CONGENITAL OBLIQUE TALUS

[CHERRY KOVOOR]

Dear Friends

1 yr old boy . deformity of both feet since standing. Valgus of the forefeet. Veiwed from side there is rockerbottom deformity and hind foot equinus Clinically mid foot break felt

 

x-rays show oblique talus. Stress plantar flexion x-rays of the feet show reduction of the forefoot on the talus [ navicular not ossified]

 

I feel it is an oblique talus deformity .

 

What is the suggested treatment- My plan is serial casting with reverse Ponset technique  and Tendo Achilles tenotomy if needed . the question is will this method be successful or should I go for open reduction first?

 

Attaching clinical pics and x-rays in 2 mails.

[Myles Clough]

I claim no expertise on this subject - but when has that stopped me from sounding off!?

It looks from the abstract of a podiatry article quoted below as if this is Congential Convex Pes Valgus (CCPV) rather than Oblique Talus. The distinction offered appears to be that the talonavicular joint dislocates in CCPV and not in Oblique Talus. Your case does seem to dislocate. I don't agree with the interpretation that the stress plantar flexion views show reduction; (IMO) the forefoot is still out of alignment with the hindfoot. Because they think that the primary problem is dislocation of the talonavicular joint with equinus of the hindfoot secondary, many authors prefer CCPV over Congenital Vertical Talus (CVT) as a name for the condition. However, there is quite a lot of literature on CVT if you need to do a PubMed search. My search used the search string "Foot Deformities, Congenital"[majr] (vertical talus) OR (convex pes valgus) and returned 87 papers

I wasn't able to find a full text copy of the first reference (below) but did get a pdf version of the second paper (from JBJS). It's too big to send as an attachment to a message to Orthopod. You can download it directly for free from the JBJS B site or from my public dropbox folder This paper says that the condition should be treated surgically as the dislocation is irreducible.

Has anyone treated this condition with Ilizarov technique?

Clin Podiatr Med Surg. 2000 Jul;17(3):419-42.

The oblique talus deformity. What is it, and what is its clinical significance in the scheme of pronatory deformities?

Harris EJ.

Department of Orthopaedics and Rehabilitation, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA.

Abstract

The advantage for maintaining oblique talus deformity as a diagnostic entity is obvious. It describes a deformity that is somewhere between the severe form of flexible pes planus and congenital convex pes valgus. It is important to recognize that the two subsets (oblique talus deformity with maintenance of the calcaneal inclination angle and oblique talus deformity with reversal of the calcaneal inclination) differ from congenital convex pes valgus by the absence of dislocation of the talonavicular joint. In many cases, the talonavicular joint is merely pushed to its maximum range, and does not even meet the definition of subluxation. Maintaining these distinctions prevents overdiagnosis of congenital convex pes valgus. Additionally, better evaluation of treatment for congenital convex pes valgus results because those cases with better prognosis and better response to nonsurgical intervention are not included in the data for the management of congenital convex pes valgus.

J Bone Joint Surg Br. 1999 Mar;81(2):250-4.

Congenital convex pes valgus.

Duncan RD, Fixsen JA.

Hospital for Sick Children NHS Trust, London, England.

Abstract

Congenital convex pes valgus (congenital vertical talus) is a rare condition. We reviewed ten feet in seven patients who had had surgical correction. All had been operated on by the senior author (JF) and the same surgical technique was used throughout, incorporating transfer of the tibialis anterior to the neck of the talus. The mean age at surgery was 31 months and the mean follow-up was nine years (6 to 14). All patients completed a questionnaire and had clinical, radiological and photographic evaluation performed by an independent examiner. None had required further surgery. All but one were satisfied with the result, and had no functional limitations. They all wore normal shoes. The mean ankle dorsiflexion was 17 degrees and plantar flexion 21 degrees. The mean arc of subtalar motion was 27 degrees. All radiological parameters measured were within the normal range, although irregularity of the talonavicular joint was common. No avascular necrosis of the body of the talus was seen. We conclude that the medium-term results of this procedure are very satisfactory.

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Myles Clough MD FRCSC

Orthopaedic Surgeon, Retired

Kamloops, BC

myles...@shaw.ca

Clinical Instructor, University of British Columbia

Associate Editor, Orthogate www.orthogate.org

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