congenital vertical talus ug lecture
TRANSCRIPT
CONGENITAL VERTICAL TALUS
Dr Dhananjaya Sabat MS, DNB, MNAMS
Assistant Professor OrthopedicsMAMC & STC. New Delhi
INTRODUCTIONCongenital convex pes
valgusuncommon disorder of the
foot; 1BIN 10000. 50% B/LManifested as a rigid rocker-
bottom flatfootdefined by an irreducible and
rigid dorsal dislocation of the navicular on the talus.
left untreated, CVT results in a painful and rigid flatfoot with weak push-off power.
should be recognised at birth and treated before the age of 2.
ETIOLOGYIdiopathicGenetic/syndromic: Spina bifida, trisomy,
marfan, DDH Neuromuscular: Congenital myopathies and
distal arthrogryposis
Abnormal variation in muscle fiber size, type I muscle fiber smallness, and abnormal fiber type predominance (Merrill)
.Contracture of the tendo-Achilles, EDL, EHL,
tibialis anterior
CLINICAL PRESENTATIONrigid flatfoot with a rocker-
bottom appearance of the footPersian slipper appearanceCalcaneus in fixed equinus Achilles tendon is very tight The hindfoot is in valgusThe head of the talus is found
medially in the soleThe forefoot is abducted and
dorsiflexed.
Coleman divided CVT into 2 typesType 1 was associated with a calcaneocuboid
dislocationType 2 was not associated with a
calcaneocuboid dislocation. This distinction is important clinically
because the type 1 deformity is stiffer and particular attention must be paid to releasing the calcaneocuboid joint.
IMAGING STUDIESAP: increased talocalcaneal anglePlantarflexed lateral: fixed forefoot
dorsal dislocationDorsiflexed lateral: fixed equinus
of hindfoot
Lateral radiographs of the foot in maximal plantarflexion can reveal if the navicular is reducible; CONGENITAL OBLIQUE TALUS
Because the navicular may not be ossified, the alignment of the first metatarsal to the talus must be evaluated.
Hamanishi described 2 radiographic angles: the talar axis–first metatarsal base angle (TAMBA) and the calcaneal metatarsal base angle (CAMBA). The changing point from a flexible oblique talus to rigid CVT is a TAMBA of approximately 60° and a CAMBA of 20
NONOPERATIVE TREATMENT
Serial casting to stretch the foot in plantarflexion and inversion while counterpressure is applied to the medial aspect of the talus
Reverse Ponseti methodComplete correction rarely
achieved.
SURGICAL TREATMENTsingle-stage surgical
correction Cincinnati approach or
the dorsal approach (Seimon)
Peroneus tertius & an abnormal band of the inferior retinaculum causing a tether from the tibia to the calcaneus: release
Talonavicular joint & calcaneocuboid joint opened
Percutaneus tendo achilles tenotomy
Talonavicular joint is reduced, fixed with K wire
Cast for 2 weeks. f/b brace
COMPLICATIONS
Wound complicationRecurrenceStiffnessAVN talus
LATE PRESENTATIONSTR + navicular excisionSubtalar arthrodesis 21/2-6yrTriple arthrodesis >6yr