If left untreated, it progresses to a painful rigid flatfoot by adolescence or early adulthood. Wearing shoes and gait become awkward. The patient bears weight on the talus and the heel does not touch the ground. The hind foot points down and the forefoot points up. Abnormal pressure in utero is postulated to be the cause in some cases.
Muscle imbalance is shown in others.
If recognized, surgical intervention is preferred before the age of two. Casting and manipulation alone are not usually effective, though they can be used preoperatively to stretch soft tissue. This is combined with a reduction and pinning of the navicular. In adolescents and adults salvage is performed by triple arthrodesis and often requires the removal of a large portion of the talus. The essential feature is open reduction and pinning of the talonavicular joint.