Children with congenital vertical talus (CVT) have been treated with extensive soft-tissue releases, with a high rate of complications. Recently, reverse Ponseti-type casting followed by percutaneous reduction and fixation has been described, with excellent results in separate cohorts of children with CVT, of either idiopathic or teratological aetiology. There are currently no studies that compare the outcome in these two types. We present a prospective cohort of 13 children (21 feet) with CVT of both idiopathic and teratological aetiology, in which this technique has been used. Clinical, radiological and parent-reported outcomes were obtained at a mean follow-up of 36 months (8 to 57). Six children (nine feet) had associated neuromuscular conditions or syndromes; the condition was idiopathic in seven children (12 feet). Initial correction was achieved in all children, with significant improvement in all radiological parameters. Recurrence was seen in ten feet. Modification of the technique to include limited capsulotomy at the initial operation may reduce the risk of recurrence. The reverse Ponseti-type technique is effective in the initial correction of CVT of both idiopathic and teratological aetiology. Recurrence is a problem in both these groups, with higher rates than first reported in the original paper. However, these rates are less than those reported after open surgical release. Cite this article: Bone Joint J 2014;96-B:274–8

Operative correction of congenital vertical talus in nine feet in six patients is described. The operation consists of the comprehensive lengthening of the tendons in the foot and full peritalar release without excision of the navicular; it is performed through a dorsal transverse incision

Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet

The December 2022 Children’s orthopaedics Roundup. 360. looks at: Immobilization of torus fractures of the wrist in children (FORCE): a randomized controlled equivalence trial in the UK; Minimally invasive method in treatment of idiopathic congenital vertical talus: recurrence is uncommon; “You’re O.K. Anaesthesia”: closed reduction of displaced paediatric forearm and wrist fractures in the office without anaesthesia; Trunk range of motion and patient outcomes after anterior vertebral body tethering versus posterior spinal fusion: comparison using computerized 3D motion capture technology; Selective dorsal rhizotomy for individuals with spastic cerebral palsy; Scheuermann’s kyphosis and posterior spinal fusion; All-pedicle-screw constructs in skeletally immature patients with severe idiopathic early-onset scoliosis; Proximal femoral screw hemiepiphysiodesis in children with cerebral palsy

Background: The treatment of congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Dobbs et al in patients with idiopathic congenital vertical talus, but applied in teratologic congenital vertical talus. Methods: Five consecutive cases of teratologic congenital vertical talus deformity were prospectively followed at a minimum of nine months post treatment with serial casting and limited surgery consisting of percutaneous Achilles tenotomy, fractional lengthening of the anterior tibial tendon, and percutaneous pin fixation of the talonavicular joint. The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Clinical and radiographic assessments were carried out at the initial, immediate postoperative and the latest follow-up. Results: Initial correction was obtained both clinically and radiographically in all five feet. A mean of eight casts was required for correction. At the final evaluation, the mean ankle dorsiflexion was 20° and the mean plantar flexion was 31°. Radiographically, dorsal subluxation of the navicular recurred in one patient, but was functionally insignificant as the patient was a non-ambulator and required treatment for seating purposes only. At the time of the latest follow-up, there was a significant improvement in all of the measured radiographic parameters compared with the pretreatment values. Conclusions: Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, and deformity correction, in patients with teratologic congenital vertical talus

The August 2014 Children’s orthopaedics Roundup. 360 . looks at: Conservative treatment still OK in paediatric clavicular fractures; Femoral anteversion not the usual suspect in patellar inversion; Shoulder dislocation best treated with an operation; Perthes’ disease results in poorer quality of adult life; Physiotherapy little benefit in supracondylar fractures; Congenital vertical talus addressed at the midtarsal joint; Single-sitting DDH surgery worth the effort; and cubitus valgus associated with simple elbow dislocation

