Congential Convex Pes Valgus - Vertical Talus Flashcards
What is congenital convex pes valgus (vertical talus)
- extremely rare congenital pedal disorder
- presents as rigid, rocker-bottom flatfoot deformity
- multifaceted: abnormalities of talar position, talocalcaneal navicular joint dislocation, both ligamentous and musculotendinous changes
What is the hallmark of congenital convex pes valgus (vertical talus)
Dorsal dislocation of the navicular on the talar head and neck
NB in true CCPV, thick plantar skin surfaces wraps around the back of foot
Patients with congenital vertical talus walk with what type of gait
Peg-like gait (awkward gait with limited forefoot push-off)
Describe the osseous pathology of the calcaneus in congenital vertical talus
- valgus and equinus
- no anterior talocalcaneal articulation
- dorsolateal subluxation of the calcaneocuboid
- sustentaculum tali blunting
- posterior STJ abnormalities
Describe the osseous pathology of the talus in congenital vertical talus
- fixed in a vertical position
- medial angulation
- associated hypoplasia of the talar head and neck
Describe the osseous pathology of the navicular in congenital vertical talus
Rigidly articulates with the dorsal cortex of the talar neck
Describe the standard DP in congenital vertical talus
- increased talocalcaneal angle
- forefoot abduction
Describe the lateral view on radiograph for congential vertical talus
- calcaneus in equinus
- vertical position of the talus
- dorsal displacement of forefoot on talus
What happens to Kite’s angle on DP view in congenital vertical talus
Increased TC (kite’s angle)
What is the talar-metatarsal axis?
A line bisecting the talus and the longitudinal axis of the metatarsals
What is the normal talar-metatarsal axis
3 degrees
What happens to talar-metatarsal axis in vertical talus
Increases in vertical talus
How does talar-metatarsal axis differ Tia the vertical talus from oblique talus
Oblique talus - malaligned in lateral view and aligned in the lateral plantar flexion view
Vertical talus - malaligned in both lateral and lateral plantar flexion view
Because of the lack of navicular ossification in infants, longitudinal axis relations among the ____, ____, ____ and ____ bones must be assessed
Talus
Calcaneus
1st MT
Cuboid
What is the calcaneal-metatarsal axis
Line bisecting the long axis of the calcaneus with the longitudinal axis of the MT
What is the normal calcaneal-metatarsal axis
-10 degrees
What happens to calcaneal-metatarsal axis in vertical talus
Increased
What is lateral dorsiflexion view
Assess the degree of fixed equinus of the calcaneus
What is the lateral plantar flexion view
Irreducibility of the deformity by forced plantar flexion lateral views (Eyre-Brook test) distinguish this condition from flexible plantar flexed talar deformities
What is the most important radiograph for vertical talus
Lateral planatarflexion view
What is the goal for treatment of vertical talus
Reduce and maintain the anatomic relationship of the navicular and calcaneus to the talus
Describe casting for vertical talus
Start at birth, continue for 3-4 months
Reduce Talonavicular dislocation
Elimination of forefoot varus
Position foot reverse of Ponseti series, start at position #5 and move to position #1
Open surgical correction is sometimes necessary
Surgical procedure for vertical talus pts 6-12 mths
Soft tissue procedures -
Cincinnati incision
Posterior capsulotomy
Tendon lengthening
Reduce talocalcaneal and Talonavicular joints
Surgical treatment for vertical talus, late treatment
Boney procedure
2-6 yrs - Grice-Green subtalar arthrodesis
>6 yrs - triple arthrodesis
When should surgery be performed in vertical talus patients
As early as 3 mths if reverse Ponseti has failed
Casting beneficial for stretching prior to surgery
What are the 4 surgical approaches for vertical talus
Talar procedures
Navicular procedures
Talonavicular joint procedures
Tarsal stabilization procedures
What is the talar procedure for vertical talus
Complete talectomy
Excision of head and neck of talus
What is the navicular procedures for vertical talus
Navicular excision
Dorsal wedge excision
What is Talonavicular joint procedures for vertical talus
Open reduction with K-wire fixation
Open reduction with peroneus brevis transfer to talar neck
What is the tarsal stabilization procedure for vertical talus
Triple arthrodesis
Subtalar arthrodesis
