Congenital vertical talus

1. Congenital Vertical Talus
Dr. DITESH JAIN
DEPT. OF ORTHOPAEDICS
LILAVATI HOSPITAL & RESEARCH CENTRE

2. Definition
• It’s a rare foot deformity consisting of irreducible dorsal
dislocation of navicular on talus producing a rigid flat foot.
• AKA:
• Congenital convex pes valgus
• Reverse club foot
• Rocker bottom feet
• Talipus convex pes valgus

3. • Patient with reducible navicular dislocation on
stretched plantar flexion lateral films is termed as
Congenital Oblique Talus.
• Epidemiology:
• Incidence: 1 in 10,000
• Male = Female
• Bilateral in 50%

4. Etiology
• Idiopathic [50%]
• Neuromuscular disorder: Myelodysplasia, Sacral Agenesis,
Arthrogryposis, Diastematomyelia.
• Genetic/Familial [1/5th]: Trisomy 13, 15 & 18, Mutation in HOXD10,
GDF5 – AD inheritance (12 – 20%).
• Syndromes: Prune Belly, Costello, Rasmussen & De Barsy syndrome.

5. Pathoanatomy
• Hindfoot:
• Equinus and Valgus: Contracture of tendo-achillis and peroneal tendons.
Calcaneum turns plantar and valgus.
• Midfoot:
• Midfoot is dorsiflexed on hindfoot (rocker bottom feet – Prominent talus head on
plantar aspect).
• Dorsal dislocation of talo-navicular joint.
• Anterior contracture of EHL, EDL, TA & anterolateral contracture of peroneus
tertius.
• Advanced cases associated with concurrent dorsal dislocation of cuboid.

6. • Forefoot:
• Abducted and
Dorsiflexed.
• Due to contracture
of EHL, EDL, TA &
anterolateral
contracture of
peroneus tertius.

7. Classification
• Coleman Classification based on patho-anatomy:
• Type I : CVT associated with calcaneo-cuboid dislocation.
• Type II : CVT not associated with calcaneo-cuboid dislocation.

8. Clinical Features:
• Deformity: Forefoot-Abduction & Dorsiflexed, Hindfoot-Equinus &
valgus.
• Foot everted and external rotated.
• Convex plantar surface – Rocker bottom feet.
• Deep Antero-Lateral crease.

9. • Talar head prominent plantar and medially.
• Palpable gap between Talar neck and Navicular dorsally.
• Painful callosities around talar head plantarlly.
• Heel doesn't touch the ground.
• Due to deformity; difficult shoe wearing.

10. Radiographic Evaluation:
• Films required in AP and Lateral projection in forced plantar and
dorsal flexion.

11. • On forced plantar flexion lateral
film:
• Rigid Dorsal displacement of Ist
Metatarsal – Meary`s Angle > 20 deg
aka TAMBA (Talar axsis 1st metatarsal
base axsis)
• In CVT TAMBA = 60 deg, and
• CAMBA = 20 deg, (Caalcaneum axsis
1st metatarsal base axsis)
TAMBA
CAMBA

12. • Talo-Calcaneal angle > 40 deg
(N:20-40 deg)
• Tibio-Calcaneal Angle: Decreased
(N: 60-90 deg)
• Tibio-Talar angle: Decreased (N:
Approx 92.5 deg )

13. Diffrential
• Congenital Oblique Talus
• Tarsal Coalaltion
• Pes Valgus deformity either congenital or paralytic

14. Managment
• Conservative: Serial Manipulation and casting.
1. Reverse Ponsetti: In mild CVT and COT
patient.
• The foot is stretched into plantar flexion and
inversion while counter pressure is applied to
the medial aspect of the head of the talus.
• After a few minutes of manipulation, A/K cast
applied in two sections, with knee in 90’ of
flexion.
• 4-6 plaster cast is usually enough to achieve
reduction of the talonavicular joint.
• Cast changed on weekly basis

15. 2. Dobb`s Method: Manipulation with plantar flexion and inversion
followed by fixation of navicular over talus once satisfactory
correction is achieved.
3. To Correct Equinus Additional TA tenotomy always neccessory.

16. • Surgical Meethod: Standard method
1. Coleman Two Staged procedure:
• 1st: Lengthening of EHL, EDL & TA with anterior capsule release
• 2nd: Tendo-achillis and posterior capsular release.
2. Seimon Single stage procedure:
• EHL and peroneus tendon are tenotomized and talo-navicular joint is reduced by
open reduction and fixed with K-Wire fixation.
• Achillis tenotomy is mandatory.
• These procedure can be done in children upto 4 yr old; preferred upto 2yr.

17. • For older children with residual deformity:
• Required salvage procedure like Naviculectomy, Talectomy,
Subtalar arthrodesis or Triple Fusion.
• 4-8 yr: Open reduction with soft tissue release along with Extra-
articular subtalar arthrodesis.
• Neglected cases or presenting after 12 yr ofter have arthrosis and
rigid deformities that cant be corrected. Best treated by Triple
arthrodesis.