Congenital vertical talus is a rare deformity. Many different surgical procedures have been described, and there is debate about whether the correction should be done in one or two stages. We review the results of single stage surgical correction of congenital vertical talus. Between 1992 and 2000, five boys and seven girls were treated, ranging in age from eight months to two years. In six children both feet were involved, so there was a total of 18 feet. One child had spina bifida, four had arthrogryposis multiplex congenita and three had syndromes and chromosomal abnormalities. Four cases were idiopathic. Dorsolateral and medial incisions were used. Through the dorsolateral the sinus tarsus, calcaneocuboid and talonavicular joints were released and the extensors lengthened. Through the medial incision the navicula was reduced onto the talus, the tibialis posterior and talonavicular capsule were reefed and the tendo Achillis lengthened. The talonavicular and calcaneocuboid joints were pinned. The tibialis anterior was re-routed through the talar neck. Plasters were changed after two weeks and serial plasters were applied for four to six months. Follow-up ranged from one to seven years. Results were assessed clinically and radiologically, using the Adelaar 10 point scoring system. There were no wound complications or cases of avascular necrosis of the talus. Further surgery was required to correct cavus in two feet, to correct forefoot abduction in two, and to correct hindfoot valgus in one. Results were rated good in 12 feet and fair in six. Radiologically there was notable improvement in the anteroposterior and lateral talocalcaneal and tarso-first metatarsal angles. All patients were ambulant at last follow-up. In treating congenital vertical talus, good clinical and radiological results can be obtained with single stage correction of the hindfoot and midfoot deformities

1. The clinical and radiological features of thirty-two feet with congenital vertical talus are described and subdivided into groups determined by the presence or absence of associated abnormalities. 2. The differential diagnosis of congenital vertical talus from flat foot, talipes calcaneus and uncorrected club foot is discussed. 3. No benefit came from either non-operative treatment or tenotomy of the tibialis anterior

1. Four cases of true congenital vertical talus are described; in three of the four cases there were other major deformities of the skeleton. All were treated by open operation; the operation sacrificed part of the substance of the navicular bone, which was placed between the forepart of the calcaneus and the head of the talus. 2. The results five to ten years after operation show that stable reduction was maintained without any further treatment. They suggest, however, that more of the navicular bone could have been removed or that the whole navicular might be excised, at least in the more severe deformities. 3. Congenital vertical talus resembles club foot (equino-cavo-varus) in that difficulty in reduction and in maintenance of the reduction results from the tension in the medial pillar of the foot. Easing of the tension can result in recurrence of the dislocation or, alternatively, a reversal of the deformity

1. Eight cases of congenital vertical talus in infancy are reported. The principal differential diagnosis at this age is from talipes calcaneo-valgus. 2. The deformity is primarily a dorsal dislocation of the talo-navicular joint. 3. Closed reduction can be achieved if treatment begins at birth. Open reduction is indicated for the deformity uncorrected by the age of three months

1. Congenital vertical talus is described and the criteria for diagnosis are emphasised. The need for its distinction from other forms of convex pes valgus is stressed. 2. The operative technique of Stone for Lloyd-Roberts (1963) is detailed and the results of seven such operations are examined. 3. Departure from the technique in any respect has resulted in an unsatisfactory outcome, whereas stringent observation of the operative details has resulted in uniformly good results in four patients. 4. Certain aspects of diagnosis, differential diagnosis, etiology, pathology and surgical management are discussed, together with a review of some of the relevant literature

