The clinical presentation and radiographic findings are consistent with congenital oblique talus (COT), not congenital vertical talus (CVT). The plantarflexion lateral radiograph is key to differentiating between these two conditions. In congenital oblique talus, the talonavicular joint will reduce and the talus will align with the first metatarsal on plantarflexion radiographs. However, the talus will not reduce in CVT, and with plantar flexion the long axis of the first metatarsal remains dorsal to the long axis of the talus. This is shown in Illustration A, which demonstrates plantarflexion radiographs of a congenital oblique talus (A) and congenital vertical talus (B). The distinction is important as congenital vertical talus is a true dislocation of the talonavicular joint which requires casting followed by surgery.
Mazzaocca et al retrospectively evaluated 33 feet with congenital vertical talus who were treated surgical release through either a traditional posterior approach or a single stage dorsal approach. The feet treated with the dorsal approach had shorter surgical times, better clinical outcomes, fewer complications (AVN was significant in posterior approach), and fewer revisions.
Kodros et al reviewed 55 patients treated with a single stage Cincinnati incision (a transverse posterior approach at the level of the tibiotalar joint). There were no cases of AVN. Ten feet required a secondary surgery. At final clinical and radiographic follow-up 75% were stratified as good results and 25% were fair.
Mazzaocca AD, Thomson JD, Deluca PA. Comparison of the posterior approach versus the dorsal approach in the treatment of congenital vertical talus. J Pediatr Orthop 2001;21:212-217.
PMID:11242252 (Link to Abstract)
Kodros SA, Dias LS: Single-stage surgical correction of congenital vertical talus. J Pediatr Orthop 1999;19:42-48.
PMID:9890285 (Link to Abstract)
Vacarro AR 9ed): Orthopaedic Knowledge Update 8. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2005, pp 757-765.