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Vertical Talus

Vertical talus is a rare deformity of the foot that is diagnosed at birth. Because babies are born with the condition, it is also known as congenital vertical talus. It is one of the causes of a flatfoot in the newborn. One foot, or both feet, may be affected.

Although it is not painful for the newborn or even the toddler, if it is left untreated, vertical talus can lead to serious disability and discomfort later in life.


The talus (TAY-lus) is a small bone that sits between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). The tibia and fibula sit on top and around the sides of the talus to form the ankle joint. The talus is an important connector between the foot and the leg, helping to transfer weight across the ankle joint.

anatomy of hindfoot

The talus bone sits between the bones of the lower leg and the calcaneus (heel bone).


In vertical talus, the talus bone has formed in the wrong position, and subsequently, the other bones in the foot are not lined up properly. As a result, the front of the foot points up and may even rest against the front of the shin. The bottom of the foot is stiff and has no arch — in fact, it usually curves out — and is often described as "rocker bottom." This is distinctly different than a clubfoot.

vertical talus in bone feet
This 9-month-old infant has vertical talus in both feet.
Reproduced from Kasser JR, ed: Orthopaedic Knowledge Update, ed 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, p 507.

Vertical talus is usually diagnosed at birth. Other foot deformities in the newborn are more common, and vertical talus is often initially misdiagnosed as some other type of newborn flatfoot, such as an oblique talus or calcaneovalgus deformity. Some clinicians with less experience in these newborn foot conditions have even incorrectly thought of this as a clubfoot.

x-rays of normal foot and vertical talus
(Left) An X-ray of an infant's foot showing normal bone position. In this X-ray, the talus is pointing toward the toes. (Right) An X-ray of an infant's foot with vertical talus. In this X-ray, the talus is pointing straight down.
(Left) Courtesy of Texas Scottish Rite Hospital for Children (Right) Courtesy of Campbell Clinic Orthopedics


The exact cause of vertical talus in not known. Many cases, however, however, are associated with a neuromuscular disease or other disorder, such as arthrogryposis, spina bifida, and numerous syndromes. Your doctor may decide to perform additional tests to discover whether your infant has any of these other conditions.

Doctor Examination

Pediatric orthopaedic doctors are able to diagnose vertical talus by simply examining the child. Your doctor may order a special X-ray of your child's foot to confirm the diagnosis.


The goal of treatment for vertical talus is to provide your child with a functional, stable, and pain-free foot.

It is important for vertical talus to be treated early. A vertical talus will not prevent your child from walking, but if the deformity is allowed to progress and your child learns to walk on an abnormal foot, calluses and painful skin problems will develop. It becomes hard to find shoes that fit properly, and your child will not be able to walk normally.

Treatment usually involves a combination of nonsurgical and surgical intervention.

 toddler with congenital vertical talus
A toddler with untreated vertical talus. Note the severe flatfoot.
Courtesy of Texas Scottish Rite Hospital for Children

Nonsurgical Treatment

Initial treatment is usually nonsurgical and includes a series of stretching and casting designed to increase the flexibility of the foot. In some cases, these manipulations can correct most of the defority, and a minimal procedure can complete the treatment. After this, some doctors also recommend physical therapy exercises and bracing to continue to stretch the foot and improve flexibility.

Surgical Treatment

If the initial nonsurgical treatment does not sufficiently correct the problem, your doctor may recommend surgery as early as 9 to 12 months of age.

Surgical Procedure. Surgery is designed to correct all aspects of the deformity, including problems with the foot bones, as well as the ligaments and tendons that support the bones.

During the operation, your child's doctor will put the bones in the correct position and apply pins to keep them in place. Tendons and ligaments that may have shortened as a result of the deformity will be lengthened.


After the operation, the doctor will apply a cast to your child's foot to keep it in the corrected position. Your child will most likely stay in the hospital for at least one night after surgery to help control pain, and for the doctor to monitor any swelling in the foot.

After 4 to 6 weeks, the cast will be removed. A brace or special shoe may be required to help prevent the deformity from returning.


Without treatment, you child's vertical talus will most likely result in future pain and disability.

With treatment, you can expect a stable and functional foot that should serve your child well throughout their life. If your child has no other conditions that limit function and development, you can expect your child to run and play without pain, and to wear normal shoes.

Your child's doctor will likely recommend repeat clinic visits over the years to observe the growth and development of your child's foot.

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Learn more about this topic at POSNA's OrthoKids website:

Vertical Talus

Last Reviewed

July 2021

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.