Dawaa Reference

Clinical reference

Congenital musculoskeletal anomaly

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Clubfoot - StatPearls (NCBI Bookshelf NBK551574) - https://www.ncbi.nlm.nih.gov/books/NBK551574/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD55 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Congenital musculoskeletal anomaly - disease-level clinical article (congenital-musculoskeletal-anomaly-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Signs — what you find (4)

  • The hindfoot points outward and downward while the forefoot turns outward and bends upward at the midfoot
  • The sole of the foot becomes convex, giving a rocker-bottom appearance
  • Deep skin creases appear over the outer, upper part of the foot
  • The head of the talus bone can be felt as a bony bump on the inner sole of the midfoot [skin nodule]

Tests (6)

  • Standing X-rays are used once a child can bear weight, and neutral-position X-rays are used in infants
  • Diagnosis at birth can be difficult because several foot bones are not yet ossified
  • Forced dorsiflexion and plantar flexion X-ray views are needed to confirm the diagnosis and to rule out a calcaneovalgus or oblique talus foot
  • The classic finding is an increased talus-to-heel-bone angle, with the talus lying vertical and parallel to the shinbone on the side-view X-ray
  • On forced upward bending the shin-to-heel angle decreases and the talus misaligns with the navicular bone, while forced downward bending misaligns it with the first metatarsal
  • A full neurologic exam of the spine and limbs should be done to check for associated abnormalities

If not this — what else fits (3)

  • Vertical talus displaces the talonavicular joint medially and downward, unlike a related deformity where the same joint shifts laterally and upward
  • In calcaneovalgus foot, a palpable gap between the talar neck and navicular bone closes with forced downward bending, unlike vertical talus
  • Clubfoot and posterior medial bowing of the tibia are also on the differential for this foot deformity

SourceStatPearls "Congenital Vertical Talus" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)

1st line
Adult dose and duration

Broad grouping of congenital skeletal deformities (clubfoot, bow leg, craniofacial malformation, foot deformities) usually identified at birth or in infancy; management is bracing/casting or surgical, not pharmacologic, so the GP's role is early recognition and prompt referral. - Refer

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Broad grouping of congenital skeletal deformities (clubfoot, bow leg, craniofacial malformation, foot deformities) usually identified at birth or in infancy; management is bracing/casting or surgical, not pharmacologic, so the GP's role is early recognition and prompt referral.

Cautions
  • Associated syndromic features or other congenital anomalies; clubfoot needs referral early in infancy for best results with corrective casting.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Children with congenital vertical talus require prompt evaluation and treatment to prevent permanent bony deformities (rocker-bottom foot) and significant long-term disability.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.