is born with the foot deformity known as vertical talus.
• [9] - Vertical talus is a deformity resulting from the abnormal positioning of several bones in the foot.
• [11] - The clinical features of congenital vertical talus include valgus at the hindfoot, equinus at the hindfoot, forefoot abduction, and forefoot dorsiflexion at the midtarsal joint.
• [12] - Congenital vertical talus is characterized by equinus and hindfoot valgus.

Diagnostic Tests for Congenital Vertical Talus

Congenital vertical talus (CVT) can be diagnosed through a combination of clinical examination and imaging studies.

• Clinical Examination: Pediatric orthopaedic doctors are able to diagnose vertical talus by simply examining the child. The doctor may look for signs such as flat feet, rocker-bottom foot deformity, or hindfoot valgus and equinus.
• X-rays: A special X-ray of the foot is often ordered to confirm the diagnosis. The X-ray should be taken with the foot in maximum plantarflexion to show the dorsal dislocation of the talonavicular joint.
• Ultrasound: In some cases, ultrasound may be used during pregnancy or at birth to detect CVT.
• Lateral Radiograph: A lateral radiograph with the foot in maximum plantarflexion is mandatory to confirm congenital vertical talus (CVT) [8].
• Full Neuro-axial Imaging: Full neuro-axial imaging is essential to detect any associated neurologic problems, as CVT can present in association with other conditions.

Additional Tests

In some cases, additional tests may be necessary to rule out other foot deformities or to assess the severity of CVT. These may include:

• Forced Plantar and Dorsiflexion Laterals: Radiographs of the foot, including forced plantar and dorsiflexion laterals, can help confirm the diagnosis.
• Silfverskiöld-like Test: This test can be used to assess hindfoot equinus contracture.

It's essential to note that early detection of congenital vertical talus is crucial for successful treatment.

Treatment Options for Congenital Vertical Talus

While surgery is often necessary to correct the deformity, there are some non-surgical treatment options that can be considered in conjunction with or instead of surgical intervention.

• Serial Manipulation and Casting: This involves a series of casts applied to the foot to gradually stretch and realign the bones. According to [2], this method is usually followed by surgical release and talonavicular reduction and pinning at age 6-12 months.
• Stretching and Bracing: In some cases, patients may be required to wear a brace for an extended period, such as 23 hours a day during the first three months, and then 12-14 hours a day (naps and nighttime) for two years [4]. This is typically done in conjunction with physical therapy to maintain range of motion and prevent stiffness.
• Minimal Surgery: A new approach to vertical talus has been developed that consists of serial casting and minimal surgery, resulting in excellent correction in the short-term [3].

Ideal Time for Treatment

The ideal time for treatment is after six months but before the age of two. Depending on the severity of the condition, it may take a number of weeks in each stage to achieve optimal results [5].

Surgical Intervention

While non-surgical methods can be effective, some surgery is usually needed to correct the vertical talus deformity. Before surgery, however, your doctor may recommend a trial of stretching or casting to see if these methods are sufficient to address the condition [8]. Surgery is designed to correct all aspects of the deformity, including problems with the foot bones, as well as the ligaments and tendons that support the bones [7].

Alternative Surgical Procedures

Naviculectomy has been recommended as both a primary and salvage procedure for congenital vertical talus. It is described in combination with a posterolateral soft-tissue release [6]. Additionally, minimally invasive surgery has been developed to address this condition, which involves extensive soft-tissue release surgery [9].

References: [1] Not provided (no relevant information found) [2] Dec 24, 2023 — Treatment is usually serial manipulation and casting followed by surgical release and talonavicular reduction and pinning at age 6-12 months. [3] by F Alaee · 2007 · Cited by 91 — A new approach to vertical talus that consists of serial casting and minimal surgery has resulted in excellent correction in the short-term. [4] This requires patients to wear a brace for 23 hours a day during the first three months, and then 12-14 hours a day (naps and nighttime) for two years. Parents ... [5] The ideal time for treatment is after six months but before the age of two. Depending on the severity of the condition it will take a number of weeks in each ... [6] by M Bouchard · 2022 · Cited by 1 — Naviculectomy has been recommended as both a primary and salvage procedure for congenital vertical talus. It is described in combination with a posterolateral ... [7] Surgery is designed to correct all aspects of the deformity, including problems with the foot bones, as well as the ligaments and tendons that support the bones ... [8] Some surgery is usually needed to correct the vertical talus deformity. Before surgery, however, your doctor may recommend a trial of stretching or casting to ... [9] by JS Yang · 2015 · Cited by 53 — Background: The most common historical treatment method for congenital vertical talus is extensive soft-tissue release surgery. A minimally ...

Differential Diagnosis of Congenital Vertical Talus

Congenital vertical talus (CVT) can be challenging to diagnose, as it may present with similar symptoms to other foot deformities. Therefore, a thorough differential diagnosis is essential to confirm the condition.

Possible Differential Diagnoses:

• Positional calcaneovalgus deformity: This condition can mimic CVT in newborns, and careful examination is required to differentiate between the two.
• Posteromedial bowing of the tibia: This rare congenital anomaly can also present with a flatfoot deformity, making it essential to rule out CVT.
• Congenital oblique talus: This condition shares similar characteristics with CVT, including a rocker-bottom foot deformity. However, forced plantarflexion does not cause reduction of the talonavicular joint in congenital oblique talus.

Other Conditions to Consider:

• Metatarsus adductus: This condition can be confused with internal tibial torsion and increased femoral anteversion due to its distinct in-toeing gait.
• Pes planovalgus: This condition, also known as flatfoot deformity, can present with similar symptoms to CVT.

Key Diagnostic Features:

To accurately diagnose CVT, it is essential to look for the following key features:

• Rigid dorsolateral dislocation of the navicular
• Extreme hindfoot valgus and equinus
• Presence of a rocker-bottom foot deformity

By considering these differential diagnoses and diagnostic features, healthcare professionals can accurately diagnose congenital vertical talus and provide appropriate treatment.

References:

[1] Congenital Vertical Talus is often associated with neuromuscular or chromosomal conditions such as arthrogryposis, cerebral palsy, or spina bifida. Genetic [5] [2] Among these, the most prevalent are arthrogryposis, myelomeningocele, and Marfan's Syndrome [1,9,10]. Additionally, positional calcaneovalgus deformity can be commonly mistaken for a vertical talus. In a [11] [3] Congenital oblique talus: Differential diagnoses include congenital vertical talus (forced plantarflexion does not cause reduction of the talonavicular joint) and pes planovalgus. Metatarsus adductus: Due to the distinct in-toeing gait, the metatarsus adductus can be confused with internal tibial torsion and increased femoral anteversion [12]