Congenital Vertical Talus -Procedures, Side effects, Recovery time, Costs and alternatives

A congenital vertical talus is a condition where a child after birth has foot deformity. It is a very rare condition where a child is born with such deformity. In some cases, there is deformity in only one foot but there have been cases where a child is having a deformity in both the feet. A talus bone present in the foot of every child. This rests between fibula of the lower leg, tibia and the heel bone.

The lower leg is connected to the foot by talus bone. Usually, the talus bone in the baby faces the toes of the baby, however, in the condition of vertical talus, the talus bone faces downwards. When the talus gets positioned in an incorrect direction the bones get formed on thetop of the talus rather than being formed in the anterior area of the talus. In congenital vertical talus, the anterior end of the bone is facing downwards towards the sole and the posterior end of the talus bone is bent upwards. This leads to a foot that has no arch and is stiff. It is commonly referred to as rocker bottom foot.

The occurrence is congenital vertical talus is idiopathic which means that the cause of occurrence is not known. It is however believed that congenital vertical talus can have a genetic origin. It is associated with chromosomal abnormality cases. A congenital vertical talus may also occur due to conditions like spine bifida, arthrogryposis, or any other neuromuscular disease. This condition is not painful for the kids despite their appearance.

Some toddlers are even able to walk despite the abnormality. It is essential that the condition of congenital vertical talus gets treated as early as possible before further spreading of deformity. The treatment for congenital vertical talus includes both non-surgical and surgical process. But the most important thing to note is that the optimal age for the treatment is six months after birth to 2 years of age.

• Non-surgical treatment: Over the years minimally invasive and less painful techniques have been developed which make the surgery required to treat congenital vertical talus unnecessary. This non-surgical treatment is used in combination with surgery. In the non-surgical procedure, the foot and ankle of the patient are stretched and held in a position by making use of casts. If some deformity remains after the application of cast then a minimally invasive surgery would be performed. The foot or feet of the concerned patient are put in a cast for a duration of 2 weeks. Then the old cast is replaced with a new cast and brace. The patient is required to wear the brace for approximately 23 hours a day for the next two months. Then time for wearing the brace is reduced to approximately 14 hours a day for the duration of the next two years. Some stretching exercises are also taught to the parents of the child so that it can be effectively done in their homes. Although, this procedure might appear to be a bit tedious the benefit of not undergoing surgery numerous times for the correction makes it a worthwhile process.
• Surgical Procedure: When the foot or the feet of the patient remain deformed even to a little extent after completing the treatment with non-surgical procedures a surgery may be recommended by the doctor. The type of surgery required is based on how much deformity is left in the foot or feet of the patient after the application of the cast. If the foot of the patient has seen no improvement even after non-surgical methods then an extensive surgery would be done. The surgery is done before the patient reaches the age of 1 year. the objective of the surgery is to position the bones within the foot to a correct position. The surgical procedure would require the tendons to be lengthened for bones can move. For holding the bones in their position pins are placed in the foot of the patient. These pins are removed 4-6 weeks after surgery and then to prevent the deformity for reoccurring a specially designed shoe may be used.

The eligibility of the patient for undergoing treatment for congenital vertical talus is decided on the basis of the symptoms exhibited by the patient and the diagnosis made by the doctor. The doctor observes the following conditions for deciding the eligibility:

• The talus bone of the patient is facing downwards rather than facing the toe.
• The bones which are required to be in front of the talus are sitting on the top of the talus bone.
• If the foot is deformed due to conditions like spinal fidia then it is possible that the deformity is of vertical talus.

Whether a patient is eligible for treatment or not is decided by the doctor after running some diagnostic tests. If the x-ray of the foot of the patient does not show talus bone pointing downwards then the patient is not eligible for treatment. A patient who is suffering from any other deformity of the foot and is misdiagnosed with vertical talus is not eligible for treatment however, it rarely happens.