Congenital vertical talus
Congenital vertical talus is a rigid foot deformity present at birth in which the sole has a convex, 'rocker-bottom' shape. Unlike flexible flatfoot, it does not correct itself and needs specialist treatment from the first months of life.
- Typical age
- From birth
- Also known as
- Rocker-bottom foot · Congenital convex pes valgus · Talus verticalis
What it is
Congenital vertical talus (CVT) is a rare foot deformity present from birth. It happens because some bones and joints of the foot are not in their usual position.
The main problem is that one of the foot bones, the talus, sits abnormally in relation to other bones, especially the navicular. This makes the midfoot rigid and gives the sole a convex position, similar to the shape of a rocking chair.
In many cases the exact cause is unknown. CVT develops during pregnancy and is not caused by the baby’s position or by anything the parents did.
It is sometimes associated with other congenital abnormalities or with neurological or genetic conditions. For this reason, the specialist will assess whether further tests are needed.
It is important for parents to know that it is not their fault and that there are treatments to correct the deformity.
Signs parents may notice
Parents may notice some of the following signs:
- Convex sole: the middle of the foot bulges downwards, like a rocking chair.
- Rigid foot: the foot cannot easily be placed in a normal position with gentle movements.
- Front of the foot raised: the forefoot points upwards and outwards.
- Heel in an abnormal position: it may point downwards and outwards.
- Difficulty placing the foot properly: especially when the child starts to stand or walk.
The deformity can affect one foot or both.
In the first months of life the child may not show obvious signs of pain. However, once they start standing and walking, the abnormal weight-bearing can make walking difficult and lead to pressure areas, calluses, discomfort and problems with shoes.
When to see a specialist
When you notice that the shape of the foot is not right and that the baby has difficulty moving it.
How it is diagnosed
The diagnosis is made by examining the baby and with imaging tests.
- Clinical examination: the paediatric orthopaedic surgeon examines the shape of the foot, its mobility and the position of the joints.
- X-rays: these show the alignment of the bones. In some cases they are taken with the foot in different positions to confirm that the deformity is rigid.
- Other tests: these may be requested if associated abnormalities are suspected.
It is important to distinguish CVT from other foot deformities, especially flexible flatfoot, because the treatment is different.
Treatment
Today, treatment combines gradual correction with serial casts and limited surgical procedures when needed. This approach aims to avoid, whenever possible, the extensive surgical releases that were historically used to correct this deformity.
Non-surgical treatment: reverse Ponseti method
The reverse Ponseti method is a gradual correction technique based on the principles of the Ponseti method used for congenital clubfoot.
In vertical talus, the manoeuvres are performed in the opposite direction to those used in clubfoot, with the aim of gradually reducing the talonavicular dislocation and improving the alignment of the forefoot relative to the hindfoot.
Treatment includes:
- Gentle, specific manipulations of the foot.
- Serial casts, usually changed every week.
- Gradual correction of the position of the forefoot and hindfoot.
- Clinical and X-ray monitoring of progress.
The number of casts depends on the initial stiffness, the severity of the deformity and the individual response.
This technique requires specific experience, as inappropriate manipulation or casting can make correction harder or allow deformities to persist.
Surgical treatment
Minimally invasive surgery
After the casting phase, many patients need a limited operation to complete and stabilise the correction.
Depending on the anatomy and how reducible the deformity is, it may include:
- Reduction of the talonavicular joint: the navicular is repositioned relative to the talus to restore the alignment of the midfoot.
- Temporary fixation with a Kirschner wire: this holds the joint in place while the tissues heal.
- Percutaneous Achilles tendon lengthening: performed when tightness persists and prevents correction of hindfoot equinus.
- Limited additional procedures: in selected cases, these may be needed to correct residual tightness of the tendons or joint capsule.
The exact technique depends on the child’s age, the severity of the deformity and the result achieved with casting.
After surgery, the correction is maintained with immobilisation, followed by an individual plan of braces, exercises and follow-up.
The aim is to achieve a stable correction with as little damage as possible to the joints and soft tissues.
When is more extensive surgery needed?
Although gradual correction and limited surgery have reduced the need for extensive releases in many patients, not all feet respond in the same way.
More extensive reconstructive treatment may be needed when there is:
- A rigid deformity that cannot be adequately reduced.
- A persistent talonavicular dislocation.
- Significant residual deformity after initial treatment.
- A recurrence that does not respond to further non-surgical measures.
- A complex deformity associated with neuromuscular or syndromic conditions.
In these cases, surgery must be carefully planned for each child to correct the deformity, preserve joint function and minimise the risk of stiffness or new problems during growth.
Outlook and recovery
Early treatment significantly improves the alignment of the foot and makes functional weight-bearing on the sole easier to achieve.
Techniques based on serial casting and limited surgery have shown good clinical and X-ray results, although the outlook depends on each patient’s characteristics and on long-term follow-up.
The aims of treatment are to:
- Achieve a plantigrade foot that rests properly on the sole.
- Correct the talonavicular dislocation.
- Improve the alignment of the hindfoot and forefoot.
- Support a stable, functional gait.
- Reduce pain and problems with shoes.
- Avoid extensive surgery as far as possible.
- Reduce the risk of residual deformity and recurrence.
In patients with neuromuscular conditions or associated syndromes, results may be less predictable and the risk of recurrence may be higher. Follow-up must therefore be adapted to individual needs.
Can the deformity come back?
Yes. Congenital vertical talus can recur after the initial correction, especially when factors that favour the deformity persist or there is an associated neuromuscular condition.
At check-ups, the position of the foot, ankle mobility, stability of the talonavicular joint and weight-bearing are assessed.
A persistently convex foot, loss of correction or new functional difficulties should prompt a new specialist assessment.
Treatment of a recurrence depends on age, foot flexibility and the abnormalities present. It may include further manipulation and casts, braces or additional surgery.
Follow-up during growth
The initial correction is not the end of treatment. Follow-up is essential to check that the foot keeps good alignment and that function develops well.
Check-ups allow early detection of recurrence, assessment of musculoskeletal development and adaptation of treatment to each stage of growth.
How often the child is seen is decided individually, taking into account the initial severity, the technique used, any associated conditions and how things progress.
Frequently asked questions
Is congenital vertical talus the same as flatfoot?
No. Flexible flatfoot is common in childhood and usually partly corrects when the child stands on tiptoe or takes weight off the foot. Congenital vertical talus is a rigid structural deformity, characterised by an abnormality of the talonavicular joint and a convex sole. It needs specialist assessment and treatment.
Is it the same as clubfoot?
No. Although both are congenital foot deformities, their orientation and anatomical abnormality are different. Clubfoot combines cavus, adductus, varus and equinus. In vertical talus the foot has a convex deformity, with a valgus hindfoot and dorsal dislocation of the talonavicular joint. For this reason, the correction manoeuvres and the casting sequence are different.
Can it be treated without surgery?
Serial casts can progressively correct a large part of the deformity. However, many children need limited surgery to complete the reduction and stabilise the talonavicular joint, and to correct any residual equinus.
When should treatment start?
A specialist assessment is recommended as soon as possible after birth. Early treatment allows gradual correction to begin while the tissues are more flexible and makes it easier to plan any procedures needed.
Will my child be able to walk normally?
The aim is a plantigrade, functional foot that allows a stable gait to develop. The outlook depends on how severe the deformity is, whether there are associated conditions and how the foot responds to treatment.
Will more procedures be needed during growth?
Not all children need further procedures. However, some may develop residual deformity or recurrence that needs additional treatment. Regular check-ups make it possible to identify these problems and act early.
This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.