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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.

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, so 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. Instead, it usually curves out and is often described as "rocker bottom."

This is distinctly different than a clubfoot. Vertical talus is a rigid deformity, and the foot appears flat even when the child is not standing.

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.

(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, are associated with a neuromuscular disease or other disorder, such as arthrogryposis or spina bifida. Your child's doctor may decide to perform additional tests to discover whether your infant has any of these other conditions.

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 over time:

• Calluses and painful skin problems will develop.
• Finding shoes that fit properly will become challenging.
• Your child will start having pain that impacts their function.

Treatment usually involves a combination of nonsurgical and surgical intervention.

A toddler with untreated vertical talus. Note the severe flatfoot.

Courtesy of Texas Scottish Rite Hospital for Children

Without treatment, your 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. The most important factor affecting your child's outcome is whether there is an underlying neuromuscular or genetic condition. 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.