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Congenital Vertical Talus

Congenital vertical talus
Objectives
  1. Describe the pathology of congenital vertical talus
  2. Describe a rational approach to treatment based on the pathology
  3. List conditions described as being associated with congenital vertical talus
  4. Describe the assessment of the newborn with congenital vertical talus

Discussion points
  1. At what age should surgery be performed, and why?
  2. After the diagnosis has been made in the newborn, what type of workup is indicated?
  3. How should the newborn be treated?
  4. Is there a genetic component to the etiology of congenital vertical talus?

Discussion
Congenital vertical talus is a perplexing entity that can occur as an isolated entity on in conjunction with neuromuscular conditions such as arthrogryposis, myelomeningocele, or spinal dysraphism. One series (Ogata) reported about half occurred as isolated entities, the rest were divided between being associated with other disorders with and without neurologic deficit. Stern described a family with an autosomal dominant pattern, but this is unusual. The pathology consistently described is a fixed dorsal dislocation of the talonavicular joint. Various authors have used a number of other descriptive terms in the literature for congenital vertical talus; however the term "congenital vertical talus" has been generally accepted by common usage, even though not descriptive of the basic pathology. The intrinsic musculature of the foot is lacking, and cannot protect the midfoot from the pull of the dorsiflexors, which subsequently displace the talonavicular joint by pulling the midfoot dorsally and laterally, leaving the talar head to plunge inferomedially (Specht). It is not surprising, given its proximity, that the calcaneocuboid joint can also demonstrate varying amounts of disruption. Forced dorsiflexion and plantarflexion lateral radiographs can demonstrate whether a dislocation of the talonavicular joint is fixed by assessing the relationship of the metatarsals to the talar head, the navicular of course being totally nonossified in infancy. Nonoperative treatment is ineffective. Some authors recommend operative treatment at 3-6 months, others prefer to wait until about 12 months. At present, most authors prefer a one-stage release with reduction and fixation of the talonavicular joint, often but not universally with lengthenings of the dorsiflexors and heelcord. Duncan transfers the anterior tibial to the talus. Although subtalar fixation was previously routinely performed, many present reports omit this procedure as a routine part of the correction. Longterm results that would be necessary to resolve this question are still pending.

References
  1. Daumas L, Filipe G, Carlioz H. [Congenital convex talus. Methods and results of a single-stage surgical correction]. Revue de Chirurgie Orthopedique et Reparatrice de l Appareil Moteur 1995; 81( 6): 527-37.
  2. Drennan JC. Congenital vertical talus. Instructional Course Lectures 1996; 45: 315-22.
  3. Duncan RD, Fixsen JA. Congenital convex pes valgus. Journal of Bone & Joint Surgery -British Volume 1999; 81( 2): 250-4.
  4. Kodros SA, Dias LS. Single-stage surgical correction of congenital vertical talus. Journal of Pediatric Orthopedics 1999; 19( 1): 42-8.
  5. Ogata K, Schoenecker PL, Sheridan J. Congenital vertical talus and its familial occurrence: an analysis of 36 patients. Clinical Orthopaedics & Related Research 1979( 139): 128-32.
  6. Specht EE. Congenital paralytic vertical talus. An anatomical study. Journal of Bone & Joint Surgery -American Volume 1975; 57( 6): 842-7.
  7. Stern HJ, Clark RD, Stroberg AJ, Shohat M. Autosomal dominant transmission of isolated congenital vertical talus. Clinical Genetics 1989; 36( 6): 427-30.
  8. Stricker SJ, Rosen E. Early one-stage reconstruction of congenital vertical talus. Foot & Ankle International 1997; 18( 9): 535-43.
  9. Wirth T, Schuler P, Griss P. Early surgical treatment for congenital vertical talus. Archives of Orthopaedic & Trauma Surgery 1994; 113( 5): 248-53.
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