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Congenital Vertical Talus Workup

  • Author: Jeffrey D Thomson, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
 
Updated: May 09, 2016
 

Imaging Studies

Radiography

Weightbearing anteroposterior (AP) and lateral views of the foot are the first radiographs that must be obtained. A lateral radiograph with the foot in maximum plantarflexion is mandatory to confirm congenital vertical talus (CVT).

Because the navicular may not be ossified, the alignment of the first metatarsal to the talus must be evaluated. In a vertical talus, the metatarsal does not line up with the talus. Lines drawn through the long axis of the first metatarsal and the talus converge on the plantar aspect of the foot. Hamanishi described two radiographic angles: the talar axis–first metatarsal base angle (TAMBA) and the calcaneal axis–first metatarsal base angle (CAMBA).[23] The changing point from a flexible oblique talus to rigid CVT is a TAMBA of approximately 60° and a CAMBA of 20°.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) of the spine may be indicated if an occult spinal dysraphism, such as lipomeningocele, is suspected.[24] Posterior and lateral lumbar spine radiographs also may be useful to exclude occult spinal dysraphism.

Thometz et al evaluated nine patients with CVT using MRI to evaluate the three-dimensional morphologic changes and pathoanatomy. They concluded that there is significant pathology at the level of the subtalar joint.[25]

Ultrasonography

Ultrasonography has been reported to be helpful in distinguishing between CVT (irreducible talonavicular dorsal dislocation) and oblique talus (reducible talonavicular dorsal dislocation).

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Histologic Findings

In 2011, Merrill et al published a report evaluating the skeletal muscle abnormalities in CVT.[7] Of note is that their subjects did not constitute a homogenous group: Six of the 11 patients had idiopathic vertical talus, whereas the remaining five had a variety of associated findings. The authors took biopsy samples from the abductor hallucis muscle and found that all patients with CVT had abnormalities. These abnormalities included abnormal variation in muscle fiber size, type I muscle fiber smallness, and abnormal fiber type predominance.

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Contributor Information and Disclosures
Author

Jeffrey D Thomson, MD Associate Professor, Department of Orthopedic Surgery, University of Connecticut School of Medicine; Director of Orthopedic Surgery, Department of Pediatric Orthopedic Surgery, Associate Director of Clinical Affairs for the Department of Surgical Subspecialties, Connecticut Children’s Medical Center; President, Connecticut Children's Specialty Group

Jeffrey D Thomson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

George H Thompson, MD Director of Pediatric Orthopedic Surgery, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, and MetroHealth Medical Center; Professor of Orthopedic Surgery and Pediatrics, Case Western Reserve University School of Medicine

George H Thompson, MD is a member of the following medical societies: American Orthopaedic Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Academy of Orthopaedic Surgeons

Disclosure: Received none from OrthoPediatrics for consulting; Received salary from Journal of Pediatric Orthopaedics for management position; Received none from SpineForm for consulting; Received none from SICOT for board membership.

Chief Editor

Murali Poduval, MBBS, MS, DNB Associate Professor, Department of Orthopedic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India

Murali Poduval, MBBS, MS, DNB is a member of the following medical societies: Indian Orthopedic Association, Association of Medical Consultants of Mumbai, Bombay Orthopedic Society, Indian Society of Hip and Knee Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Mininder S Kocher, MD, MPH Associate Professor of Orthopedic Surgery, Harvard Medical School/Harvard School of Public Health; Associate Director, Division of Sports Medicine, Department of Orthopedic Surgery, Children's Hospital Boston

Mininder S Kocher, MD, MPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, Pediatric Orthopaedic Society of North America, American Association for the History of Medicine, American Orthopaedic Society for Sports Medicine, Massachusetts Medical Society

Disclosure: Received consulting fee from Smith & Nephew Endoscopy for consulting; Received consulting fee from EBI Biomet for consulting; Received consulting fee from OrthoPediatrics for consulting; Received stock from Pivot Medical for consulting; Received consulting fee from pediped for consulting; Received royalty from WB Saunders for none; Received stock from Fixes-4-Kids for consulting.

