From the Research
Rocker bottom deformity is best managed with a treatment approach that prioritizes early diagnosis and intervention, with serial casting and surgical correction for congenital cases, and custom orthotic devices and specialized footwear for acquired cases, as evidenced by the most recent and highest quality study 1. The deformity is characterized by a convex sole that resembles the curved bottom of a rocking chair, resulting from a vertical talus that displaces downward and forward, causing the navicular bone to sit on top of the talus rather than in front of it. Key features of the deformity include:
- A plantar convexity appearing between three and six months of age with the hindfoot equinus position remaining constant 2
- The convexity initially involves the medial column, radiologically identified by the talo-first metatarsal angle and secondly by the lateral column, revealed radiologically as the calcaneo-fifth metatarsal angle 2
- The apex of the deformity is usually at the midtarsal with a dorsal calcaneocuboid subluxation 2 Treatment options vary by age and cause, with the following approaches recommended:
- For congenital cases in infants, serial casting followed by surgical correction is typically recommended within the first year of life for optimal outcomes, with a procedure that usually involves reduction of the talonavicular joint and tendon transfers to maintain proper alignment 1
- For adults with acquired deformity from Charcot arthropathy, treatment focuses on custom orthotic devices, specialized footwear with rocker soles to redistribute pressure, and strict offloading to prevent ulceration, with surgical intervention necessary for severe cases but carrying higher complication risks 3, 4 Early diagnosis and intervention are crucial as untreated rocker bottom deformity leads to abnormal gait, pain, callus formation, and potential skin breakdown. The most recent and highest quality study 1 supports the use of serial casting and surgical correction for congenital cases, and custom orthotic devices and specialized footwear for acquired cases, highlighting the importance of a treatment approach that prioritizes early diagnosis and intervention.