What is Vertical Talus?
Vertical talus is a deformity resulting from the abnormal positioning of several bones in the foot. This creates a rigid, flat foot where the arch of the foot curves down and out like the bottom of a rocking chair.
If left untreated, a child will start to walk on the inside of the foot. This leads to the formation of painful calluses, skin breakdown and foot pain. It will also affect the child’s gait (way the child walks) and ability to wear properly-fitting shoes.
How it Occurs
Most children born with vertical talus have no other congenital problems. When it occurs in isolation it is referred to as idiopathic (“unknown” cause). In other cases, it may be associated with a chromosomal abnormality or occur as a part of a genetic syndrome or neuromuscular disorder that secondarily disrupts the structure of the foot. Medical examination by your doctor should be able to determine whether your baby’s vertical talus is idiopathic. There is increasing evidence that isolated vertical talus is related to select gene mutations.
Stretching and serial casting
Initial treatment consists of gentle manipulation of the foot to stretch the contracted tissues. The doctor will stretch your child’s foot into the desired amount of correction and apply a plaster cast in two sections, paying careful attention to the molding of the foot and ankle. Most of the treatment takes place in the doctor’s office. This phase generally requires four to six plaster casts that are changed weekly in the office.
Once the foot is corrected with casting, your child is scheduled for a minimally-invasive surgical procedure to insert a temporary pin to hold the bones of the foot in proper alignment. At the same time, a percutaneous (without skin incision) heel cord tenotomy is performed to correct the tightness that remains in the ankle. After surgery, your child’s foot is placed into a long leg cast for two weeks. When this cast is removed, your child will be measured for a special brace. At the same visit, a new long leg cast is applied and worn for four additional weeks. This cast will be removed in the operating room along with the pin.
Post-Operative Care and Bracing
After the final cast is removed, your child will begin wearing a brace (foot abduction orthosis) designed to prevent the vertical talus deformity from recurring. Even when well-corrected, vertical talus has a tendency to relapse. It is very important to follow all of your doctor’s instructions for bracing and stretching. For the first two months, the brace must be worn for 23 hours a day and then 12-14 hours a day (naps and nighttime) for 2 years. You will be taught stretching exercises for your child’s to maintain flexibility.