Vertical talus, also known as congenital vertical talus or convex pes valgus, is a rare foot deformity present at birth (congenital) in which the talus bone, located in the ankle, is positioned improperly. This misalignment causes the foot to have a rigid, rocker-bottom appearance. Unlike flexible flatfoot, which is common and usually resolves on its own, vertical talus does not improve without treatment and can make it difficult for a child to walk normally.

Symptoms and Characteristics

The key characteristics of congenital vertical talus include:

• A noticeable convex curve on the bottom of the foot, giving it a rocker-bottom appearance.

• Stiffness and rigidity in the foot, with limited movement, particularly in trying to bring the top of the foot towards the shin (dorsiflexion).

• The front of the foot (forefoot) may be turned outward in relation to the heel (valgus).

• In some cases, there may be other associated conditions or syndromes.

Causes

The exact cause of congenital vertical talus is not always known, but it can be associated with neuromuscular disorders, genetic conditions, or other syndromes. In some instances, it occurs as an isolated foot deformity without any other medical issues.

Diagnosis

Diagnosis of congenital vertical talus involves a physical examination of the foot and imaging studies. X-rays are crucial for confirming the diagnosis, as they can clearly show the abnormal positioning of the talus and its relationship with other bones in the foot.

Treatment

Treatment for congenital vertical talus is usually surgical. The goal of treatment is to correct the alignment of the foot to enable normal foot function and appearance. Treatment typically involves:

• Casting and manipulation: In some newborns, treatment may begin with gentle manipulation of the foot followed by the application of a series of casts. This approach can gradually move the foot into a better position but is often not entirely effective in correcting the deformity due to the rigid nature of the condition.

• Surgery: Surgical correction is commonly required and may involve several procedures to reposition the bones, release contracted soft tissues, and, in some cases, insert pins or other hardware to maintain the corrected position. Surgery is typically performed within the first year of life to take advantage of the foot's natural flexibility and to correct the deformity before the child begins to walk.

• Post-surgical care: After surgery, casting and bracing are used to maintain the correction, and physical therapy may be recommended to strengthen the foot and improve its function.

Early and appropriate treatment for congenital vertical talus is crucial to enable a child to walk normally and participate in typical activities without pain or limitation. The specific treatment plan should be developed by a team of specialists experienced in pediatric foot deformities to ensure the best possible outcome.