New Born Child with Congenital Bilateral Birth Defect foot cured at NeotiaGetwel

A newly born child was referred to Orthopaedic Surgeon DrSabyasachiGhosh, Sr. Consultant- Orthopaedics& Joint Replacement by the Paediatric team of Neotia Getwel Multispecialty Hospital. On inspection it was found that the child was born with Bilateral Congenital TalipesEquinovarus .This is one of the commonest musculo skeletal birth defects in children (incidence 1 in 250-1000) and commonly occurs in males and bilaterally (50%).It is more common in the Maoris and Pacific islands.

Several theories have been proposed for its development.25% are thought to be genetic and it commonly occurs in siblings. It can be associated with other congenital abnormalities as well.

The defect has four components Mid foot is in cavus (more arched), hind foot is in equinus and varus (pointing downwards and inwards) and the forefoot is adducted (angled inwards towards the midline).The child had all the four components of the deformity and the left side was more rigid than the right side.
The child’s family was counselled about the deformity and the treatment was started at 2 weeks of birth. DrSabyasachiGhosh Using the standard method of Ponsetti developed by Ignacio Ponsetti of USA slowly corrected all four components of the deformity over a period of 6 months in the Outpatient department of Neotia Getwel Multispecialty Hospital.

The family used to travel 200kms every Saturday from Bihar for the serial casting technique over a period of two months. First the cavus was corrected followed by the adduction of forefoot and finally the equinovarus of the hind foot.
85 % of children with this problem need a tendo Achilles lengthening which was required in his case as well.

This was done in theatre under local anaesthetic after 2 months of serial casting where percutaneous lengthening was done on both sides after which a new cast was applied for another 6 weeks. The child had to stay in the hospital for 1 night only.

After this the plaster management was over and with the help of an orthotist a Denis Brown shoe was made which was put on at almost 4 months. The child will need to wear this for a long duration.

“Management of club foot was revolutionised by Prof IgnasioPonsetti and we are glad that we are able to bring this technique to NeotiaGetwel Healthcare Centre for benefit of the masses in this part of the country “said DrSabyasachiGhosh.
In most of such cases due to lack of proper facility locally, children remain untreated and left without correction of the problem which otherwise would have given them a better life to lead.