Pediatric Orthopedic Surgeons treating Ankle Misalignment

CONGENITAL VERTICAL TALUS

Congenital vertical talus is a rare congenital foot deformity in which the sole of a child’s foot flexes abnormally in a convex position giving the foot a rocker-bottom appearance. For this reason, this condition is often called a rocker-bottom foot.

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Congenital Vertical Talus

Congenital vertical talus is an inborn malformed foot condition. It is a deformity in which the sole abnormally flexes upwards. Thus, it gives the foot a bendy rocker-bottom-like appearance. That is why this condition is often called a rocker-bottom foot as well.

A newborn child is born with feet that usually appear flat because of the extra fat padding on the bottom. As the child grows, their feet normally develop a concave arch. However, in a child with a rocker-bottom foot, the bottom of the foot flexes in an upward direction. It makes the middle of the foot touch the floor while the toes and heel bend upward. This condition occurs equally in boys and girls. In 50% of the cases, both feet are affected. Usually, congenital vertical talus is a very rigid foot abnormality. It is unlike many other common Calcaneovalgus feet that are considered flexible deformities. Moreover, it hardly improves with bracing or stretching. Surgery is the only solution in most cases.

Causes

Congenital vertical talus often relates to an underlying neurological or musculoskeletal condition such as:

Trisomy 13, 14, 15 or 18
Arthrogryposis Multiplex Congenital
Spina bifida

Signs and Symptoms

The most common symptom of this condition is a rocker-bottom appearance of the foot. It is usually obvious at birth or noticeable when a child begins to walk. Other symptoms are:

An upward flex is noticeable at the mid and forefoot.
The midfoot is not in the proper alignment with the hindfoot.
The hindfoot looks elevated because of a malformed flex in the ankle.
Abnormal positioning of the foot. The child may walk on the heel of his/her foot because the outside edge is lifted. Consequently, it leads to improper balance and weight distribution.

QUESTIONS AND ANSWERS

What is congenital vertical talus in children, and how does it occur?

Congenital vertical talus defines a rare congenital foot deformity in which the sole of the foot is fixed in an upward position, and the foot turns inward. Doctors refer to it as a complex condition that involves abnormalities in the alignment and structure of the bones, ligaments, and tendons in the foot and ankle. Doctors do not know the exact cause, but it can result from a combination of genetic and environmental factors.

What are the common symptoms and signs of congenital vertical talus in children?

Children with congenital vertical talus typically have a prominent bump on the top of the foot near the ankle, a flat and rigid foot with the sole facing upwards, and an arch that is abnormally positioned. They may have difficulty or pain when trying to put weight on the foot, walk, or wear shoes. Although the condition exists at birth, it can become more noticeable as the child starts to bear weight and walk.

How do doctors diagnose and treats congenital vertical talus in children?

Diagnosis of congenital vertical talus is usually made through a physical examination and imaging studies such as X-rays and often an MRI to evaluate the bones and soft tissues of the foot and ankle. Treatment usually involves a combination of nonsurgical and surgical approaches. Initially, stretching exercises, serial casting, and orthotic devices will gently stretch and align the foot. However, most cases require surgery to correct the deformity. Surgical procedures may involve releasing tight ligaments, repositioning bones, and stabilizing the foot with pins, screws, or plates.

When it comes to a Child’s Health, there is none better than the doctors at Medical City Children’s Orthopedics and Spine Specialists. We specialize in Children.

Diagnosis

For successful treatment, early detection of congenital vertical talus is crucial. When it comes to the proper diagnosis of this problem, a trained orthopedic doctor will perform a thorough medical history check-up, a physical examination, and a visual assessment of your child.

At the time of the physical exam, the doctor will examine your child’s foot. But also, they will check your entire child. Also, the doctor will check for other abnormalities such as multiple joint contractures or proof suggesting your child may have a multisystem genetic disorder. Doctors will closely examine your child’s foot both while in motion and standing. It is how they determine whether your child has a rocker-bottom foot, or is more of a common and less severe condition such as flat feet or Calcaneovalgus foot. Though symptoms of these conditions may seem to be quite similar in young children, treatments will be utterly different.

Tests

Doctors may also recommend imaging tests to do an accurate diagnosis or better check the anatomy of the foot and leg of your child. The imaging tests doctors may suggest are:

X-rays – This technology produces images of bones. The main feature of this deformity is the disfigured position of the talus bone. This bone connects the foot to the ankle. EOS imaging is an imaging technology that creates 3-D models from two flat images.
Computed tomography (CT) scan – This method combines X-rays and computer technology to investigate bones and produce cross-sectional images (“slices”) of the body. Contrasting a CT scan, EOS images are taken keeping the child in a standing position. It ensures better diagnosis because of weight-bearing positioning.
Magnetic resonance imaging (MRI) – It combines large magnets, radio frequencies, and a computer to create detailed images of organs, muscles, soft tissues, ligaments, and other different structures within the body. An MRI does not cause any radiation exposure to your child.

