Congenital paralytic vertical talus. An anatomical study

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Developmental Biology

Background:

• Congenital vertical talus is a complex foot deformity.
• It is often associated with neuromuscular conditions like myelomeningocele.
• Understanding its etiology is crucial for effective treatment.

Observation:

• Dissections compared an infant with paralytic congenital vertical talus to a normal foot.
• Key differences included absent plantar intrinsic muscles and dorsal talonavicular dislocation.
• The talonavicular joint is identified as the foot's least stable mid-tarsal joint.

Findings:

• A proposed mechanism involves intrinsic muscle failure against anterior crural muscle dorsiflexion.
• This imbalance disrupts the talonavicular joint, leading to dorsal dislocation.
• Plantar flexion forces then create equinus, resulting in the vertical talus.
• Absence of plantar intrinsic muscles is a primary pathological finding.

Implications:

• Treatment should address talonavicular dislocation and hindfoot equinus.
• Restoration of plantar flexion strength through muscle substitution is necessary.
• Early intervention can improve outcomes for congenital vertical talus.