Rocker bottom foot

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Rocker bottom foot (Congenital vertical talus)

Congenital vertical talus is a very stiff foot deformity present at birth. The foot has several unusual features: the heel sits in a plantar-flexed position making the heel bone (calcaneus) prominent, the sole is rounded because the head of the talus sticks upward, and the front part of the foot (forefoot and midfoot) is dorsiflexed and abducted on the hindfoot. The shape of the foot resembles the bottom of a rocking chair.

There are two types: idiopathic (isolated) and non-idiopathic, which can occur with other conditions such as arthrogryposis, genetic syndromes, or neuromuscular disorders. It can be seen with Edwards’ syndrome (trisomy 18), Patau syndrome (trisomy 13), Trisomy 9, or HOXD10 gene mutations.

Treatment options fall into two broad groups: conservative and surgical. The mainstay of treatment is serial manipulative casting, also called the reversed Ponseti technique. This involves gradual, step-by-step correction of the deformity, usually with weekly cast changes. If some deformity remains after casting, the surgeon may perform a minimally invasive operation at the talo-navicular joint to achieve full correction.

Surgery is generally considered if casting does not fully correct the problem. The classic, more extensive soft tissue release aims to reposition the talo-navicular joint, but results can be unpredictable. Several surgical methods exist.

Naviculectomy (removal of the navicular bone) is a form of midtarsal joint reconstruction. It may be used with limited soft tissue releases for remaining deformities, especially in resistant or complex cases (neglected, previously operated, or recurrent). Naviculectomy is less aggressive than extensive peri-talar releases and can be useful when a plantigrade foot is unlikely to be achieved by casting alone.

In all cases, long-term follow-up is important to watch for any recurrence of the deformity, regardless of the treatment used.