CVT and COT

Congenital Oblique Talus

  • Talonavicular Subluxation: The talus and navicular are misaligned.
  • Key Feature: This condition can be corrected by passive plantarflexion, which helps to differentiate it from Congenital Vertical Talus (CVT).

Congenital Vertical Talus (CVT)

Aetiology

  • Congenital Irreducible Dorsal Dislocation of the Navicular
  • Vertical Talus Orientation
  • Severe Soft Tissue Contractures
  • Occurs in 50% bilateral cases
  • 50% associated with other congenital issues: Conditions like arthrogryposis, neuromuscular diseases, and myelodysplasia.

Clinical Features

Feature Description
Disability Causes significant disability due to rigid foot structure.
Rigid Convex Sole The sole has a rounded, convex shape.
Valgus Hindfoot Outward angulation of the heel.
Rocker Bottom Foot The foot resembles a “Persian slipper” or rocker bottom.
Peg Leg Gait Stiff foot limits push-off, resulting in a peg leg gait.

Imaging

  • Lateral X-Ray in forced plantarflexion is diagnostic.
  • Key Findings:
    • Navicular is dorsally dislocated.
    • Talus is not parallel to the calcaneus.
    • Talo-Calcaneal Angle: Increased to >40° (normal: 0-20°).
    • Meary’s Angle: Increased to >20° (normal: 0-10°).

Management

  • Non-surgical management is ineffective.
  • Surgical Options:
    • Open Reduction of talus and extensive soft tissue release, though may fail.
    • Talectomy as a last resort.
    • Triple Fusion as an alternative.
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