congenital vertical talus
Introduction
Introduction to congenital vertical talus Congenital vertical talus (congenital verticaltalus) is a rare congenital malformation, also known as deformity from the joint dislocation of the joint, congenital convex valgus foot, is a type of congenital flat foot, due to primary dislocation from the joint The scaphoid forms a joint with the talus back, so that the talus is in a vertical position. basic knowledge The proportion of illness: 0.003% Susceptible people: young children Mode of infection: non-infectious Complications: neurofibroma
Cause
Congenital vertical talus
First, the cause
It is generally believed that this malformation has been formed within the first three months of the embryo. There are two kinds of clinically arc-shaped and accompanying hairstyles. The latter are mostly spinal meningocele, multiple joint contracture, neurofibromatosis, and trisomy. One of the congenital diseases such as 13 to 15, 18 diseases, the cause of the vertical vertical talus is still unclear. It is suggested that the development of the foot embryo is blocked. Bitsila uses the young rabbit to do the experiment and cuts the long extensor digitorum. The tibialis anterior and transverse ligaments of the lower leg and the shortening of the gastrocnemius muscles resulted in the successful establishment of an animal model of vertical talus. Therefore, he proposed that primary soft tissue lesions are the main cause of the deformity, and some scholars have found that some The incidence of family and twins is significantly higher than that of the general population and is thought to be related to genetic factors.
Second, pathological changes
Pathological changes can be divided into bony deformities and soft tissue lesions. Bony deformities mainly form joints between the scaphoid and the dorsal aspect of the talus neck. The talus is locked in a vertical state, and the talus is flat or oval above the talus. Shortened, the dorsal side forms the articular surface, the proximal scaphoid joint is inclined to the temporal side, the calcaneus is displaced to the posterior lateral side, the anterior calcaneus is deflected to the lateral side and flexed to the temporal side, and the sacral dysplasia is lost. Supporting the talus, the lateral column is concave, and the medial column is relatively long.
Soft tissue also has obvious changes. The sacral ligament, which is the main factor affecting the reduction, is the main factor affecting the reduction. The lateral ligament contracture causes foot abduction, and the talus ligament and the Achilles tendon ligament collapse, hindering the posterior lateral aspect of the calcaneus. The displacement is reversed, and the sacral ligament with the scapula is elongated from the scapular side and the medial joint capsule. The tibialis anterior muscle, the toe length, the long extensor muscle, the tibialis brevis and the calf triceps are increased due to contracture. The longus muscle of the humerus and the tendon of the posterior tibial muscle move to the front of the ankle and play the role of the extensor muscle.
Third, the pathogenesis
Dislocation of the scaphoid joint may be formed in the uterus within 3 months of pregnancy, and the adjacent subtalar joint, interphalangeal joint and ankle joint subluxation are secondary, and the disease may be single or multiple systemic. A part of the deformity.
The scaphoid bone forms a joint with the dorsal aspect of the talus neck, which makes the talus vertical. The talus is deformed, the talus neck is shortened, and the talus is displaced to the posterolateral side. It is drooping. The talus is convex on the sole of the foot, and other interphalangeal joints are also present. Corresponding changes, the anterior bundle of the triangular ligament, the dorsal lateral ligament, the patellofemoral ligament, the heel ligament and the Achilles tendon ligament have different degrees of contracture, and the posterior joint capsule of the ankle joint and the subtalar joint are shortened. The ligament is stretched and slackened, and the calf muscles (temporal anterior muscle, long extensor muscle, long extensor digitorum, triceps, etc.) are contracted; the posterior tibial muscles and the long bones of the humerus are displaced forward and become Dorsal flexor.
Prevention
Congenital vertical talus prevention
The disease is a congenital disease, there is no effective preventive measures, early diagnosis and early treatment is the key to the prevention and treatment of this disease, and some scholars believe that if the child is older than 5 years old, if the release is still released, it can increase the ischemic necrosis of the talus. The probability of complications, so early diagnosis and treatment is extremely important, in addition to avoid rough detachment of the talus during surgery, so strict surgical indications to avoid blind peeling during surgery is an important measure to reduce ischemic necrosis of the talus.
Complication
Congenital vertical talus complications Complications
The age at which the child begins to walk is not delayed, but the gait is awkward. When standing, the forefoot is obviously abducted. The talus and calcaneus are loaded at the position of the valgus, but the back of the calcaneus cannot touch the ground.
