congenital vertical talus/ MAA

Question 1

Clinical symptoms of congenital vertical talus

Answer 1

talus is plantarflexed so severely the navicular primarily dislocates dorsally onto the neck of talus, locking the talus in vertical position.

Forefoot is abducted and dorsiflexed at the midtarsal joint, calcaneus in valgus and equinus, and more plantarflexed
foot may actually touch the front of the tibia at birth

Talus on the medial plantar aspect of foot

rigidity and foot with a convex rocker bottom plantar, prominent talar head is the hallmark

gastroc-soleus contracted, spring ligament elongated

Question 2

Radiographic evaluation for vertical talus

Answer 2

anterior facet-absent
middle facet- hypoplastic
posterior facet: malformed

xray foot maximally plantarflexed is rigid
talocalcaneal angle on AP > 40 deg
talar neck hypoplastic and may have hour glass shape

Question 3

Surgical treatments for vertical talus at

3 month-3 yrs

Answer 3

if closed reduction fails, open reduction should be performed at 3 months.

posterior release and reduction of TN joint
Achilles lengthening, spring ligament repair

Question 4

Surgical treatments for vertical talus at

3 to 6 yrs

Answer 4

extra-articular arthrodesis (green grice type) or arthroeresis to maintain reduction and stabilize the STJ

Question 5

Surgical treatments for vertical talus at

6+ yrs

Answer 5

at this time, best to post pone surgery until skeletal maturity (10-14 yrs), at that time the triple arthrodesis is performed

Question 6

Grice and green extra-articular subtalar arthrodesis

Answer 6

a bone graft inserted laterally in sinus tarsi between the talus and calcaneus.

Question 7

what is the hall mark for vertical talus

Answer 7

rigidity

Question 8

which foot is more commonly affected for vertical talus

Answer 8

right

Question 9

what type of gait does vertical talus have

Answer 9

peg like

Question 10

most common congential deformity vertical talus occurs with

Answer 10

arthrogryposis: characterized by multiple joint contractures (stiffness) and involves muscle weakness found throughout the body at birth. (pocket pod)

Myelodysplasia is the most commonly seen disorder to co-exist with vertical talus at birth ( BBN)

Question 11

Capsulotomies and ligament release of all lisfranc joints for MAA

what do you keep intact?

Answer 11

Heyman Herndon and Strong

Keep the plantar lateral ligaments and capsules intact, to prevent dorsal subluxation/dislocation

Question 12

Oblique V shaped osteotomies at the bases of all metatarsals the apex angled towards rearfoot for MAA

what age range is best for this

Answer 12

Steytler and Van der Walt (3-10 yrs old)

Question 13

Opening wedge of medial cuneiform osteotomy

and soft tissue release of what? and name of procedure ?

Answer 13

Fowler osteotomy

plantar fascia, abductor hallucis, TAA

Question 14

Sectioning the abductor hallucis tendon

Answer 14

Lichtblau

Question 15

1st TMT fusion, central osteotomy of 3 central metatarsals and possible wedge resection of cuboid (for neglected cases)

Answer 15

McCormick and Blount

Question 16

Excision of bases of 3 central metatarsal, osteotomy of 5th metatarsal, and correction of any TAA abnormality.

Answer 16

Peabody and Muro

Question 17

oblique rotational osteotomies (for transverse plane) of the 3 central metatarsals with 1st and 5th met oblique base wedge osteotomies for rotational correction

oblique osteotomies cuts should be parallel to what?

Answer 17

Leipard osteotomy

parallel to WB surface

Question 18

Closing base wedge of the cuboid with opening base wedge of medial cuneiform

Answer 18

Ganley and Ganley

Question 19

which metatarsus adductus osseous procedure that included all mets except or the first met

Answer 19

peabody and muro

Question 20

Rigid Athrogryphosis may develop between ages 3 and 6 with vertical talus, tx?

Answer 20

excise navicula

Question 21

To differentiate between a paralytic pes planovalgus deformity with supple reducibility and other causes of a vertical talar orientation, what can you order`

Answer 21

Note: Take a lumbosacral x-ray on a neonate with CVT.`

Question 22

Lateral base crescentic osteotomies on all metatarsal bases for MAA

Answer 22

berman and gartland

Question 23

Skewfoot vs MAA

Answer 23

Skewfoot: adducted forefoot, normal midfoot, and (fixed) valgus hindfoot

usually acquired from gradual compensation of metatarsus varus

MAA: FF adductus at the metatarsal joint with rearfoot normal

Question 24

clinical symptoms of MAA

Answer 24

intoed gait, frequent tripping, prominent styloid process

Question 25

Etiology of MAA

Answer 25

interauterine position

tight abductor hallucis muscle
absent/hypoplastic medial cuneiform

abnormal insertion of TA

Question 26

bleck classification

Answer 26

bisecting the heel and extending the line to see where it falls on toes..
Normal is when line is between 2nd and 3rd

Mild: through 3rd toe
Moderate Between 3rd and 4th
Severe: between 4th and 5th

Question 27

Engle angle

Answer 27

bisection of intermediate and 2nd met: normal is <24 deg

Question 28

what is the primary compensation for MAA

Answer 28

primary compensation for metatarsus adductus is STJ pronation.

Question 29

what devices can be used for tx MAA

Answer 29

The Wheaton brace, Ganley splint, and Bebax shoe are all devices that can be used to treat metatarsus adductus.

Question 30

Heyman Herndon and Strong/ primary complication

Answer 30

Originally described as transverse incision; Better to use three longitudinal incision
Releasing of all soft tissue structures at lisfranc joint except lateral 1/3 of plantar ligament

Complications include malposition of the metatarsals in the sagittal plane, growth plate disturbance, and development of arthritis

Question 31

Thompson procedure/ primary complication

Answer 31

(1) Resect abductor hallucis muscle
(2) Primary indication is hallux varus with adductus
(3) Primary complication is HAV

Question 32

when are osseous procedures appropriate for MAA

Answer 32

typically >8 yrs