A case of Untreated Clubfeet in an Arthrogrypotic child
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September 24, 2020This is a case of a child’s untreated clubfeet treated by Dr. Ratnav Ratan
Background
A 3yr old girl child from Iraq had stiff crooked feet since birth. They were turned inward and upward since birth, and no treatment had helped her walk normally. She had frequent falls while walking and could not balance herself. Her parents travelled to India to get her treated.
Diagnosis
On examination, she was diagnosed with a rare genetic condition called Distal Arthrogryposis, which causes joint contractures, deformities of the upper limb, and stiff deformed feet. The child was diagnosed as a case of Freeman Sheldon syndrome (FSS) with a typical whistling face appearance, thumb-in-palm deformity, camptodactyly. The feet were extremely stiff and were completely turned in with the sole facing upward.
Management
We thoroughly investigated the child. The treatment was challenging, and sequential correction with fixators was not possible as they could not have stayed in India for long. The child was taken up for a single-stage correction of both feet deformities. A posteromedial release with multiple tendon tenotomies, Z lengthening of tendon Achilles, anterior calcaneal shortening was done to correct both feet in one operative sitting.
Follow-up
Post-operatively the child did exceptionally well. Plasters were removed after 6 weeks, and the wound healed well. She started walking with plantigrade feet for the first time in her life. She is learning to walk now. The parents were extremely content with the outcome. It was a life-changing surgery for her. Without treatment, the child would have further worsened the deformity with age, and the joints would have become arthritic and painful.
Correction of hand deformities is planned in their next visit to India.
Dr. Ratnav Ratan
Pediatric Orthopedist and Sports Medicine specialist