Background. Congenital vertical talus (CVT) is a rare deformity of the foot. It has been historically treated with extensive soft tissue releases with significant associated complications. Recently, reverse Ponseti-type casting followed by minimally invasive or percutaneous reduction and fixation has been described with excellent results in separate cohorts of either idiopathic or teratologic cases of CVT. There are currently no studies that compare the outcomes between the two types. Methods. We present a prospective cohort of 13 patients (21 feet) in which this technique has been used in both idiopathic and teratologic associated cases of CVT. Clinical, radiographic and parent-reported outcomes were obtained at a mean follow up of 36 months (range 8–57). Clinical and radiographic scoring was according to the system of Adelaar and parent-reported outcomes were assessed using the POSNA paediatric outcomes data collection instrument (PODCI). Results. Six patients (9 feet) had associated neuromuscular conditions or syndromes; seven patients (11 feet) were idiopathic. Initial correction was achieved in all patients with significant improvement in all radiographic parameters. The recurrence rate was 48%; there was no statistical significance between idiopathic and teratologic cases for rate of recurrence. Further treatment was required in the form of casting in 2 feet and open release in 6 feet. Adelaar scores were significantly lower in the recurrence group than in those with no recurrence. PODCI scores for global functioning at latest follow-up were a mean of 72 (range 18–98). Pain/comfort scoring was uniformly good with an average score of 99. Conclusions. The reverse Ponseti-type technique is effective in initial correction of both idiopathic and teratologic cases of CVT. Recurrence is a problem in both these groups, with higher rates than first reported in the original paper. However, these rates are less than those reported for open surgical releases. Level of evidence: II

After gaining experience from 1990 to 2003 using the Cincinnati incision in the surgical treatment of congenital clubfoot, we were able to extend its use to the early surgical treatment of congenital vertical talus (CVT). Eight of the 172 feet were affected by CVT; four were idiopathic, three were associated with arthrogriposis and one with cerebral palsy. The average age of the six children at the time of the operation was 13.5 months (range 6–27 months). We performed a posterior, medial and lateral release of the subtalar joint and of the talona-vicular joint. The reduction of the talus was performed using a K-wire placed through the posterolateral aspect of the talus in its longitudinal axis. After the calcaneus was reduced from its everted position, a second K-wire was placed through the calcaneus and into the talus. The medial talonavicular joint capsule was opened and the redundant capsule reconstructed. Peroneal tendon lengthening was performed in five cases. The radiological evaluation, according to Hamanishi, showed preoperatively a talo-first metatarsal angle of 94° (NV: 3.3 ± 6.4 SD) and a calcaneal-first metatarsal angle of 54° (NV: −9 ± 4.5 SD); postoperatively the values were 24° and 7°, respectively. There were no wound complications or avascular necrosis of the talus. With the Cincinnati incision we were able to visualise the talo-calcaneal and talo-navicular dislocation in all three spatial planes. It also allowed us to correct the deformity in all three mentioned planes and in a single-step procedure

We describe a successful modified operative procedure at an average 19 months follow-up in 3 patients with congenital dislocation of the patella and compare its merits to the other procedures already reported in the literature. Congenital dislocation of the patella may be associated with other congenital conditions or syndromes i.e. Down’s syndrome, congenital vertical talus and cerebral palsy. Numerous operative techniques have been described in the literature which may be divided into 3 basic groups. A modification of the Langenskiold & Ritsila procedure is described. The original procedure describes an extensive lateral release with detachment and medial transfer of the patellar tendon through a curved incision. The tendon is routed through a fold of synovium medially and fixed distally to bone with sutures through drill holes in the proximal tibia. We found at surgery this synovium was too fragile to hold the transferred tendon and the use of drill holes unnecessary. The main alterations include a limited and straight anterior skin incision, a fashioning of a ‘buckle’ of the transferred distal patellar tendon to a distally based flap which avoids drill holes in the growing bone. This modification of the Langenskiold procedure was used successfully in 3 cases, including a revision of a failed Goldthwaite- Roux procedure in a mentally handicapped child. The results at average 19 months follow-up are successful. The early results confirm that the patella remains located and tracks normally. The valgus and flexion deformities have significantly improved. This modification of the Langenskiold & Ritsila procedure requires less dissection than other operations, with no bony surgery and a cosmetic scar. The Langen-skiold & Ritsila procedure has been successful and we feel that this modification simplifies and improves on the original technique

