Congenital Vertical Talus

Congenital vertical talus is a rare (1 in 150,000 births) foot condition that is present at birth. It causes the foot to have a rigid “rocker-bottom” shape, where the arch is curved downward instead of upward. This occurs because some of the bones in the foot are not lined up correctly. Congenital vertical talus can affect one or both feet and does not improve on its own. With early diagnosis and proper treatment, the condition can typically be corrected.

What Causes Congenital Vertical Talus in Children?

Congenital vertical talus occurs when the bones of the foot do not form or align normally during pregnancy. The exact cause is not always known, but it may be associated with:

• Genetic or chromosomal conditions
• Neuromuscular disorders
• Differences in muscle or tendon balance
• Family history of foot or limb conditions

In some children, vertical talus occurs on its own. In others, it may be part of a broader medical condition.

What Are the Symptoms?

Signs of congenital vertical talus are usually noticeable at birth and may include:

• A stiff, flat-looking foot with a curved sole (“rocker-bottom” appearance)
• The front of the foot points upward
• Difficulty placing the foot flat on the ground
• Tightness in the heel cord (Achilles tendon)

One or both feet may be affected. Unlike flexible flat feet, congenital vertical talus is rigid and cannot be easily corrected by gently moving the foot.

When Should My Child See a Specialist?

Your child should be evaluated by a pediatric orthopedic specialist as soon as congenital vertical talus is suspected or diagnosed. Early treatment leads to better outcomes and can often reduce the need for more complex surgery later.

How Is Congenital Vertical Talus Diagnosed?

Diagnosis starts with a physical exam of your child’s foot. Imaging studies can help determine the most effective treatment plan. Imaging may include:

• X-rays to confirm abnormal bone alignment
• Special positioning X-rays to assess flexibility

Additional tests may be necessary if an underlying condition is suspected.

How Is Congenital Vertical Talus Treated?

Treatment almost always begins early in infancy. The approach depends on:

• Your child’s age
• Severity of the foot deformity
• Whether other conditions are present

Treatment goals focus on:

• Correcting foot alignment
• Creating a stable, flexible foot
• Allowing normal standing and walking
• Preventing pain and future problems

Nonsurgical Options

Early treatment typically begins with a series of gentle foot manipulations and casts to gradually align the foot in a more natural position. This is similar to treatment used for clubfoot and may include:

• Weekly casting to stretch and reposition the foot
• Bracing after casting to maintain correction

Casting alone typically does not fully correct vertical talus, but it helps prepare the foot for less invasive surgery.

Surgical Options

Almost all children with congenital vertical talus need a surgical procedure to fully correct the bone alignment.Surgery typically involves:

• Repositioning the bones of the foot
• Releasing tight tendons
• Stabilizing the joints so the foot stays in proper alignment

Surgery is usually done in early childhood and has a high success rate.

What Are the Risks of Surgery?

As with any surgery, risks may include:

• Infection
• Stiffness
• Incomplete correction
• Need for additional procedures as your child grows

Your child’s surgeon will review all risks and benefits in detail.

What Does Recovery From Treatment Involve?

After surgery, your child will likely:

• Wear a cast for several weeks
• Transition to braces or special shoes
• Begin gentle physical therapy as recommended

Parents play an important role in helping children wear braces as directed to maintain correction.

How Long Does Recovery Take?

Initial healing usually takes 6–8 weeks. Bracing may be required for several months or longer to hold the foot in the correct position. Most children are able to walk and run normally as they grow.

What Is the Outlook for My Child?

With early treatment, the outlook for congenital vertical talus is very good. Most children develop a functional, pain-free foot and can participate in regular activities without limitation.