Congenital Vertical Talus

NewsBot · Jun 6, 2006

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Early Results of a New Method of Treatment for Idiopathic Congenital Vertical Talus
The Journal of Bone and Joint Surgery (American). 2006;88:1192-1200.

Background: The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Ponseti for the treatment of clubfoot deformity, followed by pinning of the talonavicular joint and percutaneous tenotomy of the Achilles tendon in patients with idiopathic congenital vertical talus.
Methods: The cases of eleven consecutive patients who had a total of nineteen feet with an idiopathic congenital vertical talus deformity were retrospectively reviewed at a minimum of two years following treatment with serial manipulations and casts followed by limited surgery consisting of percutaneous Achilles tenotomy (all nineteen feet), fractional lengthening of the anterior tibial tendon (two) or the peroneal brevis tendon (one), and percutaneous pin fixation of the talonavicular joint (twelve). The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic measurements obtained at these times were compared. In addition, the radiographic data at the final evaluation were compared with normal values for an individual of the same age as the patient.

Results: Initial correction was obtained both clinically and radiographically in all nineteen feet. A mean of five casts was required for correction. No patient underwent extensive surgical releases. At the final evaluation, the mean ankle dorsiflexion was 25° and the mean plantar flexion was 33°. Dorsal subluxation of the navicular recurred in three patients, none of whom had had pin fixation of the talonavicular joint. At the time of the latest follow-up, there was a significant improvement (p < 0.0001) in all of the measured radiographic parameters compared with the pretreatment values, and all of the measured angles were within normal values for the patient's age.

Conclusions: Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographically at a minimum two years, in patients with idiopathic congenital vertical talus.
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Craig Payne · Jun 6, 2006

Here are my lecture notes on congenital vertical talus:

Congenital vertical talus

Rare. Dorsal dislocation of navicular on talus (may be a form of clubfoot).

Cause unknown – but intrauterine position, genetic and neuromuscular conditions have been implicated. May be isolated deformity of part of another syndrome (eg arthrogryposis multiplex congenita; neurofibromatosis; nail-patella syndrome).

Rocker bottom appearance to foot; talus is prominent talus head in plantar medial side of foot; dorsal creasing in the MTJ region; rigid STJ; forefoot is abducted and dorsiflexed.
On x-ray, the dorsal dislocation of the navicular off the head of the talus onto the talar neck is seen

Posterior tibial tendon is more dorsally located --> acts as a dorsiflexor

Two types:
1. Dislocation of talonavicular joint, subluxation of subtalar joint, normal calcaneocuboid joint (more flexible)
2. Dislocation of talonavicular joint, subluxation of subtalar joint and calcaneocuboid joint, ankle joint equinus (more rigid)

Initially treatment at birth is manipulation and casting – later treatment is surgical. Prognosis is often not good without surgery.
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robcox · Aug 12, 2008

Hi Craig

I have a 14 year old female patient who has bilateral anterior knee pain. Tip toe test shows no reformation of the medial arch and no calcaneal inversion. She is max pronated and supination resistance is hard. There is excessive medial buldging and she has previously not been able to tollerate neutral type casted orthoses. Her STJ ROM is normal and the forefoot in not plantarflexed on rearfoot (as you mention above).
Whilst I haven't yet taken x-ray, I am certain this is a structural type flat foot deformty abd have considered a vertical talus as a cause.
Have you any thoughts on this and on what orthoes may work?

Kind regards

Rob

Craig Payne · Aug 12, 2008

All the ones I have come across needed surgery.

Adrian Misseri · Aug 12, 2008

With all the reseach with congenital foot deformities, casing is really only effective if commenced in really early stages (like first coupel of months of life). Past that, ossification of bones means taht surgery is required.. Robcox, if this was a congenital vertical talus, you'd see it without an X-ray, it's quite pronounced. Think those old rocker bottom feet in old people with abducted forefeet and huge lumps under the MLA.
Cheers!

NewsBot · Aug 29, 2009

Mid-term results of one-stage surgical correction of congenital vertical talus.
Mathew PG, Sponer P, Karpas K, Shaikh HH.
Bratisl Lek Listy. 2009;110(7):390-3.

OBJECTIVE: Congenital vertical talus is a rare condition but a well-known cause of severe rigid flatfoot in children. The aim of this study was to evaluate the mid-term clinical and radiological results of one-stage surgical correction in children with congenital vertical talus.

METHODS: Five feet in three children diagnosed with congenital vertical talus who had undergone surgical correction were followed up for a mean period of seven and half years. During this period they were clinically evaluated for subjective complaints and objective findings focused on the range of movement at the ankle joint, position of the hindfoot, and weight-bearing ability of the treated extremity. They were also evaluated on the basis of radiographs of foot and ankle made in standard projections.

RESULTS: All the children had a good functional range of movement and normally shaped foot. The range of movement remains restricted and decreased during the follow-up period without causing any functional disability. All radiological measurements were within normal limits. There was no evidence of necrosis of talus.

CONCLUSION: We recommend operative treatment for congenital vertical talus by the end of first year of age. The range of movement remains restricted and seems to decrease during follow-up, which had a little effect on the functional outcome of the ankle joint
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NewsBot · Jun 25, 2010

MRI pathoanatomy study of congenital vertical talus.
Thometz JG, Zhu H, Liu XC, Tassone C, Gabriel SR.
J Pediatr Orthop. 2010 Jul-Aug;30(5):460-4.

BACKGROUND: Prior reports regarding the pathologic anatomy for congenital vertical talus have noted some disagreement as to which elements of the pathologic anatomy are consistently present. The purpose of his study is to evaluate the 3-dimensional morphologic changes and pathoanatomy of the congenital vertical talus using magnetic resonance imaging.

METHODS: Nine patients with congenital vertical talus (ranging from 5 mo-11 y) underwent magnetic resonance imaging of both feet. A foot and ankle coil was used for the 1.5 T system. The protocol consisted of T1-weighted spin echo sequence image and T2-weighted fast spin echo sequence image in the sagittal, coronal, and axial planes. Slice thickness ranged from 3 to 4 mm with 0 to 1.0 mm interspace thickness. A descriptive analysis was performed based upon the T1-weighted image by physicians.

RESULTS: At the level of the talonavicular joint, the navicular was seen significantly subluxed dorsally with associated wedging of the navicular. At the level of the calcaneocuboid joint, often there was a significant dorsal subluxation of the cuboid in relation to the calcaneus. Lateral obliquity of the calcaneocuboid joint could be present to varying degrees. The anterior calcaneus was significantly laterally displaced in relation to the talar head with an element of lateral translation and eversion of the calcaneus at the subtalar joint. Distal cavus at the cuneiform-first metatarsal joint was observed in 5 patients.

CONCLUSIONS: This study suggests that there is significant pathology at the level of subtalar joint in congenital vertical talus. In addition to satisfactory reduction of the talonavicular joint, methods to ensure realignment of the calcaneus under the talus may be a crucial component of deformity correction and to prevent recurrence of deformity.
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NewsBot · Jul 21, 2010

Skeletal Muscle Abnormalities and Genetic Factors Related to Vertical Talus.
Merrill LJ, Gurnett CA, Connolly AM, Pestronk A, Dobbs MB.
Clin Orthop Relat Res. 2010 Jul 20. [Epub ahead of print]

BACKGROUND/RATIONALE: Congenital vertical talus is a fixed dorsal dislocation of the talonavicular joint and fixed equinus contracture of the hindfoot, causing a rigid deformity recognizable at birth. The etiology and epidemiology of this condition are largely unknown, but some evidence suggests it relates to aberrations of skeletal muscle. Identifying the tissue abnormalities and genetic causes responsible for vertical talus has the potential to lead to improved treatment and preventive strategies.

