Rocker bottom foot

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Congenital vertical talus
Other namesCongenital vertical talus
Specialty Medical genetics Orthopedics podiatry

Unlike the flexible flat foot that is commonly encountered in young children, congenital vertical talus is characterized by presence of a very rigid foot deformity. The foot deformity in congenital vertical talus consists of various components, namely a prominent calcaneus caused by the ankle equines or plantar flexion, a convex and rounded sole of the foot caused by prominence of the head of the talus, and a dorsiflexion and abduction of the forefoot and midfoot on the hindfoot. It gets its name from the foot's resemblance to the bottom of a rocking chair. [1] [2] There are two subcategories of congenital vertical talus namely idiopathic or isolated type and non-idiopathic type which may be seen in association with arthrogryposis multiplex congenital, genetic syndromes and other neuromuscular disorders. [1]

Contents

It can be associated with Edwards' syndrome (trisomy 18), Patau syndrome (trisomy 13), Trisomy 9 and mutation in the gene HOXD10. [3]

Treatment

The treatment of congenital vertical talus can be broadly classified into conservative and surgical. [1] [2] [4]

Serial casting

The mainstay of management of congenital vertical talus is serial manipulative casting also known as the reversed Ponseti technique. [1] This technique involves gradual step-wise correction of the deformity usually on a weekly basis. In the event there is residual deformity or incomplete correction at the end of the serial castings, the orthopedic surgeon may resort to a minimally invasive surgery at the talo-navicular joint to achieve full correction. The results of the serial manipulative casting technique or reversed Ponseti technique are satisfactory especially if started shortly after birth. [1]

Classic soft tissue release

The classic or extensive soft tissue release involves a peri-talar release of tight or contracted ligamentous and capsular structures with the intent of achieving a complete repositioning or reduction of the talo-navicular joint. In that regard, various surgical techniques have been described.[reference] The extensive soft tissue release may be indicated in cases where the conservative methods – serial manipulative casting technique – have failed to achieved full correction of the deformity. However, the results are guarded. [5] All patients need close long term follow-up to allow for early detection of deformity recurrence. This is irrespective of the treatment modality used to attain deformity correction.[ citation needed ]

Naviculectomy or simply navicular excision represents a form of mid-tarsal resection arthroplasty. It may be necessary to associate naviculectomy with limited soft tissue releases to address the remaining components of the deformity. [2] [6] [7] [8] [9] Naviculectomy has been practiced on ambulatory [2] [6] and non-ambulatory (non-walkers) patients. [7] Naviculectomy is usually reserved for children with resistant or complicated forms of congenital vertical talus such as neglected, previously operated and recurrent cases. Naviculectomy may be indicated in the above resistant case of congenital vertical talus on the condition that a plantigrade foot is considered unlikely by the conservative serial casting methods. And on the condition that extensive soft tissue release is not expected to yield a satisfactory clinical and functional result. [2] [6] Generally, naviculectomy is a more tissue-friendly procedure in contrast to the more aggressive classic and extensive peri-talar soft tissue releases. The clinical and radiologic results of naviculectomy are satisfactory on the short term, [2] [9] and long term [8] follow-up.

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Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not typically cause problems, but more severe cases can affect breathing and movement. Pain is usually present in adults, and can worsen with age. As the condition progresses, it may impact a person's life and hence, can also be considered a disability.

<span class="mw-page-title-main">Polydactyly</span> Physical anomaly involving extra fingers or toes

Polydactyly or polydactylism, also known as hyperdactyly, is an anomaly in humans and animals resulting in supernumerary fingers and/or toes. Polydactyly is the opposite of oligodactyly.

<span class="mw-page-title-main">Ankle</span> Region where the foot and the leg meet

The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular joint. The movements produced at this joint are dorsiflexion and plantarflexion of the foot. In common usage, the term ankle refers exclusively to the ankle region. In medical terminology, "ankle" can refer broadly to the region or specifically to the talocrural joint.

