Abstract
Congenital vertical talus is an uncommon foot deformity that is present at birth and results in a rigid flatfoot deformity. Left untreated the deformity can result in pain and disability. Though the exact etiology of vertical talus is unknown, an increasing number of cases have been shown to have a genetic cause. Approximately 50% of all cases of vertical talus are associated with other neuromuscular abnormalities or known genetic syndromes. The remaining 50% of cases were once thought to be idiopathic in nature. However, there is increasing evidence that many of these cases are related to single gene defects. Most patients with vertical talus have been treated with major reconstructive surgeries that are fraught with complications such as wound necrosis, talar necrosis, undercorrection of the deformity, stiffness of the ankle and subtalar joint, and the eventual need for multiple operative procedures. Recently, a new approach to vertical talus that consists of serial casting and minimal surgery has resulted in excellent correction in the short-term. Longer follow-up will be necessary to ensure maintenance of correction with this new technique. A less invasive approach to the correction of vertical talus may provide more favorable long-term outcomes than more extensive surgery as has been shown to be true for clubfoot outcomes.
Highlights
Congenital vertical talus, known as congenital convex pes valgus, is an uncommon foot deformity that is present at birth and has an estimated incidence of 1 in 10,000 [1]
It is characterized by a fixed dorsal dislocation of the navicular on the talar head and neck [2] resulting in a rigid flatfoot deformity
An emphasis of this review will be on recent findings regarding the genetic etiology of idiopathic vertical talus as well as a new approach to treating the deformity that consists of serial manipulations, castings, and minimal surgery
Summary
Congenital vertical talus, known as congenital convex pes valgus, is an uncommon foot deformity that is present at birth and has an estimated incidence of 1 in 10,000 [1]. It is characterized by a fixed dorsal dislocation of the navicular on the talar head and neck [2] resulting in a rigid flatfoot deformity It occurs as an isolated deformity (idiopathic) in approximately half of all cases and is associated with neuromuscular and genetic disorders in the remaining cases [1, 3,4,5]. Central nervous system/spinal cord Myelomeningocele Spinal muscular atrophy Diastematomyelia Sacral agenesis Muscle Distal arthrogryposis Arthrogryposis multiplex Neurofibromatosis Chromosomal abnormality Trisomy 18 Trisomy 15 Trisomy 13 Known genetic syndromes Neurofibromatosis Prune-Belly syndrome Rasmussen syndrome Split hand and split foot Costello syndrome De Barsy syndrome Single gene defects HOXD10 CDMP1 neurologic disorders tend to be more rigid and difficult to treat than idiopathic vertical talus. A forced plantar flexion lateral radiograph of an oblique talus will demonstrate restoration of a normal relationship between the long axis of the talus and the first metatarsal (Fig. 4a, b)
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