QUESTIONS/PURPOSES: We therefore (1) determined whether skeletal muscle abnormalities are present in patients with vertical talus and (2) identified associated congenital anomalies and genetic abnormalities in these patients.

METHODS: We identified associated congenital anomalies and genetic abnormalities present in 61 patients affected with vertical talus. We obtained abductor hallucis muscle biopsy specimens from the affected limbs of 11 of the 61 patients and compared the histopathologic characteristics with those of age-matched control subjects.

RESULTS: All muscle biopsy specimens (n = 11) had abnormalities compared with those from control subjects including combinations of abnormal variation in muscle fiber size (n = 7), type I muscle fiber smallness (n = 6), and abnormal fiber type predominance (n = 5). Isolated vertical talus occurred in 23 of the 61 patients (38%), whereas the remaining 38 patients had associated nervous system, musculoskeletal system, and/or genetic and genomic abnormalities. Ten of the 61 patients (16%) had vertical talus in one foot and clubfoot in the other. Chromosomal abnormalities, all complete or partial trisomies, were identified in three patients with vertical talus who had additional congenital abnormalities.

CONCLUSIONS: Vertical talus is a heterogeneous birth defect resulting from many diverse etiologies. Abnormal skeletal muscle biopsies are common in patients with vertical talus although it is unclear whether this is primary or secondary to the joint deformity. Associated anomalies are present in 62% of all cases.
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NewsBot · Sep 8, 2011

Treatment of vertical talus with the Dobbs method
Eberhardt O, Fernandez FF, Wirth T.
Z Orthop Unfall. 2011 Apr;149(2):219-24.

AIM:
The widely accepted treatment of vertical talus after casting is correction by extensive surgery. Dobbs described a new method for the treatment of vertical talus by casting and minimally invasive surgery. The purpose of the present study was to evaluate the efficacy of this new method.

MATERIAL AND METHOD:
Between 11/06 and 11/09 we treated 7 patients with 12 vertical tali. Treatment followed the protocol of Dobbs. The initiation of treatment, number of casts, surgery, as well as clinical and radiological results were documented. To evaluate the radiological result we used the Hamanishi score.

RESULTS:
From the beginning all feet could be treated successfully with the Dobbs method. According to the Hamanishi classification we have four excellent and five good results. Two feet had a relapse with subluxation or dislocation of the talonavicular joint.

CONCLUSION:
Treatment of vertical talus with the Dobbs method is successful. Extensive surgery could be reduced. We recommend the method as primary treatment for vertical talus
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NewsBot · Aug 7, 2012

Minimally invasive approach for the treatment of non-isolated congenital vertical talus.
Chalayon O, Adams A, Dobbs MB.
J Bone Joint Surg Am. 2012 Jun 6;94(11):e73.

BACKGROUND:
Traditional extensive soft-tissue release for the treatment of congenital vertical talus is associated with a myriad of complications. A minimally invasive approach has recently been introduced with good short-term results in patients with isolated vertical talus. The purpose of the present study was to evaluate the effectiveness of this approach for the treatment of rigid vertical talus associated with neuromuscular and/or genetic syndromes.

METHODS:
Fifteen consecutive patients (twenty-five feet) with non-isolated congenital vertical talus were retrospectively reviewed at a minimum of two years following treatment with serial casting followed by limited surgery. The surgery consisted of percutaneous Achilles tenotomy in all feet and either pin fixation of the talonavicular joint through a small medial incision to ensure joint reduction and accurate pin placement (five feet) or selective capsulotomies of the talonavicular joint and the anterior aspect of the subtalar joint (twenty feet). Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic data at the time of the latest follow-up were compared with age-matched normative values.

RESULTS:
Initial correction was obtained in all cases. The mean number of casts required was five. Mean ankle dorsiflexion was 22° and mean plantar flexion was 25° at the time of the latest follow-up. Recurrence was noted in three patients (five feet), all of whom had had initial subluxation of the calcaneocuboid joint. All radiographic parameters measured at the time of the latest follow-up had improved significantly (p < 0.0001) compared with the values before treatment, and the mean values of the measured angles did not differ significantly from age-matched normal values.

CONCLUSIONS:
Serial manipulation and casting followed by limited surgery, consisting of percutaneous tenotomy of the Achilles tendon and a small medial incision to either palpate the talonavicular joint or perform capsulotomies of the talonavicular joint and the anterior aspect of the subtalar joint to ensure accurate reduction and pin fixation, result in excellent short-term correction of the deformity while preserving subtalar and ankle motion in patients with rigid congenital vertical talus associated with neuromuscular and/or genetic syndromes.
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NewsBot · Aug 21, 2012

The short-term effect of an anchor in treatment of congenital vertical talus in infants.
Zhu ZX, Lei W, Huang LY.
Orthop Surg. 2010 Aug;2(3):218-22.

OBJECTIVE:
To investigate the short-term effect of a mini anchor in treatment of congenital vertical talus (CVT) in infants.

METHODS:
From February 2006 to March 2008, seven patients (nine feet) with CVT were treated in the authors' hospital by the Kumar method combined with transferring and fixing the tendon of the anterior tibial muscle to the head of the talus with a mini anchor. There were five girls and two boys, aged from 10 to 42 months (mean, 18 months). All the feet had a rocker-bottom when the infants were taken to the hospital by their parents and none of them could walk independently. All cases were followed up in the outpatient department, and the Hamanishi and Adelaar standards were used to evaluate the radiograph and clinical results, respectively.

RESULTS:
All cases were followed up for 20 to 29 months (mean, 24 months). The parents of these infants were all satisfied with this operation, and five infants can now walk independently. At the most recent follow-up, seven feet were fine and two good according to the Adelaar standard, and six feet were good and three fine according to the Hamanishi standard.

CONCLUSION:
The short-term effect of an anchor in treatment of CVT in infants was satisfactory with no recurrence nor talus necrosis.
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NewsBot · Sep 3, 2012

Bilateral congenital vertical talus with severe lower extremity external rotational deformity:
Treated by reverse Ponseti technique
Adem Aydın, Halil Atmacaemail, Ümit Sefa Müezzinoğlu
The Foot Volume 22, Issue 3 , Pages 252-254, September 2012

Congenital vertical talus, also known as congenital convex pes valgus, is a complex, rare, foot deformity that is resistant to conservative treatment. We report a case of bilateral congenital vertical talus with severe lower extremity external rotational deformity that was treated by means of a method of serial manipulations and casts. Although the initial manipulation and casting before surgical treatment is the current concept of idiopathic congenital vertical talus, a good result can be obtained by a well-organized conservative treatment with the help of patient compliance, so routine surgical release of the Achilles tendon may not be necessary in all cases.
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NewsBot · Nov 12, 2012

The talar axis–first metatarsal base angle in CVT treatment: a comparison of idiopathic and non-idiopathic cases treated with the Dobbs method
Oliver Eberhardt, Francisco Fernandez Fernandez, Thomas Wirth
Journal of Children's Orthopaedics; November 2012

Purpose
Congenital vertical talus (CVT) appears as an idiopathic or non-idiopathic deformity. In this study, we analysed the talar axis–first metatarsal base angle (TAMBA) values of idiopathic and non-idiopathic CVT cases treated with the Dobbs method.

