Congenital vertical talus in arthrogryposis and other contractural syndromes.

No practical classification system exists to identify which patients may have successful outcome following treatment of congenital vertical talus in arthrogryposis. We classified 229 patients into five distinct groups: Group I had amyoplasia or so-called classic arthrogryposis, Group II had distal arthrogryposis, Group III had a specific syndrome as a diagnosis, Group IV had severe systemic or neurologic involvement, and Group V had unclassifiable contracture syndromes. No patient with amyoplasia (Group I) had congenital vertical talus. The congenital vertical talus seen in distal arthrogryposis (Group II) was milder than that seen in Groups III or IV and feet in this group responded well to early one-stage surgical correction. Congenital vertical talus that occurred in association with a generalized syndrome or with extensive systemic and neurologic involvement (Groups III and IV) was severe and refractory to treatment. Most children in these groups were unable to walk; therefore, the goal of treatment should be to achieve a pain-free foot to allow fitting of normal shoes. Most children in Group V were able to walk and responded well to operative correction; they should be treated before walking age.