<span class="mw-page-title-main">Clubfoot</span> Bone development disease

Clubfoot is a congenital or acquired defect where one or both feet are rotated inward and downward. Congenital clubfoot is the most common congenital malformation of the foot with an incidence of 1 per 1000 births. In approximately 50% of cases, clubfoot affects both feet, but it can present unilaterally causing one leg or foot to be shorter than the other. Most of the time, it is not associated with other problems. Without appropriate treatment, the foot deformity will persist and lead to pain and impaired ability to walk, which can have a dramatic impact on the quality of life.

<span class="mw-page-title-main">Navicular bone</span> Small bone found in the feet of most mammals

The navicular bone is a small bone found in the feet of most mammals.

<span class="mw-page-title-main">Pes cavus</span> Medical condition

Pes cavus, also known as high arch, is a human foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed plantar flexion of the foot. A high arch is the opposite of a flat foot and is somewhat less common.

<span class="mw-page-title-main">Arthrogryposis</span> Medical condition

Arthrogryposis (AMC) describes congenital joint contracture in two or more areas of the body. It derives its name from Greek, literally meaning 'curving of joints'.

<span class="mw-page-title-main">Flat feet</span> Deformity in which the foot arches contact the ground

Flat feet, also called pes planus or fallen arches, is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. Sometimes children are born with flat feet (congenital). There is a functional relationship between the structure of the arch of the foot and the biomechanics of the lower leg. The arch provides an elastic, springy connection between the forefoot and the hind foot so that a majority of the forces incurred during weight bearing on the foot can be dissipated before the force reaches the long bones of the leg and thigh.

<span class="mw-page-title-main">Talus bone</span> One of the foot bones that forms the tarsus

The talus, talus bone, astragalus, or ankle bone is one of the group of foot bones known as the tarsus. The tarsus forms the lower part of the ankle joint. It transmits the entire weight of the body from the lower legs to the foot.

<span class="mw-page-title-main">Kyphoscoliosis</span> Medical condition

Kyphoscoliosis describes an abnormal curvature of the spine in both the coronal and sagittal planes. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of lungs, pulmonary hypertension, difficulty in performing day-to-day activities, psychological issues emanating from anxiety about acceptance among peers, especially in young patients. It can also be seen in syringomyelia, Friedreich's ataxia, spina bifida, kyphoscoliotic Ehlers–Danlos syndrome (kEDS), and Duchenne muscular dystrophy due to asymmetric weakening of the paraspinal muscles.

<span class="mw-page-title-main">Plantar calcaneonavicular ligament</span> Ligaments on the underside of the foot

The plantar calcaneonavicular ligament is a complex of three ligaments on the underside of the foot that connect the calcaneus with the navicular bone.

<span class="mw-page-title-main">Ignacio Ponseti</span>

Ignacio Ponseti was a Spanish-American physician, specializing in orthopedics. He was born on 3 June 1914 in Menorca, part of the Balearic Islands, Spain, Ponseti was the son of a watchmaker and spent his childhood helping repair watches. This skill was said to eventually contribute to his abilities as an orthopedist. He served three years as a medic during the Spanish Civil War treating orthopedic injuries of wounded soldiers. He left Spain shortly after the end of the war and became a faculty member and practicing physician at the University of Iowa, where he developed his ground-breaking, non-surgical treatment for the clubfoot defect - the Ponseti Method.

The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Ignacio V. Ponseti of the University of Iowa Hospitals and Clinics, US, in the 1950s, and was repopularized in 2000 by John Herzenberg in the US and Europe and in Africa by NHS surgeon Steve Mannion. It is a standard treatment for clubfoot.

<span class="mw-page-title-main">HOXD10</span> Protein-coding gene in humans

Homeobox D10, also known as HOXD10, is a protein which in humans is encoded by the HOXD10 gene.

<span class="mw-page-title-main">Trevor disease</span> Medical condition

Trevor disease, also known as dysplasia epiphysealis hemimelica and Trevor's disease, is a congenital bone developmental disorder. There is 1 case per million population. The condition is three times more common in males than in females.

<span class="mw-page-title-main">Accessory bone</span> Additional bone found in some people

An accessory bone or supernumerary bone is a bone that is not normally present in the body, but can be found as a variant in a significant number of people. It poses a risk of being misdiagnosed as bone fractures on radiography.