Materials and methods
Between January 2007 and July 2012, 20 cases of CVT were treated, starting with a manipulation, casting and a minimally invasive surgical approach. We analysed retrospectively the TAMBA values in idiopathic and non-idiopathic CVT. As a new indicator for the mobility in the talonavicular complex, we used the difference of the TAMBA in neutral position and the TAMBA in plantarflexion. TAMBA measurements of CVT successfully treated with the Dobbs method were compared to TAMBA values of CVT unsuccessfully treated using a minimally invasive approach.

Results
Out of 20 CVT, 14 were successfully treated with the Dobbs method. Of these 14, five feet were non-idiopathic and nine feet were idiopathic. Six feet did not have complete correction following the Dobbs protocol, and were associated with arthrogryposis or caudal regression syndrome. The initial TAMBA in idiopathic feet ranged from 70 to 110° (mean 88°). The TAMBA in non-idiopathic feet ranged from 75 to 128° (mean 105). Feet successfully treated with the Dobbs method had an initial TAMBA between 74 and 110° (mean 87°). Feet unsuccessfully treated with the Dobbs method had an initial TAMBA between 95 and 128° (mean 118°).The measurement difference between the TAMBA in neutral and plantarflexion positions in cases unsuccessfully treated with the Dobbs method were smaller compared to values of feet successfully treated with the Dobbs method. These differences were statistically significant (p < 0.0001).

Conclusion
In our series, the success of the Dobbs method in CVT treatment depended on the flexibility in the talonavicular complex. The TAMBA value and TAMBA difference (TAMBA neutral minus TAMBA plantarflexion) express the flexibility in the talonavicular joint and could be predictive for the success of a minimally invasive treatment. Only in a few cases is the success of the Dobbs method limited. These feet are associated with a TAMBA greater than 120° in neutral position and, particularly, a TAMBA difference smaller than 25°.
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NewsBot · Nov 28, 2012

Dynamic US study in the evaluation of infants with vertical or oblique talus deformities.
Supakul N, Loder RT, Karmazyn B.
Pediatr Radiol. 2012 Nov 27.

BACKGROUND:
Congenital vertical talus (CVT) is a rare foot deformity that is sometimes difficult to differentiate from oblique talus (OT) by physical examination and foot radiography.

OBJECTIVE:
The purpose of this study was to summarize our experience with US in evaluation of CVT and OT deformities.

MATERIALS AND METHODS:
We identified all children (2005-2011) younger than 6 months who underwent dynamic focused US of the foot at our tertiary-care facility to evaluate clinically equivocal cases of CVT. Diagnostic criteria for CVT were persistent talonavicular dislocation on forced plantar flexion of the foot. OT was diagnosed based on reduction of the talonavicular dislocation on forced plantar flexion. Medical and imaging charts were reviewed for diagnosis on US and plain radiographs (when available) and for underlying neuromuscular disorders, treatment and outcome on follow-up.

RESULTS:
Ten patients (eight boys and two girls, mean age 33 days) were evaluated by US for CVT. Radiographs of the foot were obtained in only two children and were non-diagnostic. Thirteen feet were evaluated by US. Diagnosis of CVT was confirmed by surgery in seven children, three of whom had bilateral CVT. Diagnosis of OT in three children was supported by response to casting treatment.

CONCLUSION:
Dynamic US can reliably distinguish between CVT and OT deformities.
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NewsBot · Mar 16, 2013

Narrowing the critical region for congenital vertical talus in patients with interstitial 18q deletions.
Mark PR, Radlinski BC, Core N, Fryer A, Kirk EP, Haldeman-Englert CR.
Am J Med Genet A. 2013 Mar 13.

Interstitial deletions of 18q lead to a number of phenotypic features, including multiple types of foot deformities. Many of these associated phenotypes have had their critical regions narrowly defined. Here we report on three patients with small overlapping deletions of chromosome 18q determined by microarray analysis (chr18:72493281-73512553 hg19 coordinates). All of the patients have congenital vertical talus (CVT). Based on these findings and previous reports in the literature and databases, we narrow the critical region for CVT to a minimum of five genes (ZNF407, ZADH2, TSHZ1, C18orf62, and ZNF516), and propose that TSHZ1 is the likely causative gene for CVT in 18q deletion syndrome
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NewsBot · May 21, 2013

Vertical talus : Current diagnostic and therapy options
Arbab D, Rath B, Quack V, Lüring C, Tingart M.
Orthopade. 2013 May 19.

Congenital vertical talus is a rare condition which presents as an isolated deformity or in association with neuromuscular and/or genetic disorders. Pathoanatomically the deformity shows a dislocated talonavicular and subtalar joint. The etiology and pathogenesis are still not finally determined although in some cases a genetic basis has been identified. The clinical picture is that of a flat, convex longitudinal arch with abduction and dorsiflexion of the forefoot and an elevated heel. Clinical diagnosis is confirmed by plain radiographic imaging. Congenital vertical talus should not be confused with other deformities of the foot, such as congenital oblique talus, flexible flat feet or pes calcaneus. The object of treatment of congenital vertical talus is to restore a normal anatomical relationship between the talus, navicular and calcaneus to obtain a pain-free foot. Major reconstructive surgery has been reported to be effective but is associated with substantial complications. Good early results of a modified non-operative treatment using serial manipulation, cast treatment and minimally invasive surgery may change therapeutic concepts.
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NewsBot · Feb 6, 2014

Reverse Ponseti-type treatment for children with congenital vertical talus: Comparison between idiopathic and teratological patients.
Wright J, Coggings D, Maizen C, Ramachandran M.
Bone Joint J. 2014 Feb;96-B(2):274-8.

Children with congenital vertical talus (CVT) have been treated with extensive soft-tissue releases, with a high rate of complications. Recently, reverse Ponseti-type casting followed by percutaneous reduction and fixation has been described, with excellent results in separate cohorts of children with CVT, of either idiopathic or teratological aetiology. There are currently no studies that compare the outcome in these two types. We present a prospective cohort of 13 children (21 feet) with CVT of both idiopathic and teratological aetiology, in which this technique has been used. Clinical, radiological and parent-reported outcomes were obtained at a mean follow-up of 36 months (8 to 57). Six children (nine feet) had associated neuromuscular conditions or syndromes; the condition was idiopathic in seven children (12 feet). Initial correction was achieved in all children, with significant improvement in all radiological parameters. Recurrence was seen in ten feet. Modification of the technique to include limited capsulotomy at the initial operation may reduce the risk of recurrence. The reverse Ponseti-type technique is effective in the initial correction of CVT of both idiopathic and teratological aetiology. Recurrence is a problem in both these groups, with higher rates than first reported in the original paper. However, these rates are less than those reported after open surgical release
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NewsBot · Mar 29, 2014

Serial casting for neuromuscular flatfoot and vertical talus in an adolescent with hereditary spastic paraplegia.
Sweet LA, Oʼneill LM, Dobbs MB.
Pediatr Phys Ther. 2014 Summer;26(2):253-64.

