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Pediatric Orthopedics > Congential Convex Pes Valgus - Vertical Talus > Flashcards

Congential Convex Pes Valgus - Vertical Talus Flashcards

1
Q

What is congenital convex pes valgus (vertical talus)

A
  • 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
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2
Q

What is the hallmark of congenital convex pes valgus (vertical talus)

A

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

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3
Q

Patients with congenital vertical talus walk with what type of gait

A

Peg-like gait (awkward gait with limited forefoot push-off)

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4
Q

Describe the osseous pathology of the calcaneus in congenital vertical talus

A
  • valgus and equinus
  • no anterior talocalcaneal articulation
  • dorsolateal subluxation of the calcaneocuboid
  • sustentaculum tali blunting
  • posterior STJ abnormalities
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5
Q

Describe the osseous pathology of the talus in congenital vertical talus

A
  • fixed in a vertical position
  • medial angulation
  • associated hypoplasia of the talar head and neck
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6
Q

Describe the osseous pathology of the navicular in congenital vertical talus

A

Rigidly articulates with the dorsal cortex of the talar neck

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7
Q

Describe the standard DP in congenital vertical talus

A
  • increased talocalcaneal angle
  • forefoot abduction
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8
Q

Describe the lateral view on radiograph for congential vertical talus

A
  • calcaneus in equinus
  • vertical position of the talus
  • dorsal displacement of forefoot on talus
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9
Q

What happens to Kite’s angle on DP view in congenital vertical talus

A

Increased TC (kite’s angle)

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10
Q

What is the talar-metatarsal axis?

A

A line bisecting the talus and the longitudinal axis of the metatarsals

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11
Q

What is the normal talar-metatarsal axis

A

3 degrees

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12
Q

What happens to talar-metatarsal axis in vertical talus

A

Increases in vertical talus

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13
Q

How does talar-metatarsal axis differ Tia the vertical talus from oblique talus

A

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

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14
Q

Because of the lack of navicular ossification in infants, longitudinal axis relations among the ____, ____, ____ and ____ bones must be assessed

A

Talus
Calcaneus
1st MT
Cuboid

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15
Q

What is the calcaneal-metatarsal axis

A

Line bisecting the long axis of the calcaneus with the longitudinal axis of the MT

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16
Q

What is the normal calcaneal-metatarsal axis

A

-10 degrees

17
Q

What happens to calcaneal-metatarsal axis in vertical talus

A

Increased

18
Q

What is lateral dorsiflexion view

A

Assess the degree of fixed equinus of the calcaneus

19
Q

What is the lateral plantar flexion view

A

Irreducibility of the deformity by forced plantar flexion lateral views (Eyre-Brook test) distinguish this condition from flexible plantar flexed talar deformities

20
Q

What is the most important radiograph for vertical talus

A

Lateral planatarflexion view

21
Q

What is the goal for treatment of vertical talus

A

Reduce and maintain the anatomic relationship of the navicular and calcaneus to the talus

22
Q

Describe casting for vertical talus

A

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

23
Q

Surgical procedure for vertical talus pts 6-12 mths

A

Soft tissue procedures -
Cincinnati incision
Posterior capsulotomy
Tendon lengthening
Reduce talocalcaneal and Talonavicular joints

24
Q

Surgical treatment for vertical talus, late treatment

A

Boney procedure
2-6 yrs - Grice-Green subtalar arthrodesis
>6 yrs - triple arthrodesis

25
Q

When should surgery be performed in vertical talus patients

A

As early as 3 mths if reverse Ponseti has failed
Casting beneficial for stretching prior to surgery

26
Q

What are the 4 surgical approaches for vertical talus

A

Talar procedures
Navicular procedures
Talonavicular joint procedures
Tarsal stabilization procedures

27
Q

What is the talar procedure for vertical talus

A

Complete talectomy
Excision of head and neck of talus

28
Q

What is the navicular procedures for vertical talus

A

Navicular excision
Dorsal wedge excision

29
Q

What is Talonavicular joint procedures for vertical talus

A

Open reduction with K-wire fixation
Open reduction with peroneus brevis transfer to talar neck

30
Q

What is the tarsal stabilization procedure for vertical talus

A

Triple arthrodesis
Subtalar arthrodesis

Pediatric Orthopedics (18 decks)

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