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Giant Tumefactive Perivascular Spaces
Joseph Junewick, MD FACR
over 5 years ago
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Case History

18 month old female with foot deformity.

Case Detail

Anatomy: Musculoskeletal
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: CR
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Reveal Findings

CR – Lateral radiographs of the right and left feet demonstrate severe hindfoot valgus, nearly vertical talus and abnormal talonavicular articulation bilaterally.

Reveal Discussion

Congenital vertical talus (CVT) consists of rigid pronation of the foot with a convex plantar arch and equinus of the heel. It may be an isolated conditions, exist as part of a syndrome (e.g. craniocarpotarsal dysplasia, trisomy 13, trisomy 18), or be associated with other systemic abnormalities (arthrogryposis, congenital hip dislocation). It occurs in 10 percent of patients with myelomeningocele.

On AP radiographs there is severe valgus deformity with the calcaneus displaced laterally and the talus pointing medially. Lateral images demonstrate severe equinus of the calcaneus. The talus has a vertical attitude and may have a hypoplastic neck. Contracture of the Achilles tendon and flexor digitorum longus result in navicular dislocation so it is dorsal to the talar neck instead of opposite the talar head. The metatarsals are dorsiflexed and there is convexity of the plantar arch.

Radiographs allow distinction of CVT from severe planovalgus, which may appear similar on physical exam but is distinguished by a normal position of the navicular opposite the head of the talus and absence of calcaneal equinus. Early diagnosis of CVT is necessary because it cannot be reduced by manipulation or casting, but requires surgical correction.

Reveal Diagnosis

Congenital Vertical Talus

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