PURPOSE:
The purpose of this report is to explore assessment and serial casting intervention for painful rigid flatfoot deformities with vertical talus in an adolescent girl with hereditary spastic paraplegia who was nonambulatory.
SUMMARY OF KEY POINTS:
The participant's right foot underwent 2 phases of casting with correction first toward hindfoot inversion and then dorsiflexion. Because of a vertical talus, her left foot required an intermediate casting toward plantar flexion, inversion, and forefoot adduction prior to casting toward dorsiflexion.
STATEMENT OF CONCLUSIONS:
The patient improved despite the underlying progressive neuromuscular disorder. Pain ameliorated and she returned to supported standing and transfers. Spasticity decreased bilaterally and the flexibility of her foot deformities improved to allow orthotic fabrication in subtalar neutral. Results were maintained at 12 and 16 months.
RECOMMENDATIONS FOR CLINICAL PRACTICE:
Individualized multiphase serial casting requires further investigation with patients such as those with hereditary spastic paraplegia.
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NewsBot · Sep 22, 2016

NewsBot · Jun 5, 2014

The surgical treatment of children with congenital convex foot (vertical talus): evaluation of midtarsal surgical release and open reduction.
Ramanoudjame M, Loriaut P, Seringe R, Glorion C, Wicart P.
Bone Joint J. 2014 Jun;96-B(6):837-44.

In this study we evaluated the results of midtarsal release and open reduction for the treatment of children with convex congenital foot (CCF) (vertical talus) and compared them with the published results of peritalar release. Between 1977 and 2009, a total of 22 children (31 feet) underwent this procedure. In 15 children (48%) the CCF was isolated and in the remainder it was not (seven with arthrogryposis, two with spinal dysraphism, one with a polymalformative syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to 175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°). The procedure included talonavicular and calcaneocuboid joint capsulotomies, lengthening of tendons of tibialis anterior and the extensors of the toes, allowing reduction of the midtarsal joints. Lengthening of the Achilles tendon was necessary in 23 feet (74%). The mean follow-up was 11 years (2 to 21). The results, as assessed by the Adelaar score, were good in 24 feet (77.4%), fair in six (19.3%) and poor in one foot (3.3%), with no difference between those with isolated CCF and those without. The mean American Orthopaedic Foot and Ankle Society midfoot score was 89.9 (54 to 100) and 77.8 (36 to 93) for those with isolated CCF and those without, respectively. At the final follow-up, the mean tibiotalar (120°; 90 to 152) and calcaneal pitch angles (4°; -13 to 22) had improved significantly (p < 0.0001). Dislocation of the talonavicular and calcaneocuboid joints was completely reduced in 22 (70.9%) and 29 (93.6%) of feet, respectively. Three children (five feet) underwent further surgery at a mean of 8.5 years post-operatively, three with pes planovalgus and two in whom the deformity had been undercorrected. No child developed avascular necrosis of the talus. Midtarsal joint release and open reduction is a satisfactory procedure, which may provide better results than peritalar release. Complications include the development of pes planovalgus and persistent dorsal subluxation of the talonavicular joint
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NewsBot · Jan 30, 2015

Surgical correction of congenital vertical talus by one-stage comprehensive soft-tissue release and peritalar reduction incorporating tibialis anterior transfer
Yan G, Yu Z, Yang Z, Lu M, Zhang J
Zhonghua Yi Xue Za Zhi. 2014 May 6;94(17):1322-5.

OBJECTIVE:
To evaluate the surgical efficacies of one-stage comprehensive soft-tissue release and peritalar reduction incorporating tibialis anterior transfer (CSTR-PTR-TAT) in patients with congenital vertical talus (CVT) before the age of 4 years.
METHODS:
Thirty-five feet of 21 children with true congenital vertical talus were underwent one-stage CSTR-PTR-TAT. The male-to-female ratio was 2.5: 1. Twenty-three percent (5 patients with 8 feet) belonged to isolated CVT and the remainder CVT associated with other congenital or neuromuscular abnormalities. The mean operative age was 30.1 (12-48) months. All patients were available for clinical and radiological follow-ups for a mean period of 3.5 (1.5-7) years.Kodros scoring system was utilized for assessment of final outcomes.
RESULTS:
The outcomes of 3 feet (9%) were excellent, 27 (77%) good and 5 (14%) fair. All patients wore normal shoes and were satisfied by their functional results and appearance. The patients with fair results were associated with arthrogryposis. No talar avascular necrosis was encountered.None required further operation.Radiologically there was a statistically significant postoperative improvement of measured angles compared to preoperative values (P < 0.05). All radiological parameters were within normal ranges. There was no difference of post operative angles compared to those at the final follow-up (P > 0.05).
CONCLUSION:
As a complex deformity usually associated with other congenital or neuromuscular abnormalities, CVT may be satisfactorily managed with one-stage correction by CSTR-PTR-TAT before the age of 4 years.
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NewsBot · Mar 25, 2015

Treatment of Congenital Vertical Talus: Comparison of Minimally Invasive Versus Traditional Surgical
Techniques
Justin Yang, MD, Farmington, CT
Karen Steger-May, MD, Saint Louis, MO
Matthew B. Dobbs, MD, Saint Louis, MO
Presented at AAOS Annual Meeting; March 2015

INTRODUCTION: Congenital vertical talus (CVT) is an uncommon foot deformity that is present at birth
and results in a rigid flatfoot deformity. Traditionally, most patients with vertical talus have been treated
with major reconstructive surgeries. A new technique using serial casting with a reverse Ponseti method
and minimally invasive surgery have been described. The purpose of the study was to assess the
midterm results in a cohort of patients who had been managed with the minimally invasive technique,
and compare them to a similar cohort that had been managed with traditional surgical techniques. The
hypothesis is that the minimally invasive technique will result in better motion, functional scores, and
radiographic correction.
METHODS: The records of 28 consecutive CVT patients (44 feet) were retrospectively reviewed with
minimum five-year follow up. The minimally invasive technique with serial casting (MI) was utilized
initially to treat 16 patients (24 feet), and traditional surgical techniques (TS) were used in 12 patients
(20 feet). Demographics, range of motion, Pediatric Outcomes Data Collection Instrument (PODCI)
questionnaire, and radiographs were collected for analysis.
RESULTS: Average follow-up time was 7.1 years. At latest follow up, the average arc of motion for the MI
group was 43.7° compared to 11.8° in the TS group (p<0.0001). The average PODCI normative pain score
was 51.0 in the MI group compared to 36.4 in the TS group (p=0.049). The correction in the
anteriorposterior talar axis-first metatarsal base angle was higher in the MI group (38.8° vs. 26.8°,
p=0.01). The amount of correction in all other radiographic values was similar between the two groups
(p>0.2 across all variables). All patients except for one were ambulatory at latest follow up.
DISCUSSION AND CONCLUSION: Both techniques showed significant correction of deformity and allowed
the patients to be ambulatory. However, the serial casting and minimally invasive technique resulted in
better range of motion and pain scores. To our knowledge, this is the largest series on CVT treatment in
literature with the longest follow up. Further study is needed to evaluate this technique as this unique
cohort ages.
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NewsBot · Aug 25, 2015

Treatment of Congenital Vertical Talus: Comparison of Minimally Invasive and Extensive Soft-Tissue Release Procedures at Minimum Five-Year Follow-up
Justin S. Yang, MD; Matthew B. Dobbs, MD
J Bone Joint Surg Am, 2015 Aug 19; 97 (16): 1354 -1365

Background: The most common historical treatment method for congenital vertical talus is extensive soft-tissue release surgery. A minimally invasive treatment approach that relies primarily on serial cast correction was introduced almost ten years ago, with promising early results. The purpose of this study was to assess the long-term outcome of patients with congenital vertical talus managed with the minimally invasive technique and compare them with a cohort treated with extensive soft-tissue release surgery.

