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Hello all,
Had a patient come in today in his early 20's, has Cerebral Palsy and Congenital Vertical Talus. He said he was able to walk from 8 - 12 years of age, now in an electric wheelchair and is able to weightbear long enough to transfer to a chair or bed. Are there any alternatives to surgery & what is usual ( triple arthrodesis?) He is experiencing pain in the foot at night/ late afternoon. I have suggested stronger analgesics ( currently using Panadol) in the meantiume. Any suggestions welcome!
Thanks,
Kara

 

some info for you Kara - may help ?



http://emedicine.medscape.com/article/1259681-overview#showall

 

Hi Kara:
This is difficult, mainly due to the fact that he has not walked in 8 years. Even if you were to fuse the affected foot and he was able to bear weight, he would still have issues with weakness and contractures in other weight bearing joints.

Has your patient participated in any therapy in the past 8 years?

Steve

 

Steve,
Thanks for your reply. I don't think he has had any therapy, will confirm this soon. I find it strange that it wasn't detected and corrected at an earlier age. Is the corrective surgery a fairly recent development? (Aussie pods don't perform foot surgery, unlike US pods)
He also has knee problems which led to him not being able to walk. Unable to straighten knee much past 90 degrees.
Thanks,
Kara

 

Hi Kara:
There are ways to attempt correction in pediatric patients. Adult rigid vertical talus is not really "correctible" - one can perform a triple arthrodesis and soft tissue releases to obtain a plantigrade foot.

After 8 years of being confined to a wheelchair, my concern is whether trying to perform some heroic procedures on his foot would make any real difference.

As far as detecting this at an earlier age...your patient's CP may have caused this deformity to progress over time. As you know, although a secondary pes cavus or pes cavo varus is more likely with CP, you can develop a rigid pes valgus. Perhaps this was not a congenital vertical talus.

Steve

 

Spoke to his mother at length the other day - he had lots of physiotherapy etc as a child, still doing swimming in hydrotherapy pool. He realises he will not be able to walk, is just after pain relief. He is taking ibuprofen as I suggested, which is helping, but obviously this can't be a long term solution. On x ray the navicular has moved dorsally and the 1st met is completely dislocated plantarly. He states the pain is worse mid afternoon and night. Do you think surgery would improve his pain in the long term?
Thanks,
Kara

 

Hi Kara:
Giving advice for this is a bit different than giving it for a straight forward problem such as a bunion or heel spur. The surgeon selecting the procedure (s) is really the one who would need to access the situation in detail.

For me or anyone else here to suggest that a fusion here or an arthroplasty there is going to give this patient relief would be guess work at best.

Good luck

Steve

 

Correction of neglected vertical talus deformity in an adult.
Lui TH
BMJ Case Rep. 2015 Feb 18;2015. pii: bcr2014208187. doi: 10.1136/bcr-2014-208187.