An Algorithmic Approach to the Congenital Vertical Talus

Abstract

There is scant literature on the best approach to management of the congenital vertical talus with no new techniques described since the serial casting and minimally invasive surgical approach published by Dobbs et al. in 2006. There remain many questions such as what is the optimal surgical technique, what are the lower and upper age limits of various surgical procedures, what to do if casting or the minimally invasive technique do not reduce the talonavicular joint, and what are the optimal postoperative casting and bracing protocols? This manuscript summarizes an algorithmic approach to managing the CVT from casting to postoperative bracing. A stepwise algorithm is described that can be applied to a patient of any age with untreated, neglected, or recurrent deformity. Casting should always be attempted prior to surgery, and surgery should be performed with a deliberate à la carte approach to minimize complications.