Congenital vertical talus, also known as rocker bottom foot, is a rare deformity of the foot which is diagnosed at birth. It is one of the causes of flatfoot in the newborn. One or both feet may be affected. It is not painful for the infant, but if left untreated, it can lead to serious disability and discomfort.
The talus is a small bone that sits between the heel bone and two bones of the lower leg. The tibia and fibula sit on top and around the sides of the talus to form the ankle joint. The talus is an important connector between the foot and leg, helping transfer weight across the ankle joint.
In congenital vertical talus, the talus has formed in the wrong position and the other foot bones to the front of the talus has shifted on top of it. Because of this, the front of the foot points up and may even rest against the front of the shin. The bottom of the foot is stiff and has no arch. Usually it curves out, hence the rocker bottom phrase.
Vertical talus is sometimes confused with newborn flatfoot, or even as clubfoot. The exact cause of this deformity is not known, but many cases of vertical talus are associated with a neuromuscular disease or other disorder, such as arthrogryposis, spina bifida, neurofibromatosis, and numerous syndromes. Your doctor may perform tests to see if your infant has any of these conditions.
Treatment for vertical talus centers on providing your child with a functional, stable, and pain-free foot. It is crucial to have this condition treated early, as your child will learn to walk on an abnormal foot and painful skin problems will develop.
Nonsurgical treatment includes a series of stretching and casting designed to increase the flexibility of the foot and even sometimes correct the deformity. Some doctors will also prescribe continued physical therapy exercises to improve flexibility.
Surgical treatment, however, is the most common treatment. When nonsurgical treatment has failed, your doctor will recommend surgery between the ages of nine and 12 months. Surgery is designed to correct the aspects that cause the deformity, like problems with the foot bones, ligaments, and tendons that support the bones. The surgeon will put the bones in the correct position and apply pins to keep them in place. Tendons and ligaments may have to be shortened. A cast will be placed on your child's foot, and they may have to spend the night in the hospital. After four to six weeks, the cast will be removed and a special brace or shoe may be worn to prevent the deformity from returning.
With treatment, your child's foot should make a full recovery, allowing them to run and play without pain and wear normal shoes. Your doctor may recommend repeat visits throughout the years to monitor the development of your child's foot.
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