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Reminder of important clinical lesson
CASE REPORT
Congenital talipes equinovarus and congenital vertical talus secondary to sacral agenesis
  1. Jonathan James Hyett Bray1,2,
  2. Sebastien Crosswell3,
  3. Rick Brown1
  1. 1 Trauma and Orthopaedic Department, Cheltenham General Hospital, Cheltenham, UK
  2. 2 Bristol Royal Infirmary, University of Bristol Academy, Bristol, UK
  3. 3 Department of General Surgery, The Royal Shrewsbury Hospital, Shrewsbury, UK
  1. Correspondence to Mr Jonathan James Hyett Bray, Jonathan.Bray{at}doctors.org.uk

Summary

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.

  • Congenital disorders
  • Paediatric Surgery
  • Orthopaedics

https://doi.org/10.1136/bcr-2017-219786

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    Footnotes

    • Contributors JJHB is responsible forwriting the first manuscript, producing the schematic diagram and extensivelyreviewing the literature surrounding the case. SC is responsible for obtainingconsent and radiology images. RB is the consultant orthopaedic surgeon who performedthe surgery, conceptualised the case report and thoroughly reviewed theintroductory and background literature. All authors edited and reviewed themanuscript and have approved the final version.

    • Competing interests None declared.

    • Patient consent Consent obtained from guardian.

    • Provenance and peer review Not commissioned; externally peer reviewed.