Q 3 A ) EXPLAIN IN DETAIL THE RADIOLOGICAL FEATURES OF CONGENITAL VERTICAL TALUS ?
B ) EXPLAIN IN DETAIL THE CLINICAL SIGNS AND SYMPTOMS OF A RIGID PES PLANUS DEFORMITY ?
A 3 DEFINITION
1 rocker bottom foot (also known as a congenital vertical talus) is a congenital anomaly of the foot.
2 It is characterised by a prominent calcaneus/heel and a convex rounded sole.
3 The presence of a rocker bottom foot in an antenatal ultrasound scan is sometimes classified as a soft sign for aneuploidic anomalies
4 a person is sitting or standing on their toes and they have an arch that disappears when they stand with the entire foot on the ground they have a flexible flatfoot.
5 If there is no arch, whether sitting or standing, they have a “rigid” or “true” flatfoot.
PATHOLOGY
1 It results from a dorsal and lateral dislocation of the talonavicular joint.
2 Is also associated with syndromes such as -
A ) Aneuploidic syndrome -
1 Trisomy 13
2 Trisomy 18
3 18 q deletion syndrome
B ) Non Aneuploidic Non syndromic
1 Spina bifida
2 Arthrogryposis
RADIOLOGIC FEATURES
1 Fixed Equinus - plantarflexion of calcaneus
2 vertical talus - plantarflexion of the talus ( increased talo calcaneal angle )
3 Irreducible dorsal subluxation or dislocation of navicular
4 Forefoot valgus - divergence of bases of the metatarsal heads on AP and superimposition of metatarsal bones on the lateral view
5 Long axis of the talus passes plantar to metatarsal axis on lateral view and medial to 1st metatarsal on AP view
SIGNS
1 TOO MANY TOES SIGN - Three lateral toes are visible on symptomatic left foot, compared with only two toes on the right foot
2 unable to rise up on toes because of inability to invert hindfoot.
3 Dorsiflexion contracture - only neutral
4 Fixed Varus of transverse talar joint
5 Fixed forefoot varus - is characterized by elevation of medial side of forefoot, even after heel is placed in neutral position.
SYMPTOMS
1 Visible pes planus deformity
2 Inability or pain upon attempts to perform a single-leg heel rise
3 Pain along the course of the posterior tibial tendon (PTT)
4 Difficulty in walking
5 Pain and swelling in the medial ankle and midfoot during weightbearing.
6 Loss of pushoff strength during gait occurs, and a limp may develop