Congenital vertical talus

Congenital vertical talus (CVT), also known as congenital convex pes valgus or rocker-bottom foot, is a rare congenital foot deformity present at birth in which the talus bone in the ankle is abnormally oriented in a vertical position. This causes the midfoot to be dorsally dislocated on the hindfoot, resulting in a rigid flatfoot with a characteristic 'rocker-bottom' appearance. The sole of the foot is convex, and the heel is in a fixed equinovalgus position while the forefoot is dorsiflexed and abducted. The condition can occur in one or both feet. Congenital vertical talus may present as an isolated deformity or in association with neuromuscular conditions, chromosomal abnormalities (such as trisomy 13, trisomy 18), or genetic syndromes including arthrogryposis and myelomeningocele. Isolated familial cases have been linked to mutations in the HOXD10 gene and genes in the Wnt signaling pathway. Affected infants typically have a rigid, convex sole that does not correct with manipulation, difficulty with shoe fitting, and abnormal gait once walking age is reached. Treatment has evolved significantly. The current standard of care for isolated CVT involves the reverse Ponseti method, a minimally invasive approach using serial casting to gradually correct the deformity, followed by a percutaneous Achilles tenotomy and sometimes a limited open reduction to stabilize the talonavicular joint. This technique has largely replaced more extensive surgical procedures. Early diagnosis and treatment, ideally beginning in infancy, lead to better functional outcomes. Without treatment, the deformity causes pain, callus formation on the sole, and significant difficulty with ambulation.

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