Congenital vertical talus (CVT) is a rare and severe congenital foot deformity, also known as congenital rocker-shaped flatfoot and once known as congenital flatfoot. It usually develops in a single foot, more in males than females, and can be combined with other parts of the deformity. Etiology: The pathogenesis is not yet clear, and there are several theories in the literature describing the pathogenesis. The theory of congenital embryonic malformation development, this theory believes that during embryonic development, the uterus is narrowed, which affects the development of the foot, resulting in vertical talus, and there are animal experiments to support this theory; there are other scholars who propose that it is a neuromuscular disease, due to neuromuscular abnormalities, resulting in abnormal muscle balance. A small percentage has parental heredity, suggesting that it may be related to genetic factors. Pathology: As with most deformities, the pathological changes of congenital vertical talus are reflected in two aspects: 1. skeletal changes, mainly talus dysplasia, periprosthetic dislocation, increased angle between the talus and horizontal line, and the talus head located between the navicular bone and the heel bone; 2. soft tissue changes, including muscle changes, including intraoperative weakening of the posterior tibial muscle, tension of the Achilles tendon, contracture of the anterior tibial muscle, peroneal long and short muscles, joint capsule Tension and adhesions. Clinical manifestations: The main change is the appearance of the foot. In the neonatal period, it can be found that the bottom of the foot bulges significantly, and when the affected side is weight bearing, the deformity becomes more obvious, and sometimes the talar head can be palpated. As the disease progresses, the deformity of the talus becomes more obvious, and in severe cases, the talus may be at a 90° right angle to the horizontal. At the same time, due to the increase of soft tissue contracture, the stiffness of the joint becomes more obvious, and the walking is obviously abnormal and clumsy. Imaging manifestations: mainly x-ray examination. The examination can clarify the dislocation of the talus and the development of the navicular bone.1. On the lateral film of the foot, the angle formed by the longitudinal axis of the heel talus is suggested to be significantly increased, and the longitudinal extension line of the talus does not pass through the metatarsals; on the orthopantomograph, the extension line of the talus should pass through the first metatarsal, and the angle between the extension line of the talus and the longitudinal axis of the heel bone is about 20-40°, and in patients with vertical talus, the angle is deformed. 2. Talus morphology changes include hypoplasia of the talar head, thinning of the talar neck, etc. 3. dislocation of the periprosthetic joint, other abnormal changes of the related joints, etc. Treatment and prognosis: For vertical talus, surgical treatment is mostly used because, according to the literature, conservative treatments such as local massage and brace fixation mostly fail as age increases and the disease worsens. For surgical treatment, surgery is mostly performed around 6 months of age. The purpose of surgery is to restore the normal position of the talus and strive to achieve anatomical repositioning of the periprosthetic joint. The specific surgical method is different depending on the severity of the deformity and the age of the child. For children within 1 week of age, since the secondary bone changes are not obvious, surgery can be performed only to loosen the soft tissues and anatomically reset the periprosthetic joint. As the age increases, the secondary bone changes are obvious, and surgery should be performed to loosen the soft tissues and reset the head of the talus if necessary, such as navicular osteotomy, etc. For bones close to maturity, triple joint fusion can be used. The following are some of the common surgeries. 1. soft tissue release and periprosthetic repositioning of the talar joint. The surgical indications are mainly used for those who are less than 1 year old and have insignificant skeletal changes such as Kummar surgery The surgical incision is divided into three places, and some scholars use the Cincinate incision, which also exposes the surgical field, and the specific incision is determined by the operator’s experience. The first incision is made at the lateral edge of the foot, with the talar sinus as the center, making an arc-shaped incision, and then releasing the lateral periheel, heel dice joint capsule and soft tissues around the periphery, so that there is no obvious resistance to the inversion functional position, and then the second incision is made at the medial side of the foot, with the most convex part of the foot or the talar head as the center, making an arc-shaped incision, exposing the talar head, neck, navicular bone and anterior tibial muscle, and also releasing the superficial triangular ligament and soft tissues around the periphery of the medial side, etc. The third incision was made at the medial edge of the Achilles tendon, and the Z-shaped extension of the Achilles tendon was performed to release the tibiofibular joint and the subtalar joint capsule, and then the talus, heel bone and navicular bone were fixed with kerf pins, and the wound was finally sutured and fixed in a cast. 2.Coleman surgery This surgery is mainly used for older children and those with obvious deformity. The specific surgery is as follows: daily functional exercises and inversion brace fixation can be given before the surgery, which is beneficial to the operation and later results. After the skin and subcutaneous tissues are cut, the extensor tendon is separated and protected, then the ligaments at the talocrural joint are released, and the extensor tendon and the tibialis anterior muscle are extended in a Z-shape, the talocrural joint is released, the talocrural joint is reset, the talocrural bone is fixed with a Kirschner pin, the talocrural dice joint is released, and the bone is cut at the distal end of the fibula. The bone was cut at the distal end of the fibula, about 2 cm in length, and a fusion of the inferior talocrural joint was performed, while the Achilles tendon was lengthened with a posterior medial incision, the joint capsule was sutured and the periapical ligament was reconstructed.