Methods: The records of twenty-seven consecutive patients with vertical talus (forty-two feet) were retrospectively reviewed at a mean of seven years (range, five to 11.3 years) after initial correction was achieved. The minimally invasive method was used to treat sixteen patients (twenty-four feet), and extensive soft-tissue release surgery was used to treat eleven patients (eighteen feet). Patient demographics, ankle range of motion, the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire, and radiographic measurements were analyzed.

Results: At the latest follow-up, the mean range of motion of patients treated with the minimally invasive method was 42.4? compared with 12.7? for patients treated with extensive surgery (p < 0.0001). The PODCI normative pain and global function scores were superior in the minimally invasive treatment group compared with the extensive soft-tissue release group. Greater correction of hindfoot valgus (anteroposterior talar axis-first metatarsal base angle) was achieved in the minimally invasive treatment group compared with the extensive surgery group (40.1? versus 27.9?, p = 0.03), although all other radiographic values were similar between the two groups (p > 0.1 for all). Subgroup analysis of patients with isolated vertical talus also showed superior range of motion and PODCI normative global function scores in the minimally invasive group.

Conclusions: The minimally invasive treatment method for vertical talus resulted in better long-term ankle range of motion and pain scores compared with extensive soft-tissue release surgery. Longer-term studies are necessary to determine whether the improved outcomes are maintained into adulthood and whether the superior outcome is related to reduced scarring.
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NewsBot · Sep 5, 2015

Congenital Vertical Talus: Etiology and Management.
Miller M, Dobbs MB.
J Am Acad Orthop Surg. 2015 Sep 3. pii: JAAOS-D-14-00034

Congenital vertical talus is a rare foot deformity. If left untreated, it causes significant disability, including pain and functional limitations. Although the etiology of vertical talus is likely heterogeneous, recent evidence strongly supports a genetic cause linking it to genes expressed during early limb development. Traditional management for vertical talus involves extensive surgeries that are associated with significant short- and long-term complications. A minimally invasive approach that relies on serial manipulation and casting to achieve most of the correction has been shown to produce excellent short-term results with regard to clinical and radiographic correction in both isolated and nonisolated cases of vertical talus. Although long-term studies are needed, achieving correction without extensive surgery may lead to more flexible and functional feet, much as Ponseti method has done for clubfeet.
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NewsBot · Apr 4, 2016

A comparison of the Dobbs method for correction of idiopathic and teratological congenital vertical talus.
Chan Y, Selvaratnam V, Garg N
J Child Orthop. 2016 Apr 2

INTRODUCTION:
Congenital vertical talus (CVT) is a rare deformity. Traditionally, CVT correction involved extensive soft tissue releases, and this was associated with high complication rates. The Dobbs method is less invasive and comprises serial manipulation and casting, followed by minimally invasive reduction and K-wire fixation of the talonavicular joint and percutaneous Achilles tenotomy.
AIM:
The purpose of our study was to compare the outcomes of using the Dobbs method for CVT correction in idiopathic and teratological patients.
METHODS:
A retrospective analysis of all patients treated with the Dobbs method for CVT between the years 2007 and 2012 was carried out. Notes, electronic records and radiographs were reviewed for every patient. The Oxford ankle foot score was obtained at follow-up.
RESULTS:
There was a total of ten children with 18 affected feet. Five children (ten feet) had teratological CVT. Recurrence was noted in six feet (two from the idiopathic group and four from the teratological group). The median age was 5 months (range 2-8 months). The mean follow-up was 53 months (range 24-80 months). There was a significant difference between pre-operative to initial post-operative and pre-operative to latest follow-up measurements for all angles in the successfully treated CVT group (p < 0.000001). The mean Oxford ankle foot scores for each domain in all patients are 59.9 (physical), 88.8 (school and play) and 99.1 (emotional).
CONCLUSION:
The Dobbs method is a less invasive technique of CVT correction. It is an effective initial method of treatment in both teratological and idiopathic patients. A higher recurrence rate was observed in the teratological group, although this was not statistically significant.
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NewsBot · Jan 20, 2017

Management of congenital vertical talus: comparison between mini
invasive reduction and extensive surgical technique in early age
Chauhan P et al.
Int J Res Orthop. 2017 Mar;3(2):xxx-xxx

Background: About one baby in 10,000 is born with the foot deformity known as vertical talus. In about half of those
cases, both feet are affected. The disorder occurs with equal frequency in boys and girls. Vertical talus is a rare
deformity of the foot which is diagnosed at the time of birth.
Methods: Present study was performed at Department of Orthopedics, Gujarat Adani Institute of Medical Science,
Bhuj, Kutch, Gujarat. In the study 40 patients who were treated for unilateral or bilateral congenital vertical talus at a
single institution which lead to 60 treated feet in the study. Patient with bilateral symptoms were randomly selected
for one foot in the study.
Results: The mean normative pain score was found to be 58.0 in the minimally invasive group compared with 28 in
the extensive release group (p =0.032). There was no difference between the two groups in the transfer and basic
mobility domain. The normative global function domain was higher in the minimally invasive group (48.3) compared
with the extensive soft-tissue release group (34.3, p =0.03).
Conclusions: Longer-term follow up and studies with large sample size are still necessary to determine whether the
improved outcomes are maintained into the adulthood and whether the superior outcome is related to the reduce
scarring in the patient.
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NewsBot · Sep 9, 2017

Prenatal congenital vertical talus (rocker bottom foot): a marker for multisystem anomalies.
Rubio EI et al
Pediatr Radiol. 2017 Sep 6. doi: 10.1007/s00247-017-3957-z.

BACKGROUND:
Congenital vertical talus is a rare foot anomaly characterized by a prominent calcaneus and rigid forefoot dorsiflexion. While congenital vertical talus has been associated with anomalies such as trisomy 18, myelomeningocele and arthrogryposis, postnatal series have reported cases of isolated congenital vertical talus.
OBJECTIVE:
The purpose of our study was to determine the incidence of isolated congenital vertical talus prenatally and identify the most common anomalies associated with this finding.
MATERIALS AND METHODS:
A retrospective review was performed of congenital vertical talus cases identified in our fetal center from 2006 to 2015. The prenatal US and MR imaging appearance of congenital vertical talus was evaluated and differentiation from congenital talipes equinovarus was assessed. Studies were evaluated for additional abnormalities affecting the central nervous system, face, limbs, viscera, growth and amniotic fluid. Imaging findings were recorded and correlated with outcomes when available.
RESULTS:
Twenty-four cases of congenital vertical talus were identified prenatally (gestational age: 19-36 weeks). All 24 had prenatal US and 21 also underwent fetal MRI on the same day. There were no isolated cases of congenital vertical talus in this series; all 24 had additional anomalies identified prenatally. Sixteen cases had bilateral congenital vertical talus (67%). Additional anomalies were identified in the brain (15), spine (11), face (6), abdominal wall (3), heart (8) and other limbs (12). Chromosomal abnormalities were identified in 6 of 20 patients who underwent genetic testing. Overall, US held some advantage in detecting the abnormality: in 10 cases, US depicted congenital vertical talus more clearly than MRI; in 8 cases, US and MRI were equal in detection and in 3 cases, MRI was superior. In 9/15 cases with intracranial abnormalities, MRI was superior to US in demonstrating structural anomalies. Outcomes included termination (11), intrauterine fetal demise (1), stillbirth or immediate neonatal demise (5), lost to follow-up (1), and 6 survivors with postnatal follow-up.
CONCLUSION:
In our series, there were no cases of isolated congenital vertical talus, with additional anomalies variably affecting multiple systems including the brain, spine, face, viscera and limbs. When congenital vertical talus is identified prenatally, a thorough search for additional anomalies is indicated. Fetal MRI can be a useful adjunct in confirming the diagnosis and further delineating additional anomalies, particularly in the brain and spine.
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NewsBot · Jul 29, 2019