Children's feet are smaller than those of adults, not reaching full size until the ages of 13 in girls and 15 in boys. There are correspondingly small sizes of shoes for them. In poor populations and tropical countries, children commonly go barefoot.

<span class="mw-page-title-main">Constriction ring syndrome</span> Medical condition

Constriction ring syndrome (CRS) is a congenital disorder with unknown cause. Because of the unknown cause there are many different, and sometimes incorrect names. It is a malformation due to intrauterine bands or rings that give deep grooves in, most commonly, distal extremities like fingers and toes. In rare cases the constriction ring can form around other parts of the fetus and cause amputation or even intrauterine death. The anatomy proximal to the site of constriction is developmentally normal. CRS can be associated with other malformations with club foot being most common. The precise configuration of the bands, lymphedema, and character of the amputations are not predictable and vary with each individual patient. Also, more than one extremity is usually affected, and it is rare for only one ring to present as an isolated malformation with no other manifestation of this syndrome.

Haglund's syndrome is a group of signs and symptoms consisting of Haglund's deformity in combination with retrocalcaneal bursitis. It is often accompanied by Achilles tendinitis.

<span class="mw-page-title-main">Mueller–Weiss syndrome</span> Osteonecrotic disease of the foot

Mueller–Weiss syndrome, also known as Mueller–Weiss disease, is a rare idiopathic degenerative disease of the adult navicular bone characterized by progressive collapse and fragmentation, leading to mid- and hindfoot pain and deformity. It is most commonly seen in females, ages 40–60. Characteristic imaging shows lateral navicular collapse. This disease had been historically considered to be a form of adult onset osteonecrosis, with blood flow cutoff to the navicular.

References

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  2. 1 2 3 4 5 6 El-Sobky, TA; Samir, S; Mahmoud, S (24 July 2019). "Naviculectomy for two ambulatory children with intractable congenital vertical talus: redefining the indications of an old technique". Journal of Pediatric Orthopedics. Part B. 29 (4): 387–391. doi:10.1097/BPB.0000000000000663. PMC   7255489 . PMID   31356503.
  3. Gurnett CA, Keppel C, Bick J, Bowcock AM, Dobbs MB (September 2007). "Absence of HOXD10 mutations in idiopathic clubfoot and sporadic vertical talus". Clinical Orthopaedics and Related Research. 462: 27–31. doi:10.1097/BLO.0b013e31805d8649. PMID   17417092. S2CID   28900352.
  4. van Bosse, Harold Jacob Pieter (December 2015). "Syndromic Feet". Foot and Ankle Clinics. 20 (4): 619–644. doi:10.1016/j.fcl.2015.07.010. PMID   26589082.
  5. Yang, Justin S; Dobbs, Matthew B (August 2015). "Treatment of Congenital Vertical Talus: Comparison of Minimally Invasive and Extensive Soft-Tissue Release Procedures at Minimum Five-Year Follow-up". The Journal of Bone and Joint Surgery. American Volume. 97 (16): 1354–1365. doi:10.2106/JBJS.N.01002. PMID   26290087.
  6. 1 2 3 Mosca, Vincent (2014). Principles and management of pediatric foot and ankle deformities and malformations (first ed.). Philadelphia: Lippincott Williams & Wilkins.
  7. 1 2 Laudrin, P.; Wicart, P.; Seringe, R. (September 2007). "Résection de l'os naviculaire pour déformation sévère du médio-pied de l'enfant". Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur. 93 (5): 478–485. doi:10.1016/s0035-1040(07)90330-x. PMID   17878839.
  8. 1 2 Clark, MW; D'Ambrosia, RD; Ferguson, AB (September 1977). "Congenital vertical talus: treatment by open reduction and navicular excision". The Journal of Bone and Joint Surgery. American Volume. 59 (6): 816–24. doi:10.2106/00004623-197759060-00016. PMID   908706.
  9. 1 2 Robbins, H (October 1976). "Naviculectomy for congenital vertical talus". Bulletin of the Hospital for Joint Diseases. 37 (2): 77–97. PMID   1028515.