Der Talus vertikalis

Abstract

Summary Congenital vertical talus is a rigid rocker-bottom flat-foot deformity, which was first described by Henken in 1914. Although this rare deformity may occur as an isolated primary deformity, it is usually associated with other congenital or neuro-muscular abnormalities such as neural tube defects, neuromuscu-lar disorders, malformation syndromes and chromosomal aberrations. Patients can be grouped by these associated conditions to different classification systems. The congenital vertical talus deformity is characterized by a primary irreducible dislocation of the talonavicular joint, in which the navicular articulates with the dorsal aspect of the talus. It should be differentiated from flat-foot deformities such as talipes calcaneovalgus, oblique talus deformities or hypermobile flatfeet, because prognosis and treatment are different. The objectives of treatment of congenital vertical talus are to reduce the navicular and calcaneus in a normal anatomic relationship to the talus and maintain the reduction, so that a plantigrade, weightbearing surface within the sole of the foot can be provided. Conservative means alone have had a very poor success rate, consequently open reduction has been advocated as the treatment of choice for congenital vertical talus by many authors. A number of techniques for operative treatment have been proposed, including open reduction of the talonavicular or calcaneocuboid joints with or without excision of the navicular, partial or complete talectomy, one stage or two stage techniques with open reduction in combination with different tendon transfers. Our approach to congenital vertical talus is a peritalar release using the Cincinnati approach, reduction of malposition of sub-talar joint complex and adjustment of tendons involved in the deformity, including reinforcement of the calcaneonavicular ligament. Furthermore it is recommended that for children aged from 3 to 4 years a concomitant Grice extraarticular subtalar arthrodesis can be performed to maintain correction. In older, untreated children or those in whom previous treatments have failed, a subtalar or triple arthrodesis may be necessary.