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To ascertain whether one type of treatment of the congenital vertical talus was superior to others, we conducted a retrospective analysis of 36 congenital vertical tali in 21 patients whose average follow-up of 14 years was considered to be unusually lengthy. Ten patients (48%) had an underlying primary diagnosis, and 13 patients (62%) had at least one other secondary congenital abnormality. None of the surgical techniques produced significantly better results than any other one according to criteria involving shoewear, range of motion, and degree of pain. Subtalar and talotibial motion were frequently restricted, with or without prior arthrodesis. Pain generally was not an immediate or long-term problem. To maintain maximal foot mobility, we recommend a one-stage soft tissue correction alone in the child under 3 years of age. In older, untreated children or those in whom conservative treatments have failed, a subtalar or triple arthrodesis may be necessary.

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