VERTICAL TALUS

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.

THANK YOU

BY PHYSIOFEEDS.

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