References
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  2. Eyre-Brook AL. Congenital vertical talus. J Bone Joint Surg Br. 1967 Nov. 49(4):618-27. [Medline]. [Full Text].

  3. Lamy L, Weissman L. Congenital convex pes planus. J Bone Joint Surg. 1939. 21:79-91.

  4. Coleman SS, Stelling FH 3rd, Jarrett J. Pathomechanics and treatment of congenital vertical talus. Clin Orthop Relat Res. 1970 May-Jun. 70:62-72. [Medline].

  5. Seimon LP. Surgical correction of congenital vertical talus under the age of 2 years. J Pediatr Orthop. 1987 Jul-Aug. 7(4):405-11. [Medline].

  6. Ogata K, Schoenecker PL, Sheridan J. Congenital vertical talus and its familial occurrence: an analysis of 36 patients. Clin Orthop Relat Res. 1979 Mar-Apr. (139):128-32. [Medline].

  7. Merrill LJ, Gurnett CA, Connolly AM, Pestronk A, Dobbs MB. Skeletal muscle abnormalities and genetic factors related to vertical talus. Clin Orthop Relat Res. 2011 Apr. 469(4):1167-74. [Medline]. [Full Text].

  8. Jacobsen ST, Crawford AH. Congenital vertical talus. J Pediatr Orthop. 1983 Jul. 3(3):306-10. [Medline].

  9. Saini R, Gill SS, Dhillon MS, Goyal T, Wardak E, Prasad P. Results of dorsal approach in surgical correction of congenital vertical talus: an Indian experience. J Pediatr Orthop B. 2009 Mar. 18(2):63-8. [Medline].

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

  11. Jochymek J, Skvaril J. [Surgical treatment in congenital vertical talus]. Rozhl Chir. 2009 Jan. 88(1):32-4. [Medline].

  12. Herndon CH, Heyman CH. Problems in the recognition and treatment of congenital pes valgus. J Bone Joint Surg Am. 1963. 45:413-29.

  13. Osmond-Clarke H. Congenital vertical talus. J Bone Joint Surg Br. 1956 Feb. 38-B(1):334-41. [Medline].

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  16. Stricker SJ, Rosen E. Early one-stage reconstruction of congenital vertical talus. Foot Ankle Int. 1997 Sep. 18(9):535-43. [Medline].

  17. Dobbs MB, Purcell DB, Nunley R, et al. Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Joint Surg Am. 2006 Jun. 88(6):1192-200. [Medline].

  18. Bhaskar A. Congenital vertical talus: Treatment by reverse ponseti technique. Indian J Orthop. 2008 Jul. 42(3):347-50. [Medline]. [Full Text].

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

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

  21. Yang JS, Dobbs MB. Treatment of Congenital Vertical Talus: Comparison of Minimally Invasive and Extensive Soft-Tissue Release Procedures at Minimum Five-Year Follow-up. J Bone Joint Surg Am. 2015 Aug 19. 97 (16):1354-65. [Medline].

  22. Chan Y, Selvaratnam V, Garg N. A comparison of the Dobbs method for correction of idiopathic and teratological congenital vertical talus. J Child Orthop. 2016 Apr. 10 (2):93-9. [Medline].

  23. Hamanishi C. Congenital vertical talus: classification with 69 cases and new measurement system. J Pediatr Orthop. 1984 May. 4(3):318-26. [Medline].

  24. Kruse L, Gurnett CA, Hootnick D, Dobbs MB. Magnetic resonance angiography in clubfoot and vertical talus: a feasibility study. Clin Orthop Relat Res. 2009 May. 467(5):1250-5. [Medline]. [Full Text].

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

  26. Supakul N, Loder RT, Karmazyn B. Dynamic US study in the evaluation of infants with vertical or oblique talus deformities. Pediatr Radiol. 2013 Mar. 43(3):376-80. [Medline].

 
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