Congenital Vertical Talus

28 year old female born with spina bifida, a rare birth defect that occurs when a baby’s spine does not form normally, and the spinal cord and the nerves that branch out of it may be damaged as a result. The patient presented with congenital vertical talus deformity of the Left foot, a condition that occurs in 10% of patients with spina bifida. It is characterised by a rigid rocker-bottom flatfoot with a malalignment of the hindfoot and midfoot. The hindfoot demonstrates equinovalgus, with the calcaneus everted on the talus. The talus is nearly vertical and the talonavicular joint is subluxated , with the navicular dorsally and laterally on the talus.

The patient underwent a talonavicular fusion in 2014 in order to reduce the chronic midfoot pain caused by the deformity and to improve foot function. She has limited toe-off control on the Left and places excessive force on the metatarsal heads to push off the forefoot what walking. There is fat pad atrophy on the Right forefoot due to overcompensation of the functionally limited Left foot. She has utilised various custom footwear and orthoses supports over the years with varying degrees of success.

The young woman attended a consultation with one of our Certified Pedorthists with a pair of ankle high custom boots and a custom made polypropylene ankle-foot orthosis (AFO) on the Left. The Left boot was wide and bulky in an effort to accommodate the AFO, and she expressed she still experienced chronic pain in the midfoot and ball of foot.