To report a rare presentation of Syndromic clubfoot (clubfoot associated with myelomeningocele) and developmental dysplasia of the hip in a neonate.
this is a longitudinal case study which involved single clinical case. all the relevant clinical data was recorded in medical file of the child in Muzaffarabad Physical Rehabilitation Centre.
A 1.5 month old baby girl presented with syndromic clubfoot (left) and metatarsal adductus (Right). She was born with birth defect myelomeningocele for which she got operated at the age of 25 days. She was also diagnosed with developmental dysplasia of the bilateral hip (DDH). Ultrasonography of both hil joints were done and on Graff's classification, the score was 3 for the right hip and 2b for the left hip joint. Ponseti treatment for the left foot was started, for the right foot below knee cast was done to correct the metatarsal adductus and for DDH Pavlick harness were given. After serial correction of the right foot and tenotomy, a foot abduction brace was applied with angle adjustment of 30 degrees right and 55 degrees left along with a Pavlic harness for DDH bilateral. The foot abduction brace protocol was slightly modified as per the correction gained. Position of child during bathing and breastfeeding were guided. It was made sure to keep the Pavlick harness on for 24 hrs.
At 9 months, hip joints were re-evaluated for the status of DDH which was normal. Foot abduction brace was shifted to night and Nap use. Ankle foot orthosis was given for day time to prevent the deformity from relapsing. She was not able to roll over and sit independently. supine to side lying facilitation, supine to side lying to prone facilitation, prone to quadruped facilitation, quadruped positioning, and corner sitting with proper posture in a corner chair was started. At the age of 1 year, she was able to do long sitting and high sitting independently but for a short period. Extensive static and dynamic balance training was started. 1.5 months later she was able to sit independently and was performing her functional activities while sitting independently. Then she was preceded towards quadriceps strengthening, standing with the assistance of a standing table, roller sitting with the weight shifts on lower limbs (hip, knee, and ankle 90-degree angle). 3 months later she improved her standing and had good static standing balance. Then static and dynamic standing balance training was started and now she can stand and take a few steps with the support of a walking frame.
Syndromic clubfoot with myelomeningocele and developmental dysplasia of hip can exist concomitantly and its treatment is challenging. In this case study, the multi-disciplinary team including an orthopaedic surgeon, radiologist, physical therapist and orthotist managed to minimize the manifestations of this complex case.
this case study will be evidence for the treatment of syndromic clubfoot with developmental dysplasia of the hip.
Developmental Dysplasia
Myelomeningocele
