Delayed Presenting Congenital Talipes Equino Varus in African Decent: A Case Report

Introduction: Congenital Talipes Equinovarus (CTEV) also known as clubfoot is one of the most common congenital musculoskeletal deformities. CTEV affect 1 in every 1000 newborns. Children born with clubfoot have an inward curved forefoot, high arches and inverted heel with a downward pointing ankle. ‘Delayed-presenting Clubfoot’ (DPC), refers here to clubfoot abnormalities, of idiopathic cause, present at birth and not treated before walking stage. We use ‘delayed presenting clubfoot’(DPC) in this paper as a preferred nomenclature as the term ‘neglected clubfoot’ infers a degree of blame and deliberate inaction on the parents and caregiver. DPC is common in low and middle-income countries (LMICS) particularly in Africa and South East Asia, due to lack of access to clubfoot treatment. Treating club foot in walking-age Children non-operatively is debated. This case report aimed at presenting the outcome of a 6 month management of a 4 years old male child with bilateral CTEV, using the Ponseti method.
Methods: A case of a 4-year-old male child who presented to the clubfoot clinic of Delta State University Teaching Hospital, Oghara with complaint of bilateral foot deformity, with no identifiable syndromic or secondary causes, he was subsequently evaluated as a case of DPC, severity and flexibility level was evaluated with the PIRANI SCORE, with the patient having a total score of 4.5. Non-Operative option of management was started immediately with the Ponseti method. Serial manipulation and casting were done, patient had a total of 6 cast sessions and percutaneous Achilles tendon tenotomy.
Result: After six manipulation and casting sessions, and subsequent Percutaneous Achilles tendon tenotomy, with foot plantigrade and all component of the clubfoot corrected. He was placed on Foot Ankle Braces (FAB). Currently on FAB for night use only and will use it for the next 4years. Patient is currently ambulating normally, with no residual deformity.
Conclusion: The implementation of the Ponseti method for the management of patients with DPC, has shown good outcome and reduced surgery rate. There is need for enlightenment on the importance of early presentation and prompt intervention. However there exist research gaps on the non-operative management of this group of patients, exploration of this area of research is needed.