Vertical Talus
Discovering that your child has vertical talus can be overwhelming. Our goal is to offer guidance to help you and your child through their vertical talus journey and provide support along the way.
On this page you will find:
- What is Vertical Talus?
- Why Does it Happen?
- How is Vertical Talus Detected?
- Treatment of Vertical Talus
- How Will Vertical Talus Affect My Child?
- Sharing the News
- Support
- Resources
What is Vertical Talus?
Vertical talus is rare, occurring in only 1 in 10,000 children. The condition is present at birth (congenital) and so it can sometimes be called congenital vertical talus (CVT).
The talus is a bone in the foot, located between the heel bone (calcaneus) and the two long bones of the lower leg (tibia/fibular). The talus has an important function as it helps to transfer weight across the ankle joint. The talus usually sits at a 45 degrees angle but when vertical talus is present, the talus points straight down. The back of the foot is often affected with the heel bone lifting and the Achilles tendon tightening. The foot will point up and out, with the heel of the foot pointing outwards and raised, usually curving outward like the bottom of a rocker. For this reason, this condition is often called rocker-bottom foot.
Vertical talus occurs both in girls and boys and can affect one or both feet. It is a rigid deformity which means the foot cannot be moved out of this position.
Why Does it Happen?
The cause of vertical talus is not known.
Although it can occur on its own and at random, it is often part of a wider problem affecting the bones and muscles (neuromuscular condition) or a genetic condition. Because of this, your doctor may decide to do more tests to check for any linked conditions which are not obvious at the time of birth.
How is Vertical Talus Detected?
Cases are unlikely to be detected before birth, but may be identified soon after birth when newborn checks are made. As vertical talus is rare, it can sometimes be misdiagnosed with the more common foot condition calcaneo-valgus and so it is important that a baby with suspected vertical talus is seen by a paediatric orthopaedic specialist to be diagnosed accurately. Healthcare professionals typically look at a family’s medical history, symptoms, and physical examinations to make a diagnosis. X-rays are often used to confirm diagnosis.
In some cases, vertical talus may be diagnosed in older children when they are at a walking age or even older. Signs of vertical talus are usually present in the form of one or both feet appearing very flat when standing.
Treatment of Vertical Talus
Ideally, the foot should be treated before your child starts to walk, although timings for treatment may vary due to other considerations. Vertical talus will not improve with just stretching and casting but will need surgical intervention. This can be performed through either a non-invasive (closed) or invasive (open) approach depending on the severity of the condition.
A common form of treatment is the reverse Ponseti technique. This involves a series of casts to realign the bones in the mid part of the foot. The casting phase is followed by surgery on the foot. A pin, or pins, may be temporarily inserted to hold the bones in proper alignment; at the same time, a cut of the tendon (tenotomy), may be performed to release the tight Achilles tendon allowing the heel bone to sit in its correct position.
Steps have produced a downloadable guide – Preparing For Your Child’s Surgery to help parents and carers prepare themselves and their child for a hospital admission.
Following the surgery, the foot is placed in a cast for several weeks. The pin will be removed at the hospital when the cast comes off and then overnight bracing (boots and bar) and daytime orthotics are used.
The wearing of the pre-fitted brace or orthotic will usually be required so as to prevent the vertical talus from recurring. Very occasionally the foot will not fully correct with this technique and will require more extensive open surgery which can vary in nature depending on the severity.
When treatment will start is very much tailored to each individual and decided upon after thorough examination and discussion with the medical team. The type and timing of non-surgical/surgical procedures will depend on many factors. The ideal time for treatment is after six months but before the age of two.
Depending on the severity of the condition, a child may be placed in a cast for a number of weeks and spend up to two years in a brace. It’s also likely that your child will see a physio who will teach you daily exercises, such as stretches, to do with your child.
How Will Vertical Talus Affect My Child?
While vertical talus is not painful in very early childhood, if left untreated it can lead to pain and disability later in life. If a child learns to walk and the deformity is allowed to progress, calluses and painful skin problems may develop. It may become hard to find comfortable footwear and walking may be affected.
However, most children who are surgically treated for vertical talus have good outcomes; some children may need an orthotic to ensure proper foot alignment during critical growth and development periods; this could be an insole or an orthotic splint (an Ankle Foot Orthotic or AFO).
Webinar on Congenital Vertical Talus:
Sharing the News
When and how you tell close family, friends and other relatives about your child’s condition is a very personal decision which will be impacted by how and when the diagnosis occurred, the individual prognosis for your child and the potential treatments available.
There is no right or wrong way or time to share the news, however, being well informed about the condition and having the opportunity to connect with other parents who can understand what you are feeling will likely help.
Once you do share the news, your relatives and friends will probably want to know how they can support you and your child, so take advantage of the experiences being shared by other parents, to help you feel better equipped to answer such questions and get the support that is right for you.
Support
Steps is here to offer emotional and practical support.
The Steps closed Facebook Group is a friendly and safe way of discussing your worries, sharing tips and finding emotional support. Our Family Contact Service identifies someone else who has been through a similar situation and who’s happy to talk about their experiences, on a one-to-one basis, to offer support.
You can reach out to Steps with your questions, concerns and requests via email info@steps-charity.org.uk or leave a voicemail message on 01925 750271 and one of the team will be in touch.
All our vertical talus links and related resources can be found below
