What’s the Diagnosis – Case 143
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What’s the Diagnosis – Case 143
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What’s the Diagnosis – Case 143
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Findings Initial radiographs demonstrate markedly disparate architecture of the talus with the right talus being vertically oriented and without change in orientation on the maximum plantar flexion view. The heel is in equinus. The alignment becomes markedly improved with treatment and the patient underwent pinning as shown via the fluoroscopic images. Later images show a near anatomic alignment of the right talus on the neutral lateral and maximum plantar flexion views.
What’s the Diagnosis – Case 143
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What’s the Diagnosis – Case 143
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Diagnosis: Congenital Vertical Talus A rare entity and one of the two causes of rigid flat foot ( the other being coalition). This represents a dorsal dislocation of the navicular on the talus. The calcaneus has abnormal plantar flexion or equinus deformity. As this is a fixed deformity it does not change on maximum plantar flexion views. This confirms the diagnosis and helps differentiate from a less severe pathology of an oblique talus which does show a reduced architecture on the maximum plantar flexion views. Unfortunately, the navicular does not ossify until 3 years of age so a surrogate has to be utilized to indicate orthotopic alignment of the talonavicular joint. In the normal situation a line along the axis of the talus in the lateral view should fall dorsal to the cuboid (which can be seen at birth) in neutral or maximum plantar flexion. In the case of congenital vertical talus, the axis of the talus falls plantar to the cuboid in both the neutral and maximum plantar flexion views.
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What’s the Diagnosis – Case 143
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Discussion Patient treatment as in this case is serial casting ( the treatment described in slide 4) with subsequent talonavicular joint pinning and Achilles tenotomy. The pinning is what is shown on the spot fluoroscopic images and the patient did undergo an Achilles tenotomy. The last plantar flexion radiograph shows the marked reconstitution of expected alignment with the axis of the talus falling dorsal to the cuboid.
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What’s the Diagnosis – Case 143
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References Congenital Vertical Talus. Etiology and Management. Miller, Mark MD; Dobbs, Matthew B. MD. JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 2015 - Volume 23 - Issue 10 - p 604-611
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