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What is Vertical Talus?

Talus is a small bone in your ankle joint. It sits between the heel bone (calcaneus) and the confluence of two bones of the lower leg (tibia and fibula). Talus connects the lower leg to the foot to form the ankle and helps transfer weight across the ankle joint.

A vertical talus, also called “congenital vertical talus or CVT”, is a rare foot deformity typically seen at the time of birth. The condition may affect one foot or both feet of your baby.

Why and How Does Vertical Talus Occur? 

In normal circumstances, the talus bone points towards the toes when connecting the lower leg to the foot. However, certain congenital factors cause the talus to form in the wrong position making the bone point towards the ground. This makes the other bones of the feet and legs to be misaligned leading to a stiff flat foot in the new-born, commonly known as “rocker bottom foot”.

Causes of Vertical Talus

The exact cause of the vertical talus is not known. However, the condition is known to be associated with either of the following:

  • Genetic syndromes or gene defects
  • Neuromuscular abnormalities or diseases

Signs or Symptoms

An extreme flatfoot and a turned ankle at birth are the most common symptoms of vertical talus. The symptoms will become obvious when your child begins to stand or walk.

Other possible symptoms include:

  • An upward bend of the mid and forefoot
  • Elevated hindfoot due to an abnormal flex in the ankle
  • Abnormal positioning (mostly outward turn) of the foot

What If the Condition is Left Untreated?

It is important vertical talus is treated early though initially, it is not painful for the newborn or the toddler.  If left untreated, the child begins to walk on an abnormal foot, which can lead to:

  • Foot pain, unusual gait, and difficulty in walking
  • Development of calluses (thick and hard skin)
  • Painful skin breakdown
  • Serious disability and discomfort later in life

Also, it may make it hard to find shoes that fit your child’s feet properly and eventually result in abnormal walking.

Diagnosis

Early detection of vertical talus is the key to successful treatment as well as the outcome.

The condition is diagnosed before birth through ultrasound during the pregnancy or at birth via physical examination.

Your doctor may also order imaging tests such as:

  • Radiograph or X-ray
  • EOS imaging
  • CT scan or MRI

These tests help the doctor to confirm the condition and better understand the anatomy of the child’s foot and leg.

Treatment

Vertical talus can be treated nonsurgically or surgically.

Nonsurgical

Nonsurgical options are typically aimed at preventing the condition from getting worse and mainly include:

  • Physical therapy exercises to stretch the foot and improve flexibility.
  • Serial manipulation and casting of the foot to reduce the upward curve.

Longer follow-up after the treatment may be necessary in both cases to sustain foot correction. Though improvements from these treatments do occur, they are often temporary and need surgical intervention to ensure complete restoration from the condition.

Surgical 

Surgery, be it extensive or minimally invasive, is usually performed when the child is 9 to 12 months of age. In the case of older children, the surgery may include additional bone work.

The goal of the surgery is to realign the bones in the correct position within the foot. Follow-up visits for a few years may be necessary to make sure your child’s foot grows well and does not need additional treatment.

Most children who are surgically treated for vertical talus have shown good results. Moreover, surgery usually ensures a stable, functional, pain-free foot that can serve your child well all through life.