# Congenital musculoskeletal anomaly

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- 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 date: 2026-08

## Verified against

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

## Treatment metadata

- No drug therapy in primary care (Recognition & Referral)

## Complete treatment card

```text
CONGENITAL MUSCULOSKELETAL ANOMALY
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
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Congenital musculoskeletal anomaly - disease-level clinical article
               (congenital-musculoskeletal-anomaly-clinical.txt)  (2026-08)

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
  Source  StatPearls "Congenital Vertical Talus" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line]
   Adult    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
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   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.
   Caution  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.
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