Approach to Congenital Vertical Talus
This is the at the extreme spectrum of flatfeet; ie. the ultimate flatfoot.
Look for associated conditions: spinal dysraphism, sacral agenesis, arthrogryposis, neurofibromatosis, DDH, CP, polio, SMA, and iatrogenic (overcorrection of a clubfoot)
Basically, the TN joint is dislocated, with the navicular riding dorsolaterally on the talar head. The calcaeneocuboid joint may also be subluxed dorsally – the whole midfoot and forefoot are swung way out into abduction
The diagnosis is made by the rigidity of the hindfoot, and the “Persian slipper” appearance.
There is no role for conservative management. Cast them only as a temporizing measure to stretch things out as best as possible prior to operating on them.
Can do a one or two stage open reduction of the TN and CC joints.
Drennan: single stage
– posterolateral release (calcaneofibular ligament), release tendoachilles, expose NV bundle, open reduction of TN joint, cut interosseous talocalcaneal ligaments, then K-wires the joint.