Congenital talipes equinovarus and congenital vertical talus secondary to sacral agenesis

Abstract

Sacral agenesis is a rare congenital defect which is associated with foot deformities such as congenital talipes equinovarus (CTEV) and less commonly congenital vertical talus (CVT). We report a 3-year-old Caucasian girl who was born with right CTEV and left CVT secondary to sacral agenesis. Her right foot was managed with a Ponseti casting method at 2 weeks, followed by an Achilles tenotomy at 4 months. The left foot was initially managed with a nocturnal dorsi-flexion splint. Both feet remained resistant and received open foot surgery at 10 months producing plantigrade feet with neutral hindfeet. At 19 months, she failed to achieve developmental milestones and examinations revealed abnormal lower limb reflexes. A full body MRI was performed which identified the sacral agenesis. We advocate early MRI of the spine to screen for spinal defects when presented with resistant foot deformities, especially when bilateral.

Keywords: Congenital disorders; Orthopaedics; Paediatric Surgery.

Figure 1

(A) Right congenital talipes equinovarus and (B) left congenital vertical talus with a schematic diagram showing net muscular force direction following muscular imbalance (red) and direction of joint subluxation (blue).

Figure 2

Foot and ankle radiographs at 4 months of age showing right congenital talipes equinovarus in an equino-serpentine position following Ponseti casting and left congenital vertical talus.

Figure 3

T2-weighted sagittal midline lumbosacral MRI frame showing sacral agenesis.