Patient's question:
My niece, who is now three months old, has been diagnosed with congenital vertical talus, congenital hip dislocation, and multiple joint contractures. The whole family is very worried about her and doesn't know what the future holds for her. We hope she can receive good treatment and live an independent life in the future.Doctor's answer:
Early treatment is key—1. Congenital vertical talus, also known as congenital cavus foot, primarily involves primary talo-calcaneal joint dislocation, where the navicular bone shifts to the dorsal side of the talus, locking the talus in a more vertical position, forming a boat-shaped foot deformity. Due to the stiffness of this deformity, the earlier the treatment, the better. It is generally believed that the best time to treat this condition is within the first three weeks of birth. Since the child is already three months old, open reduction should be performed. The surgery involves releasing contracted joint capsules and ligaments, including: ① the dorsal and lateral parts of the talonavicular ligament; ② the tibionavicular ligament and bifurcate ligament; ③ the dorsal and lateral parts of the calcaneocuboid joint capsule; ④ the calcaneofibular ligament and interosseous talocalcaneal ligament. At the same time, the contracted tendons, such as the Achilles tendon, tibialis anterior tendon, extensor hallucis longus tendon, and peroneus longus and brevis tendons, are lengthened. Subsequently, under direct vision, the talo-calcaneal joint is reduced, and after restoring the normal alignment of the foot, a K-wire is used to fix the wedge, navicular, and talus bones. Then, the calcaneocuboid plantar ligament, plantar and medial parts of the talonavicular joint capsule, and the tibialis posterior tendon are moved distally and fixed to the plantar side of the first wedge bone. Postoperatively, a long-leg cast is applied for 8–12 weeks. The K-wire is typically removed six weeks after surgery.2. Congenital hip dislocation should be treated early. Early bracing treatment can yield good results.3. Congenital multiple joint contracture syndrome is a condition characterized by fibrosis of muscles, joint capsules, and ligaments, leading to stiffness in multiple joints throughout the body. The treatment goal is to increase the range of motion in affected joints, enabling the child to walk independently or with assistance, and to maximize the improvement in upper limb and hand function. Therefore, treatment must follow the following principles: ① Early soft tissue