VERTICAL TALUS
DEFINITON
– Rocker bottom foot vertical talus the foot has an appearance of ‘ rocker bottom’ deformity
– Complete oblitertion of longitudinal arch can be seen
– Sole of the foot is convex downwards.
ANATOMY
– Talus is the secondary largest in tarsal bones.
– Lies between tibia and calcaneum , gripped on sides by the 2 malleoli.
• Side determination
1) Rounded head : directed forwards
2) Trochlear articular surface of body : directed upwards .
Concave articular surface : directed downwards.
3) Body bears a larger triangular facet ( laterally ) and a comma shaped facet ( medially ).
• Anatomical position
– Talus is held horizontally
– head placed anteriorly
– Body posteriorly.
* HEAD
√Directed forwards and slightly medially and downwards
√ Anterior surface : oval and convex .
√ Inferior surface : marked by 3 articular areas.
(a) Posterior facet :
– largest, oval and convex .
– Articulates with middle facet on sustentaculum tali of calcaneum
( b) Anterolateral facet :
– Articulates with calcaneum ( anterior facet) , spring ligament ( medial facet ).
* NECK
– Lies between head and body
– The neck- body angle is 130 to 140 degrees ( infants ) and 150 degrees ( adults ).
– Medial part of plantar surface is marked by sulcus tali.
– Sulcus tali lies opposite to sulcus calcanei , the they together enclosing a space called sinus tarsi.
– In habitual squatters , a squatting facet is commanly found ( on upper and lateral part of neck ).
* BODY
– Cuboidal in shape
– It has 5 surfaces
(1) Superior surface
– Articulates with lower end of tibia and forms ankle joint
– This surface is called Trochlear surface
– Convex (backwards) and concave ( side-to-side ).
– Trochlear surface articulates with interior surface .
(2) Inferior surface
– Articulates with posterior facet of calcaneum and forms subtalar joint
(3) Medial surface
– Comma shaped articular surface articulates with medial malleolus of tibia
– It is non-articular below.
(4) Lateral surface
– It bears a triangular articular surface ( for lateral malleolus )
– It is concave from above downwards
– Apex forms lateral tubercle of talus.
(5) Posterior process
– Small and marked by an oblique groove
– It has medial and lateral tubercles .
• Attachments of Talus
– Talus is devoid of muscle attachment but numerous ligaments are attached to it .
1) Ligaments attached to neck :
✓ Dorsal suface : Capsular ligament of ankle joint and dorsal talonavicular ligament.
✓ Inferior surface : interosseous talocalcanean and cervical ligaments
✓ Lateral part of neck : The anterior talofibular ligament
2) The lower , nonarticular part of medial surface of body :
✓ Deep fibres of the deltoid or anterior tibiotalar ligament.
3)The groove on posterior process lodges the tendon of flexor hallucis longus.
• Medial tubercle :
✓ Superficial fibres of deltoid ligament ( above )
✓ medial talocalcanean ligament ( below )
✓ Posterior talofibular ligament ( attached to upper part of posterior process )
✓ Posterior talocalcanean ligament ( attached to plantar border ).
• Causes
√ Congential : Infantile vertical talus
√ Acquired : Obesity, postural and occupational
√ Paralytic : Flaccid flat foot
√ Spasmodic
√ Arthritic
√ Traumatic
• Clinical presentation
– At birth, plantar and medial surface of foot is rounded in appearance
– Talus is distorted medially and plantarward
– Calcaneus is in equinus position
– Foot is in Dorsiflexion
* In later stage
– Talus is in hour glass shape
– Longitudinal axis of talus is as same as tibia
– Rounded anterior part of calcaneum
• Radiographs
– AP view and lateral view
• Treatment
(1) Conservative
– In early stage , gentle manipulation and Immobilization is done in plaster casts reduces the deformity
(2) Surgery
– In children’s were conservative method fails
– Children’s between 1-4 years : Open reduction is done and realignment of talonavicular and subtalar joint.
– Children’s above 3 years : Open reduction and navicular excision
– Children’s between 4-8 years : Open reduction , soft tissue release and subtalar arthrodesis
– Children’s beyond 12 years : Triple arthrodesis
(3) PHYSIOTHERAPY MANAGEMENT
– Immobilization in POP cast and strong toe flexion is encouraged
– Following removal of POP : Mobilization of foot is done gradually
– Frequent cupping and toe curling
– Standing on outer border of foot along with cupping and toe curling
– Proper gait training with surgical boots
– Walking in bare foot is helpful in developing small muscles of foot.
