paediatric
Congenital Vertical Talus
advanced
6 min
28 marks
6 questions
Clinical Scenario
A newborn girl is noted to have rigid bilateral foot deformities at birth. The feet appear to have a "rocker-bottom" shape with a prominent talar head palpable on the medial plantar surface. The forefoot is dorsiflexed and abducted. The hindfoot is in rigid equinus. Passive plantar flexion of the forefoot does not correct the deformity. The infant has generalized hypotonia and a sacral dimple. Family history is unremarkable.
Lateral weight-bearing radiograph of an infant foot demonstrating congenital vertical talus. The talus is vertically oriented with the talonavicular joint irreducibly dislocated dorsally. The navicular articulates with the dorsal neck of the talus. The calcaneus is in equinus. This creates the characteristic 'rocker-bottom' or 'Persian slipper' deformity. A forced plantar flexion view would show persistent malalignment (distinguishing from oblique talus).
Source: Congenital vertical talus: treatment by reverse ponseti technique • Bhaskar A • PMC2739479 • CC-BY
Questions
Question 1 (4 marks)
Describe the clinical and radiographic features of congenital vertical talus.
Question 2 (5 marks)
How do you differentiate CVT from oblique talus?
Question 3 (6 marks)
Describe the etiology and associated conditions.
Question 4 (5 marks)
What is the treatment algorithm including the reverse Ponseti technique?
Question 5 (4 marks)
What are the surgical options and outcomes?
Question 6 (4 marks)
How does CVT differ from clubfoot?
Exam Day Cheat Sheet
Must Mention
- •Rocker-bottom / Persian slipper appearance
- •Talonavicular dorsal dislocation (key pathology)
- •Forced plantar flexion view differentiates from oblique talus
- •50% bilateral, 50% syndromic
- •Reverse Ponseti (stretch TN first, then equinus)
- •Associated with myelomeningocele, arthrogryposis, trisomies
Common Pitfalls
- •Confusing with clubfoot
- •Missing forced PF view
- •Wrong casting sequence
- •Missing syndromic workup
- •Not knowing TN pathology
- •Confusing with oblique talus