Naviculectomy for two ambulatory children with intractable congenital vertical talus
redefining the indications of an old technique
EL-Sobky, Tamer A.; Samir, Shady; Mahmoud, Shady
Journal of Pediatric Orthopaedics B: July 24, 2019 - Volume Publish Ahead of Print - Issue - p

Congenital vertical talus is a rare and complex foot anomaly. Serial casting with or without minimally invasive surgery is a universal management strategy especially for children in the first year of life. Nevertheless, extensive surgical treatment of late-presenting, neglected and multiple operated children with congenital vertical talus may be required with guarded results. The results of naviculectomy as a more conservative intervention and directed exclusively at ambulatory children with intractable congenital vertical talus have not been reported. We present the radioclinical outcomes of two ambulatory children with intractable congenital vertical talus treated by naviculectomy/midtarsal resection and limited soft tissue release. One child had an isolated congenital vertical talus whereas the other had a non-isolated etiology. Generally, naviculectomy/midtarsal resection revealed a positive benefit-risk profile in children with intractably severe congenital vertical talus on the short-term. We reported favorable results in terms of foot appearance, function and radiology. We believe that a less invasive procedure like naviculectomy/midtarsal resection is an encouraging technique to investigate in children with intractable congenital vertical talus.
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NewsBot · Aug 4, 2019

One-stage release by double surgical approach for neglected congenital vertical talus
results in a series of walking children in Tanzania
Sanzarello, Ilaria et al
Journal of Pediatric Orthopaedics B: July 24, 2019 - Volume Publish Ahead of Print - Issue - p

Congenital vertical talus is an uncommon rigid flatfoot deformity present at birth, producing pain and disability if untreated. This study reports results and complications in a series of walking children affected by neglected congenital vertical talus treated by one-stage release through a double surgical approach in a hospital sited in the Tanzanian rural outback. Between 2009 and 2014, nine consecutive congenital vertical talus were observed in five patients (three males and two females) aged between 2 and 4 years. In two children, the deformity was idiopathic, in two it was associated to distal arthrogryposis and in one to Larsen syndrome. The surgical procedure was performed through a posteromedial and a lateral incision and included extensive soft tissue release and reduction of talo-navicular and subtalar joint, pinned with percutaneous Kirschner wires. The talar axis-first metatarsal base angle (TAMBA) was measured preoperatively and at follow-up. Results were summarized using the Adelaar score and the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire. The mean follow-up was 2.6 years (2–4). No major intraoperative complications were observed. The TAMBA passed from 74.4º (range 68–82º) to 20.2º (range 18–24º). No talar osteonecrosis was observed. The results were excellent in three cases, good in five cases and fair in one (Adelaar score). The mean postoperative PODCI score was 48 (range 38–60). None of the patients underwent further surgery. In case of neglected congenital vertical talus and limited health resources, this surgical technique has proved to be a viable option, providing satisfactory results, with low rate of surgical and postsurgical complications.
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NewsBot · Apr 13, 2020

Isolated congenital vertical talus: Genetics and genomics.
Khan YN, Basit S.
J Musculoskelet Surg Res 2020;4:66-71

Congenital vertical talus (CVT) is a distinct orthopedic condition where the bone structure and number are normal in the affected foot, but the orientation of the bones is not correct. The abnormal orientation of the bones in the affected foot is believed to be due to muscle imbalance. There are a shortening and dorsal displacement of the peroneal tendons and tibialis posterior tendon, resulting in the clinical appearance of a severe rigid flatfoot. The underlying etiology of the CVT is unknown, and limited studies have been performed to decipher the genetics of CVT. The purpose of this review is to highlight the key research articles within the CVT genetics and genomics fields that were published previously. Herein, we reviewed the current literature and discussed the genetic studies carried out in families and patients with an isolated form of CVT. It is believed that CVT segregates in an autosomal dominant fashion. Most of the studies used a candidate gene approach to identify CVT causative variants. Variants in growth differentiation factor 5, HOXD10, teashirt zinc finger homeobox 1, and skeletal muscle contractile genes have been associated with CVT. An unbiased and hypothesis-free approach of whole-exome sequencing is much needed to unwire the genetic network underlying distal hind limb development and to improve our understanding of the gene regulatory mechanism in this musculoskeletal disorder. Moreover, this review focuses on highlighting the importance of the identification of the genetics of CVT and its implications in early clinical diagnosis and management of patients.
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NewsBot · Aug 22, 2020

Talectomy by Medial Surgical Approach for Congenital Vertical Talus in Arthrogryposis Multiplex Congenita
Edward Abraham, Camille H Quan Soon, Angela Murphy, David Toby
Orthopedics. 2020 Aug 19;1-4

Arthrogryposis multiplex congenita involves stiff contracture of joints and weak atrophic muscles presenting at birth. The two most common forms are amyoplasia and distal arthrogryposis. Amyoplasia affects all 4 extremities: internally rotated shoulders, extended fixed elbows, flexed fixed wrists, extended fixed knees, clubfeet, and decreased muscle volume. Distal arthrogryposis is a group of syndromes with a genetic basis. The distal joints are contracted. Clubfeet and congenital vertical talus are the most common foot deformities. A 10-year-old boy presented with distal arthrogryposis with bilateral congenital tali. He reported having deformed and painful feet and difficulty wearing shoes. His rocker-bottom foot deformities caused him to walk with a heel to heel gait. He also had stiff extended knees. His previous foot surgeries included failed open reduction and pin fixation of the talonavicular joints with Achilles tendon lengthening and capsulotomies. The boy underwent bilateral talectomies and releases of contracted joint capsules and lengthening of multiple extrinsic tendons through separate incisions. The talectomy of each foot was performed via a novel medial surgical approach. At 2-year follow-up, he had normal-appearing plantar grade feet. He had a painless gait, could ambulate independently, and was considered to have an excellent result. This is the first detailed report of performing a talectomy via a medial approach for bilateral congenital tali in a patient with arthrogryposis multiplex congenita.
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NewsBot · Nov 2, 2020

Comparison of outcome between idiopathic and non-idiopathic congenital vertical talus treated with soft tissue release
Malhotra, Monish; Shah, Hitesh
Journal of Pediatric Orthopaedics B: October 29, 2020

The aim of the study was to compare the clinical, radiological and functional outcomes between idiopathic and non-idiopathic congenital vertical talus (CVT) treated with soft tissue release. All the consecutive cases with CVT treated with soft tissue release were prospectively followed up. Indication for soft tissue release was either late presented or failed serial manipulation and cast application. Nineteen children (33 feet) with a minimum follow-up of 2 years following the soft tissue release (the mean 5.5 years follow-up) were included. The children without any other joint involvement with the normal spine without syndromic association were categorized as idiopathic (15 feet) and the rest were categorized as non-idiopathic (18 feet). Clinical and radiological scoring was done using Adelaar and Kodros scores. The morphological, functional and radiological outcomes were assessed using the International Clubfoot Study Group evaluation scale. The clinical, radiological and functional outcomes of the idiopathic and non-idiopathic groups were compared. The range of motion was significantly higher in the idiopathic group. The functional outcome was satisfactory in both groups. All the radiological parameters improved significantly in both groups. The functional outcome was considerably better in the idiopathic group. There was no significant difference in clinical and radiological outcomes among the two groups. Soft tissue release is an effective surgery for deformity correction in children with CVT. A good clinical outcome is observed in both groups. The range of motion was significantly higher in the idiopathic group. The overall outcome was similar in both groups.
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NewsBot · Feb 13, 2021