The disease mainly produces some postoperative complications, including: scaphoid subluxation, postoperative deformity recurrence, joint stiffness, scaphoid necrosis, etc., and the most important complication is ischemic necrosis of the scaphoid, some scholars It is believed that the release of the child after the age of more than 5 years old is one of the causes of avascular necrosis of the talus. In addition, the detachment of the talus should be avoided in the operation. The trophoblastic artery of the talus is mainly in the talus neck, so the operation is strictly controlled. Indications to avoid blind peeling during surgery are important measures to reduce ischemic necrosis of the talus.
Symptom
Congenital vertical talus symptoms Common symptoms Pain in the back of the knee, ... joint stiffness gait instability fatigue foot bulge
The patient often showed the disappearance of the arch or the protrusion of the sole of the foot. The medial and temporal sides of the foot were prominent because of the talar head. The anterior part of the foot had dorsal extension and abduction deformity, the dorsal muscle of the foot, the ligament of the scapula and the boat The ligaments often have tension, contracture and affect the plantar flexion and varus in the anterior part of the foot; the calcaneus valgus deformity causes the posterior muscles, tendons, and ligaments to shorten, due to stiffness of the ankle joint, limited mobility, and severe deformity of the foot. When the patient stands or walks, the heel cannot reach the ground, the gait is unstable, the walking is slow, and the foot is prone to fatigue and pain.
Examine
Congenital vertical talus examination
There is no relevant laboratory examination. The main examination for this disease is X-ray examination:
X-ray examination shows that the talus is vertical in the lateral position, almost parallel to the longitudinal axis of the humerus, the talus is in a position of plantar flexion, and the forefoot has a significant back extension in the middle ankle joint. The ossification center has not appeared before the age of 3 years ago. The first wedge bone central axis is used to estimate the position of the scaphoid. If the line is extended backward on the dorsal side of the talus, it indicates that the scaphoid is dislocated to the dorsal side. On the side panel with strong back extension, the talus of the normal child's foot. The central axis passes through the lower part of the humerus, the central axis of the calcaneus passes through the upper part of the humerus, and the central axis of the talus of the congenital vertical talus moves to the posterior and posterior aspect of the tibia, sometimes in front of the calcaneus, and the central axis of the calcaneus When moving to the temporal side of the humerus, the visible angle of the patella was significantly increased (normal value was 20° to 40°). When the scaphoid was ossified, it was shown to be displaced to the dorsal side of the talar neck.
Diagnosis
Diagnosis of congenital vertical talus
diagnosis
Early treatment of this disease is expected to correct deformity, so early diagnosis is more important for prognosis. Congenital vertical talus is not very difficult to diagnose based on medical history, clinical manifestations and X-ray examination.
Some scholars have proposed three-point X-ray signs as a reference for clinical diagnosis:
1 The angle of the axis is too large, and the difference from the normal group is significant;
2 does not extend from the axis;
3 Displacement at the intersection with the axis of the axis.
Differential diagnosis
1 congenital toe valgus foot: no above characteristics, the foot is soft, only deformed when the weight is loaded, the foot immediately returns to the normal shape without weight or manipulative correction, the calcaneus has no flexion, the talus is not vertical.
2 with the bridge bridge deformed flat foot: is the joint surface between the calcaneus and talus to produce different degrees of bone, cartilage connection or abnormal bony prominence, limit the joint movement of the subtalar, resulting in stiff flat feet, causing the gastrocnemius tendon, causing symptoms.
3 cerebral valgus valgus: caused by damage to brain motor nerve cells, clinical manifestations of central spastic convulsions, joint involvement, scissors gait, foot valgus deformity like CV T, but X-ray examination The talus is horizontal and the calcaneus has no flexion.
4 strained flat feet: insufficient nutrition, standing too long or excessive weight can cause long humerus, short muscles, stiff feet, limited activity, forefoot abduction, dorsiflexion, talus and scaphoid are characterized by depression, joint No dislocation.
5 Different from congenital spastic flat feet and idiopathic acquired flat feet, the disease is characterized by the fact that regardless of the foot flexion or dorsal extension, the normal relationship can not be restored from the scaphoid joint.
