Vertical Talus

Vertical talus is an uncommon foot deformity present at birth, also referred to as congenital vertical talus. It is one of the primary causes of flatfoot in newborns, and can affect either one or both feet. While the condition does not cause pain in newborns or toddlers, untreated vertical talus can result in significant disability and discomfort as the child grows older. Prompt diagnosis and treatment are crucial to prevent complications later in life.

Anatomy of the Talus

The talus (pronounced TAY-lus) is a small but crucial bone located between the heel bone (calcaneus) and the lower leg bones (tibia and fibula). The tibia and fibula surround and sit on top of the talus, forming the ankle joint. As a key connector between the foot and leg, the talus plays a vital role in transferring weight across the ankle joint.

Description

In vertical talus, the talus bone develops abnormally, causing the other bones in the foot to misalign. This results in the front of the foot pointing upward, often pressing against the shin. The underside of the foot becomes stiff, lacking an arch, and typically curves outward, which is referred to as a "rocker bottom." This condition is distinctly different from a clubfoot. Vertical talus is typically diagnosed at birth. However, because other foot deformities are more common in newborns, it is often initially misdiagnosed as another type of flatfoot, such as oblique talus or calcaneovalgus deformity. In some cases, less experienced clinicians may mistakenly identify it as a clubfoot.

Cause

The exact cause of vertical talus is not fully understood. However, many cases are linked to neuromuscular disorders or other conditions such as arthrogryposis, spina bifida, and various syndromes. To determine if any of these conditions are present, your doctor may recommend additional tests for your infant.

Doctor Examination

Pediatric orthopedic specialists can often diagnose vertical talus through a physical examination of the child's foot. To confirm the diagnosis, your doctor may order an X-ray of the foot.

Treatment

The primary goal of treating vertical talus is to ensure your child has a functional, stable, and pain-free foot. Early intervention is crucial. While vertical talus itself does not prevent walking, if left untreated, the deformity can worsen. This may lead to walking on an abnormal foot, causing calluses, painful skin problems, and difficulty finding properly fitting shoes. Ultimately, untreated vertical talus can result in difficulty walking. Treatment typically involves a combination of nonsurgical and surgical approaches, depending on the severity of the condition.

Nonsurgical Treatment

The initial treatment for vertical talus is typically nonsurgical and focuses on stretching and casting to improve foot flexibility. In some cases, these methods can correct most of the deformity, with a minor procedure to finalize the correction. Following this, physical therapy exercises and bracing may be recommended to further stretch the foot and enhance its flexibility.

Surgical Treatment

If nonsurgical treatments do not fully correct the condition, surgery may be considered, typically when the child is between 9 to 12 months old.

Surgical Procedure

The goal of surgery is to address all aspects of the deformity, including issues with the bones, ligaments, and tendons that support the foot. During the surgery, the surgeon will reposition the bones and use pins to secure them. Tendons and ligaments that have become shortened due to the deformity will also be lengthened.

Recovery

After surgery, a cast will be applied to your child's foot to maintain the corrected position. Your child will likely remain in the hospital for at least one night for pain management and to monitor any swelling. After 4 to 6 weeks, the cast will be removed, and a brace or special shoes may be required to prevent the deformity from returning.

Outcomes

Without treatment, vertical talus can lead to pain and disability as the child grows. However, with appropriate treatment, your child can expect a stable, functional foot that should serve them well throughout life. If there are no other underlying conditions affecting development, your child will likely be able to run, play, and wear normal shoes without pain. Your child's doctor will recommend regular follow-up visits to monitor the foot's growth and development over the years.