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Case Reports
. 2019 Sep 27;14(5):472-476.
doi: 10.1016/j.jtumed.2019.07.004. eCollection 2019 Oct.

Meningomyelocele with unusual feet deformity combination: A report of a rare case

Ammar K Alomran  1 , Munirah A Abahussain  2 , Asma A Aldossary  2 , Isra B Alshammari  2
Affiliations
Case Reports

Meningomyelocele with unusual feet deformity combination: A report of a rare case

Ammar K Alomran et al. J Taibah Univ Med Sci. .

Abstract
in English, Arabic

A 19-month-old male infant had presented to a paediatric orthopaedic clinic at the age of 6 months with meningomyelocele and bilateral feet deformity. The patient was admitted to the neonatal intensive care unit because of multiple congenital anomalies. These anomalies included meningomyelocele, right clubfoot, left vertical talus, imperforated anus, and an indirect hernia. Radiographs confirmed the diagnosis of right clubfoot and left-sided vertical talus. The course of management was delayed because of late diagnosis. At the age of 9 months, the patient underwent serial casting using the Ponseti and reverse Ponseti techniques for right clubfoot and left-sided vertical talus, respectively. The casting was performed weekly for 12 weeks. The right foot gained normal position before the left, but we decided to keep it in the cast until surgical correction was performed for both feet. The patient underwent right Achilles tendon tenotomy and casting and left Achilles tendon tenotomy, manipulation, and talonavicular reduction and k-wire fixation with casting. The casts remained for 3 and 6 weeks (clubfoot and vertical talus, respectively). The ultimate goal of the treatment was to produce braceable, plantigrade feet with the use of a well-padded knee ankle-foot orthosis to improve the quality of life.

راجع طفل عمره ١٩ شهرا عيادة جراحة العظام للأطفال عندما كان عمره ٦ أشهر يعاني من قيلة نخاعية سحائية وتشوه في القدمين. تم تنويم المريض في وحدة العناية المركزة لحديثي الولادة بسبب التشوهات الخلقية المتعددة. هذه التشوهات تضمنت قيلة نخاعية سحائية، وقدم فحجاء حنفاء يمنى، وكاحل عمودي أيسر، وشرج أرتق وفتق لا مباشر. أكدت الأشعة تشخيص القدم الفحجاء الحنفاء اليمنى والكاحل العمودي الأيسر. تأخر العلاج بسبب تأخير التشخيص. في عمر ٩ أشهر، بدأ المريض على معالجة متسلسلة باستخدام الجبس بطريقة بونستي للقدم اليمنى وطريقة بونستي العكسية للقدم اليسرى. تم عمل الجبائر أسبوعيا لمدة ١٢ أسبوعا. اكتسبت القدم اليمنى الوضع الطبيعي قبل اليسرى، ولكن قررنا إبقاءها في الجبيرة لحين عمل التصحيح الجراحي للقدمين. خضع المريض لبضع وتر العرقوب الأيمن والجبيرة، وبضع وتر العرقوب الأيسر والمعالجة ورد للمفصل الكاحلي الزورقي وتثبيت بأسلاك كيرشنر مع الجبيرة. استمرت الجبائر لمدة ٣و٦ أسابيع (القدم الفحجاء الحنفاء والكاحل العمودي على التوالي). وكان الهدف النهائي للعلاج هو الحصول على قدم قابلة لاستعمال الدعامة باستخدام جبيرة مبطنة جيدا للركبة والكاحل والقدم لتحسين جودة الحياة.

Keywords: Clubfoot; Meningomyelocele; Talipes equinovarus; Vertical talus.

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Figures

Figure 1
Figure 1
Clinical photograph showing right clubfoot and left rocker bottom deformity due to vertical talus.
Figure 2
Figure 2
AP view of both feet showing reduced talocalcaneal (TC) angle on the right side with negative talus: first metatarsal angle and increased TC angle on the left side.
Figure 3
Figure 3
Lateral X-rays of both ankles showing the difference in talocalcaneal (TC) angle with right-sided parallel TC angle and left-sided increased TC angle. There is left vertical talus and dorsal dislocation of the navicular and right-sided cavus.
Figure 4
Figure 4
Intraoperative lateral X-ray after reduction of talonavicular joint and pinning.
Figure 5
Figure 5
A. Anterior view of a braceable plantigrade right foot. B. Lateral view of a braceable plantigrade right foot.
Figure 6
Figure 6
A. Anterior view of a braceable plantigrade left foot. B. Lateral view of a braceable plantigrade left foot.
Figure 7
Figure 7
Well-padded ankle–foot orthosis with neutral ankle and plantigrade feet.
See this image and copyright information in PMC

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