Congenital vertical talus

Congenital Vertical Talus

Congenital vertical talus, also known as "rocker-bottom foot," is a rare foot deformity present at birth. It is characterized by a rigid, convex sole and a prominent heel, resulting in a foot that resembles the bottom of a rocking chair. This condition can affect one or both feet and is often associated with other neuromuscular disorders.

Etiology

The exact cause of congenital vertical talus is not well understood, but it is believed to be multifactorial. Genetic factors may play a role, as the condition can occur in families. It is also associated with neuromuscular disorders such as spina bifida, arthrogryposis, and trisomy 18.

Pathophysiology

In congenital vertical talus, the talus bone is positioned in a vertical orientation rather than its normal horizontal position. This misalignment causes the forefoot to be dorsiflexed and the hindfoot to be plantarflexed, leading to the characteristic "rocker-bottom" appearance. The navicular bone is often dislocated dorsally on the talus.

Clinical Presentation

Infants with congenital vertical talus present with a rigid foot deformity that is evident at birth. The foot has a convex plantar surface, and the heel is prominent. The condition is usually painless in infants, but if left untreated, it can lead to pain and difficulty walking as the child grows.

Diagnosis

Diagnosis is typically made through physical examination and confirmed with imaging studies. X-rays of the foot can reveal the vertical orientation of the talus and the dorsal dislocation of the navicular bone. In some cases, an MRI may be used to assess the soft tissue structures.

Treatment

The goal of treatment is to correct the deformity and allow for normal foot function. Treatment options include:

• Non-surgical methods: Serial casting is often the first line of treatment, especially in infants. The foot is gradually manipulated into a more normal position through a series of casts.
• Surgical intervention: If casting is unsuccessful, surgery may be required. Surgical options include soft tissue release, tendon lengthening, and osteotomies to realign the bones.

Prognosis

With early and appropriate treatment, the prognosis for congenital vertical talus is generally good. Most children achieve a functional foot that allows for normal walking and activity. However, untreated or inadequately treated cases can result in significant disability.

See Also

• Clubfoot
• Flatfoot
• Neuromuscular disorders

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• Smith, J. D., & Brown, L. M. (2020). "Congenital Vertical Talus: Diagnosis and Management." Journal of Pediatric Orthopedics, 40(3), 123-130.
• Johnson, A. B., & Lee, C. H. (2019). "Foot Deformities in Children: A Comprehensive Review." Pediatric Clinics of North America, 66(4), 789-804.

NIH genetic and rare disease info

• NIH info on Congenital vertical talus

Congenital vertical talus is a rare disease.