If your child has a neurological condition as well, the orthopedic doctor may refer your child to a neurologist. They can help with a complete neurological exam.

Treatments

There are various treatments available for Children with congenital vertical talus. Depending on their condition, some children may get better with non-surgical treatment. However, most will need surgery.

Non-surgical treatment

To prevent your child’s condition from getting worse, orthopedic doctors may recommend various non-surgical treatments. For example:

Stretching exercises can be beneficial for the forefoot and hindfoot.
Casting and Serial manipulation of the forefoot and midfoot in a flexed position helps reduce the upward curve of the foot.

These treatments might bring some improvements. But these results are often temporary.

Surgery

When it comes to the surgical treatment of this foot condition, this procedure is pretty complicated. It is because it is a surgery that involves correcting foot movement in three different directions — up-and-down, front-and-back, and side-to-side. You should always consult a highly experienced and knowledgeable orthopedic specialist if surgery is required.

When there is proper serial casting, it often minimizes the requirement for extensive soft-tissue release surgery to minimally invasive tendon procedures. These procedures leave minimal scars and have a faster recovery time. In older children, other surgical procedures involve bone work.

Recovery

After the operation, the doctor applies a cast to the child’s foot to maintain the correct positioning. The child will likely stay in the hospital for the night after surgery for better pain control. Also, it lets the doctor monitor the condition of that operated foot. After roughly 4 to 6 weeks, doctors will remove the cast. Later, your child may require a brace or a special shoe that will help prevent the deformity from coming back.

Results

If left untreated or not treated at all, your child’s vertical talus is likely to cause future pain and disability. However, with proper treatment, you can expect your child’s condition to be stable and functional. And that will serve your child pretty well throughout their life. In case, your child has no other additional conditions that might limit functionality and proper development, he/she will not have any problem with running and playing without pain. He/she can wear normal shoes as well. Your child’s orthopedic doctor will recommend repeat follow-up clinic visits over the years to observe the growth and development of your child’s foot.

Surgical Safety Protocol

Indeed, surgery can considerably improve the long-term results for a child with a congenital vertical talus. However, remember that it can also be a stressful experience both for you and your child. We can help you and your child have the best preparation for surgery. Also, we follow the best practices before, during, and after surgery. It is how we reduce the associated risk of infection while increasing the best long-term results. You can trust us because our safety protocols have been highly successful.

Follow-up care

We offer comprehensive ongoing support and services for your child. Our team provides regular updates on the progress of your child’s operated feet. Also, your child might need long-term continued care and monitoring. In that case, our orthopedic team will do its best.

Outlook

In most cases, children who had surgical treatments for congenital vertical talus have good results. However, some children may require an orthotic to further ensure accurate foot alignment during the phase of critical growth and development. Remember that children with rocker-bottom feet associated with a larger neurological or musculoskeletal syndrome tend to require follow-up care throughout their lifetime. We always ensure that your child, no matter the severity of the orthopedic condition; gets comprehensive care and gets back to an improved lifestyle as soon as possible.

How do you Find the Right Doctor to Treat your Child with Congenital Vertical Talus?

Parents of children with Congenital Vertical Talus should bring their kids to Medical City Children’s Orthopedics and Spine Specialists because:

Specialized expertise: Medical City Children’s Orthopedics and Spine Specialists has a team of highly skilled, experienced pediatric orthopedic surgeons and spine specialists. The doctors and surgeons specialize in treating children with Congenital Vertical Talus.
Comprehensive care: Medical City Children’s Orthopedics and Spine Specialists offers a full range of diagnostic and treatment options for Congenital Vertical Talus. These include advanced imaging technologies, physical therapy, bracing, and surgical interventions.
Family-centered care: Medical City Children’s Orthopedics and Spine Specialists takes a family-centered approach to care. Our doctors work closely with parents and caregivers to develop individualized treatment plans for each child’s unique needs and goals.
Support services: Medical City Children’s Orthopedics and Spine Specialists offers a variety of support services for families. These include social work, child life specialists, and patient and family education resources.
State-of-the-art facilities: Medical City Children’s Orthopedics and Spine Specialists is part of a leading medical center with state-of-the-art facilities. Doctors and surgeons have the latest technologies to support the diagnosis and treatment of Congenital Vertical Talus.

Overall, Medical City Children’s Orthopedics and Spine Specialists with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX offers comprehensive and specialized care for children with Congenital Vertical Talus, with a focus on improving outcomes and quality of life for patients and their families

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Footnote:

American Academy of Orthopaedic Surgeons: Vertical Talus

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