Early diagnosis is important to prevent the vertical talus from becoming a more serious foot deformity as your child grows older. It can be treated through reverse Ponseti casting in babies, followed by bracing for 23 hours a day (including naps and nighttime) and stretching exercises to keep the foot flexible.
Diagnosis
A pediatric orthopaedic doctor usually diagnoses vertical talus with a physical exam and special X-rays. He or she will check your child’s bones for a flattened arch in the back of the foot and a protruding head on the talus bone at the front of the ankle.
The talus is the largest bone in your child’s foot and connects the ankle joint to the rest of the foot. It forms the lower part of the heel bone with the calcaneus (heel bone). The talus and calcaneus are attached by three small bones called cuboid, navicular, and cuneiform. These bones usually form during early childhood.
Congenital vertical talus is usually not painful for infants or toddlers, but if it goes untreated, the condition can cause pain in older children as they walk and wear shoes. It can also cause hardened skin lesions known as calluses. If the deformity is not treated, it can also affect how well your child walks and balances, and may lead to further health problems, including scoliosis and other spinal problems.
Most children with this condition will require surgery. Previously, surgical treatment for congenital vertical talus was often complicated and carried a high risk of complications. However, less intrusive surgical techniques are being used today and have shown promising results in correcting the deformity and limiting the release of soft tissue.
Treatment
Congenital vertical talus can be difficult to diagnose because it is similar in appearance to the more common foot condition clubfoot (talipes) and to a shin bone bend called calcaneovalgus. To distinguish the conditions, our pediatric orthopaedic doctors use x-rays and flex your child’s foot in different directions. In children with vertical talus, the joint between the talus and navicular bones in the foot is pointed inwards and downwards, while it points outwards and upwards in children with clubfoot or calcaneovalgus.
The treatment for congenital vertical talus depends on how old your child is when it’s diagnosed and the severity of the deformity. If it’s treated early, nonsurgical treatments like serial manipulation and casting often give good results. In more severe cases, surgery may be needed to correct the abnormal alignment of the talonavicular joint. The type of surgery depends on the age of your child and your surgeon’s preference.
In most cases, our pediatric orthopedic surgeons treat this condition using the Ponseti method. This involves stretches and serial casting of the feet for up to three months. Our surgeons can also perform surgical procedures to reduce the talonavicular joint or lengthen the ankle and toe extensors in older children. These surgeries typically involve a short hospital stay and a quick recovery. Whether your child needs surgery or not, our team will provide you with the best possible care.
Preventative Measures
If you are pregnant and think your child may have vertical talus, you can ask for a pelvic exam and ultrasound during the pregnancy. These tests can give your doctor a better understanding of the condition and its effect on the development of your child’s bones and muscles.
Your doctor may also want to do an X-ray with your child’s foot pointed down, or plantarflexed, to see how the bones in front of the talus line up. In some cases, the talus bone appears to be stuck on top of the front bones in a position that causes the deformity. If your child has other conditions linked to vertical talus, your doctor may decide to do more testing.
Left untreated, congenital vertical talus can cause pain by pulling on the inner side of your child’s foot as they walk and stand. This can cause calluses, skin breakdown and other problems. It can also affect the way your child stands and walks, causing problems such as the talus bone protruding into the ankle when they walk, giving their foot a “rocker bottom” appearance.
If your child has a severe case of vertical talus, they will need treatment to improve the alignment of their feet and ankles. This can be done nonsurgically or surgically. Nonsurgical treatment includes serial manipulation and casting, with the goal of reducing the upward curve in the middle of the foot. Surgical treatment is more complicated and can involve extensive soft-tissue release.
Surgery
It is important for a child with vertical talus to be seen early by a pediatric orthopedic specialist. The doctor will take a complete medical history and perform a physical examination of your child’s foot. X-rays will also be taken to confirm the diagnosis.
It may be possible to treat your child’s vertical talus without surgery. This treatment consists of serial manipulation, muscle stimulation and the application of plaster casts. The goal of this treatment is to bring close reduction in the talonavicular joint. This treatment has been shown to be effective over a period of time in treating idiopathic congenital vertical talus.
However, it is important to note that these results were based on a small number of patients with idiopathic vertical talus and a short follow-up. The authors of this study recommend further investigation with a larger sample size and longer follow-up in order to determine whether the treatment regimen recommended in this article should be maintained into childhood.
Surgery should be considered if nonoperative treatments are not achieving the desired result. Surgical management can improve the long-term outcome and provide your child with a painless, stable and functional foot that will serve them well throughout life. It involves reducing the dislocated talus bone and fusing it to the navicular bone in the heel. This can involve extensive soft tissue release and bone work in older children.