Neglected Idiopathic Bilateral Clubfoot

Original Editor - Part of ICRC and GCI Clubfoot Content Development Project

Top Contributors - Rachael Lowe and Naomi O'Reilly  

Introduction

Around the world, 150,000 – 200,000 babies with clubfoot are born each year[1].  In India, every 10 minutes a child is born with clubfoot, i.e over 50,000 children are born with clubfoot deformity every year (1 per 500 birth)[2]. Without treatment, the clubfoot deformity causes a lifetime disability. Use of the minimally invasive Ponseti method is emerging fast in low and middle-income countries, where most of the world's children with clubfoot are born. Untreated children with clubfoot find it difficult to access education, employment and experience exclusion from society.
Zameer.jpg

Patient Characteristics

Zameer has neglected idiopathic bilateral clubfoot. He is an eleven-year-old healthy school going boy. Zameer was referred to the clubfoot clinic with his three year old brother who also happens to have bilateral clubfoot. The Clubfoot clinic is run by the Ministry of Health, Jammu & Kashmir, supported by Cure International and the International Committee of the Red Cross.

Examination Findings

On examination, no other neuromuscular disorders were present. Zameer was able to stand and walk but on the dorsum of the foot where he had developed callosities, there was no weight bearing on heel. All the elements of equinus, rear foot varus, cavus, and forefoot adductus were present. Atrophy of calf muscles was also evident.

Clinical Hypothesis

To present treatment response in a child with neglected idiopathic bilateral clubfoot with the Ponseti method. 

Intervention

After detailed assessment and proper counselling, Ponseti serial casting was started. Eight serial casts were applied to correct, the cavus, adductus and varus deformities and every week the Pirani scoring was recorded.  A percutaneous heel-cord tenotomy was performed to correct the equinus, followed by 3 weeks long cast. This correction was maintained in foot abduction brace (FAB) initially 23 hours a day for 3 months and followed by night splinting which will continue approximately for 3 years. The parents were taught how to stretch the foot on removal of the splints. ZA and his family provided written consent to present his case.

Outcome

Zameer 2.jpg

The deformities of Zameer were corrected after nine serial casts. The midfoot and forefoot were corrected to Pirani 0 in both feet after eight casts. His hindfoot Pirani score was also recorded as 0 after the removal of a three-week casting after his tenotomy. Zameer is on Foot Abduction Brace from last twelve months and will continue the brace for three more years. From last twelve months, Zameer has no signs of relapse.

The outcome was measured by Pirani scoring.

References

  1. What is Clubfoot? Global Clubfoot Initiative.http://globalclubfoot.com/clubfoot/ (Accessed online 6 September 2017)
  2. Abdelgawad AA, Lehman WB, van Bosse HJ, et al. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B 2007;16(2):98-105.