Outcomes of a Minimally Invasive Approach for Congenital Vertical Talus With a Comparison Between the Idiopathic and Syndromic Feet
Mohamed Hafez, Naomi Davis
J Pediatr Orthop. 2021 Feb 5

Background: Congenital vertical talus (CVT) is a rare congenital foot disorder. Approximately half of the affected children have associated neuromuscular syndromes which may further complicate the treatment. The traditional treatment involved extensive soft tissue and bony reconstructions. The minimally invasive method (Dobbs method/reverse Ponseti) has changed the treatment of CVT. There is significant variation of the reported outcome of this method in the current literature. In this study we report the outcome of this minimally invasive technique for treatment of CVT and compare the results of treatment in syndromic and idiopathic patients.

Methods: Idiopathic and syndromic patients treated from CVT with minimally invasive method from 2006 till 2016 were included in this retrospective study. We reviewed the patients' notes, radiographs and collected parents reported outcome questionnaire (Roye score) in addition to clinical examination to comprehensively report the treatment outcome.

Results: A total of 21 patients 30 feet were included in this study. The average age of commencing treatment was 6 months (1 to 17 mo). The mean follow-up was 6.5 years (1 to 11 y). Correction of the deformities and abnormal angles were achieved in all feet. Five of the 17 syndromic feet had recurrence while no recurrence was reported in any if the 13 idiopathic feet. At the time of the index procedure no supplementary procedures were required. The average arc of motion for foot ankle dorsiflexion and plantar flexion was 30 degrees. Patients with idiopathic CVT had a mean the Roye score of 11 while syndromic patients had a mean score of 22.

Conclusion: The minimally invasive method is a valuable option for treatment of CVT. Idiopathic patients had no recurrence and better functional scores compared syndromic patients. There was no requirement for supplementary procedures such as tibialis anterior transfer or anterolateral release at the time of the initial surgery.
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NewsBot · May 1, 2022

Diagnostic yield of exome sequencing in congenital vertical talus
Naeimeh Tayebi et al
Eur J Med Genet. 2022 Apr 26

Background: Congenital vertical talus (CVT), also known as "rocker-bottom foot", is a rare foot deformity associated with a dislocation of the talonavicular joint. Although genetic causes of CVT have been described in single isolated and syndromic families, whole-exome sequencing (WES) of large cohorts have not yet been reported.

Methods: In this study, 62 probands with CVT were evaluated for likely causative single nucleotide variants (SNVs) and copy number variants (CNVs) using WES. Segregation of variants within families was determined by Sanger sequencing.

Results: In this cohort, CVT occurred as an isolated anomaly in 75.8% (47/62) and was familial in 19.3% (12/62) of cases. Analysis of WES data led to the identification of likely causative variants in known disease genes in 30.6% (19/62) of all CVT probands. More than one proband had likely causative SNVs in TSHZ1, GDF5, and LMX1B. Only two probands had likely causative CNVs: a chromosome 12q13.13 deletion of the 5' HOXC gene cluster, and a chromosome 18q22.3q23 deletion involving TSHZ1. Familial CVT was strongly predictive of identifying a molecular diagnosis [75% (9/12) of familial cases compared to 20% (10/50) of non-familial cases (Chi-square test, P-value = 0.0002)]. There was no difference in the solved rate based on isolated or syndromic presentation, unilateral or bilateral affectation, or sex.

Conclusions: CVT is genetically heterogeneous and more often caused by SNVs than CNVs. There is a high yield of WES in familial CVT cases (∼75%). Additional research is needed to identify the causes of sporadic CVT, which had much lower solved rates.
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NewsBot · Jun 28, 2022

The results of treatment of the congenital vertical
talus by Dobb`s method
Andrzej Grzegorzewski et al
Research Square

Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is
dorsiflexed and forefoot is abducted caused by a fixed dorsal dislocation of the navicular on the head of
the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and ethiology of vertical
talus is unknown. Dobbs et al in 2006 described a minimally invasive alternative avoiding the need for
extensive soft tissue release procedures in treatment a congenital vertical talus.
The study material contains group of 11 congenital vertical talus feet (group 5 according to Hamanishi)
in 8 children (4 boys and 4 girls). The age at the time of the diagnosis varied from 5 to 26 months (mean
– 14.6). Treatment involved serial manipulation and casting and then a minimally invasive approach with
temporary stabilization of the talonavicular joint by K-wire and Achilles tenotomy. On lateral radiographs
measurements include the talocalcaneal angle, tibiotalar angle and talar axis – first metatarsal base
angle (TAMBA) and on AP radiographs - the talocalcaneal angle and talar axis – first metatarsal angle.
The Wilcoxon test was used for comparison the dependent variables.
The final clinical assessment during last follow up (mean 35.8 months, range 25–52) revealed in 10
cases neutral position of the foot and normal range of motion and in one case recurrence of foot
deformity. Also X-ray assessment showed normalization all of the radiological parameters except for one
case and were statistically significant.
The minimally invasive technique described by Dobb`s should be the first option when treating the
congenital vertical talus. It allows for reducing the talonavicular joint, gives good results and preserves a
mobile foot. The attention should be put on early diagnosis.
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NewsBot · Aug 11, 2022

Minimally Invasive Method in Treatment of Idiopathic Congenital Vertical Talus: Recurrence is Uncommon
Cummings, Jason L. BS; Hosseinzadeh, Pooya MD
Journal of Pediatric Orthopaedics: August 11, 2022 - Volume - Issue - 10.1097/BPO.0000000000002235

Background:
Historically, treatment for congenital vertical talus (CVT) has included open reduction of the talonavicular joint and extensive soft tissue release. In 2006, a new minimally invasive method consisting of serial manipulation and casting followed by percutaneous fixation of the talonavicular joint and percutaneous Achilles tenotomy was introduced. Although the early results of this new technique are promising, more research is needed to verify that the talonavicular correction is maintained with time.

Methods:
We conducted a retrospective chart review of all patients with idiopathic CVT who underwent minimally invasive correction by a single surgeon at a tertiary care institution. Radiographic evaluation of the preoperative, immediate postoperative, 1 year postoperative and latest follow-up appointments were performed. Complications and clinical outcomes were recorded. Radiographic recurrence of the deformity was defined as lateral talar axis-first metatarsal base angle >30 degrees. Statistical analysis was performed on the maintenance of radiographic correction and factors associated with recurrence.

Results:
Forty seven feet in 35 patients were included in the study with average follow-up of 45 months. The average preoperative lateral talar axis-first metatarsal base angle was 74±18 compared with 12±8 after initial surgical intervention. In addition, radiographic correction of all other measured angles was achieved in every child following the initial surgery. Radiographic recurrence of talonavicular deformity was seen in 4 feet (9%). No cases of recurrence required a second corrective surgery during the follow-up period. There was a significant association between patient age at the time of treatment and recurrence of talonavicular deformity with patients older than 12 months being more likely to experience recurrence (P=0.041).

