Review Question - QID 1220

The X-ray shows a plantar flexion lateral foot X-ray denoted by the plantar flexed position of the toes. This X-ray denotes a dorsally dislocated talonavicular joint consistent with congenital vertical talus resulting in a rocker bottom foot.

The etiology, inheritance, and incidence of this entity are unknown, though a family tendency has been reported. In congenital vertical talus, the hindfoot is fixed in an equinovalgus position and the forefoot is abducted and dorsiflexed in the midtarsal region. It is rigid and uncorrectable. The plantar surface of the foot has a rounded or convex appearance (“rocker-bottom feet”) and children can develop an awkward gait due to a painful rigid foot and calluses under the midfoot.

Lateral radiographs in a neutral and maximally plantarflexed position will confirm the diagnosis, showing that in the neutral position the calcaneus is in equinus, the forefoot is fixed in dorsiflexion, and there is a dorsal talonavicular dislocation. These findings do not correct in the maximally plantar flexed position. In the similar oblique talus, the dorsally positioned navicular will reduce in line with the talus.

Treatment for the condition should begin as early as possible. Most authors agree that surgical treatment is required for correction of the deformity. Casting before surgery is performed to stretch the soft tissues, improve final surgical correction and minimize surgical intervention. Historically, a single-stage procedure through an extensile incision was most commonly used. Dobbs et al describe the success with serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon providing excellent results.