We reviewed 19 patients (30 feet) with congenital vertical talus treated surgically between 1987 and 1999, 22 of them by the same surgeon. The etiological diagnosis was idiopathic in seven patients. Six patients had associated congenital abnormalities (four arthrogryposis, two digitotalar dysmorphism) and six had associated neurological abnormalities (three microcephalic, three spinal dysraphism). Only two patients had surgery after the age of 18 months. The mean age at surgery was 14.7 months (6 to 51). In 15 feet a two-stage procedure was performed. Lengthening of the extensor tendons, notably tibialis anterior, was followed six weeks later by posterior release. In 15 feet a one-stage procedure was done, with no lengthening of the extensors or transfer of tibialis anterior. The Kidner procedure was done in seven feet, but the tibialis posterior was never found to be subluxed and the procedure was abandoned. The calcaneocuboid joint was opened and pinned in eight feet. The peroneal tendons required lengthening in eight feet. At a mean follow-up of 5.8 years (2 to 13.5), results were excellent in 17 feet (normal forefoot and hind-foot). Results were good in seven feet (normal radiographs, normal hindfoot, but pronated forefoot). In four feet the result was fair (valgus hindfoot with a plantarflexion angle of the talus more than 35(). In one patient, the results in both feet were poor (uncorrected). All seven good results followed a two-stage procedure. We concluded that this was due to relative weakening of the lengthened tibialis anterior to the peroneus longus. Where necessary, plantarflexion of the talus should be corrected at operation, and this should be correlated with intra-operative fluoroscopy. Adequate reduction of the navicula inferomedially on the talar head obviates the need for tendon transfer

Aims

There is increasing evidence that flexible flatfoot (FF) can lead to symptoms and impairment in health-related quality of life. As such we undertook an observational study investigating the aetiology of this condition, to help inform management. The hypothesis was that as well as increased body mass index (BMI) and increased flexibility of the lower limb, an absent anterior subtalar articulation would be associated with a flatter foot posture.

In a prospective study over 11 years we assessed the relationship between neonatal deformities of the foot and the presence of ultrasonographic developmental dysplasia of the hip (DDH). Between 1 January 1996 and 31 December 2006, 614 infants with deformities of the foot were referred for clinical and ultrasonographic evaluation. There were 436 cases of postural talipes equinovarus deformity (TEV), 60 of fixed congenital talipes equinovarus (CTEV), 93 of congenital talipes calcaneovalgus (CTCV) and 25 of metatarsus adductus.

The overall risk of ultrasonographic dysplasia or instability was 1:27 in postural TEV, 1:8.6 in CTEV, 1:5.2 in CTCV and 1:25 in metatarsus adductus.

The risk of type-IV instability of the hip or irreducible dislocation was 1:436 (0.2%) in postural TEV, 1:15.4 (6.5%) in CTCV and 1:25 (4%) in metatarsus adductus. There were no cases of hip instability (type IV) or of irreducible dislocation in the CTEV group.

Routine screening for DDH in cases of postural TEV and CTEV is no longer advocated. The former is poorly defined, leading to the over-diagnosis of a possibly spurious condition. Ultrasonographic imaging and surveillance of hips in infants with CTCV and possibly those with metatarsus adductus should continue.

Rocker bottom deformity may occur during the conservative treatment of idiopathic congenital clubfoot. Between 1975 and 1996, we treated 715 patients (1120 clubfeet) conservatively. A total of 23 patients (36 feet; 3.2%) developed a rocker bottom deformity. It is these patients that we have studied. The pathoanatomy of the rocker bottom deformity is characterised by a plantar convexity appearing between three and six months of age with the hindfoot equinus position remaining constant. The convexity initially involves the medial column, radiologically identified by the talo-first metatarsal angle and secondly by the lateral column, revealed radiologically as the calcaneo-fifth metatarsal angle. The apex of the deformity is usually at the midtrasal with a dorsal calcaneocuboid subluxation. Ideal management of clubfoot deformity should avoid this complication, with adequate manipulation and splinting and early Achilles’ percutaneous tenotomy if plantar convexity occurs.

Adequate soft-tissue release provides satisfactory correction for rocker bottom deformity. However, this deformity requires more extensive and complex procedures than the standard surgical treatment of clubfoot. The need for lateral radiographs to ensure that the rocker bottom deformity is recognised early, is demonstrated.