Conclusions:
In this large series, we found that correction of talonavicular deformity can be achieved and maintained in a large majority of children with idiopathic CVT who undergo treatment with this minimally invasive technique and recurrences are uncommon. Treatment with this technique should be initiated as soon as a diagnosis of CVT is confirmed and the patient is medically stable to decrease the likelihood of experiencing recurrence of talonavicular deformity.
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NewsBot · Nov 1, 2022

Understanding congenital vertical talus
Anna HK.Riemen et al
Orthopaedics and Trauma 28 October 2022

Congenital vertical talus (CVT) is a rare foot deformity that presents with a rigid flat foot at birth. CVT can present as an isolated abnormality in the newborn, however in at least 50% of cases in association with other conditions. Full neuro-axial imaging is essential to detect any associated neurologic problems. Radiographs of the foot, including forced plantar and dorsiflexion laterals, are diagnostic. Gold standard modern treatment uses the Dobbs method of serial manipulation and casting with minimally-invasive stabilization of the talonavicular joint and Achilles tendon tenotomy.
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NewsBot · Jan 12, 2023

Corrective bandages and daily manipulations for treatment of congenital vertical talus: a thirteen year follow-up
Elia Utrilla-Rodríguez et al
Int Orthop. 2023 Jan 11

Purpose: To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was needed.

Methods: A retrospective analysis of all children diagnosed with idiopathic vertical talus was carried out during the years 2008-2021. Thirty-two children (46 feet) were finally included. Children were treated with serial manipulations, muscle stimulation, and corrective bandages. Age at the time of initiation of treatment, duration of treatment, and correction or not of the deformity without surgical intervention were recorded as variables of interest. The talocalcaneal angle, TAMBA, and ankle range of motion were measured before treatment, after treatment, and at the end of the follow-up period. Statistics decision tree was used to determine which variable best discriminated whether the patient needed surgery. To complement the tree diagram, a two-step cluster analysis was carried out.

Results: After treatment, TAMBA and talocalcaneal angle changed from "vertical" to "oblique" category in 45 and 37 feet, respectively. The pathological dorsal flexion of the ankle changed to normal in 37 feet and ankle plantar flexion was normal in 46 feet. These variables showed significant changes between the three measurement moments. The results of the statistics decision tree and cluster analysis indicate that "No surgery" was associated with an age equal to or lower than one week when treatment was started, and with an ankle plantar flexion range of motion lower than 36°.

Conclusions: The beginning of this conservative treatment in the first week of life and having a plantar flexion of the ankle lower than 36° were related to the success of the treatment without surgery.
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NewsBot · Feb 6, 2023

Relapsed Congenital Vertical Talus Deformity: Outcomes of a Modified Minimally Invasive Method
Cummings, Jason L. BS; Hosseinzadeh, Pooya MD
Author Information
Journal of Pediatric Orthopaedics 43(3)

Background:
To date, there is little literature that describes the optimal management for recurrent talonavicular subluxation after an initial attempt at surgical correction in children with congenital vertical talus (CVT). The purpose of this study is to evaluate the outcomes of a modified minimally invasive technique for the management of recurrent talonavicular subluxation in patients with CVT who have previously undergone at least 1 attempt at surgical correction.

Methods:
International Classification of Diseases codes were used to identify all patients with recurrent CVT deformity treated at our institution between 2006 and 2021. Retrospective chart review, including radiographic measurements of talocalcaneal and talar axis-first metatarsal base angles (TAMBA), was performed. Complications including recurrent talonavicular subluxation (lateral TAMBA >30 degrees) and hindfoot valgus (Anteroposterior talocalcaneal >40 degrees) were recorded. All statistical analysis was performed using an alpha of 0.05.

Results:
Seventeen patients (24 feet) met all inclusion criteria, 9 (52.9%) of whom had underlying neurological syndromes. The average age at repeat treatment initiation was 26±17 months (range: 7 to 60 mo). Talonavicular reduction was achieved in all patients as evidenced by an average of 24.6 degrees and 54.9 degrees of correction in the Anteroposterior and lateral TAMBA, respectively. Radiographic recurrence of the talonavicular deformity was seen in 12 feet (50.0%). Six (25.0%) of the feet in 4 patients required a revision surgery, all of which occurred in patients with underlying syndromes (P=0.02). The average patient-reported outcome measurement information system scores in the pain interference, mobility, and peer relations domains were 44.5±7.7, 44.1±13.5, and 54.8±9.9, respectively.

Conclusions:
Our midterm results suggest that many cases of recurrent CVT can be effectively managed through a modified minimally invasive revision surgery consistent with what has been described by Dobbs and colleagues for initial treatment. Further prospective studies with longer-term follow-up are warranted to confirm these findings.
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NewsBot · Feb 21, 2023

Comparison of Different Surgical Techniques in Correction of Congenital Vertical Talus Deformity: A Systematic Review and Meta-Analysis of the Literature
Cummings, Jason L. BS; Rivera, Asdrubal E. MD; Tippabhatla, Abhishek BS; Hosseinzadeh, Pooya MD
Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000002369, February 20, 2023. | DOI: 10.1097/BPO.0000000000002369

Background:
Congenital Vertical Talus (CVT) is a rare form of congenital rigid flatfoot. Numerous surgical techniques have been developed over the years in an attempt to definitively correct this deformity. We performed a systematic review and meta-analysis of the existing literature to compare the outcomes of children with CVT treated with different methods.

Methods:
A detailed systematic search was conducted in accordance with PRISMA guidelines. Radiographic recurrence of the deformity, reoperation rate, ankle arc of motion, and clinical scoring was compared between the following 5 methods: Two-Stage Coleman-Stelling Technique, Direct Medial Approach, Single-Stage Dorsal (Seimon) Approach, Cincinnati Incision, and Dobbs Method. Meta-analyses of proportions were performed, and data were pooled through a random effects model using the DerSimonian and Laird approach. Heterogeneity was assessed using I^2 statistics. The authors used a modified version of the Adelaar scoring system to assess clinical outcomes. An alpha of 0.05 was used for all statistical analysis.

Results:
Thirty-one studies (580 feet) met the inclusion criteria. The reported incidence of radiographic recurrence of talonavicular subluxation was 19.3%, with 7.8% requiring reoperation. Radiographic recurrence of the deformity was highest in the children treated with the direct medial approach (29.3%) and lowest in the Single-Stage Dorsal Approach cohort (11%) (P<0.05). The reoperation rate was significantly lower in the Single-Stage Dorsal Approach cohort (2%) compared with all other methods (P<0.05). There was no significant difference in the reoperation rates between the other methods. The highest clinical score was seen in the Dobbs Method cohort (8.36), followed by the group treated with the Single-Stage Dorsal Approach (7.81). The Dobbs Method resulted in the largest ankle arc of motion.

Conclusion:
We found the lowest radiographic recurrence and reoperation rates in the Single-Stage Dorsal Approach cohort, while the highest rate of radiographic recurrence was seen in those treated with the Direct Medial Approach. The Dobbs Method results in higher clinical scores and ankle arc of motion. Future long-term studies focusing on patient-reported outcomes are needed.
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Congenital Vertical Talus in an adult

Congenital Vertical Talus management

Leg "Growing" Pains in Congenital Heart Disease

Congenital anomalies of the limbs in mythology and antiquity

Congenital Curved Nail of the Fourth Toe

Muscle function in adults with congenital heart disease

Congenital hypertrophy of the intrinsic muscles of the foot

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