Bilateral clubfoot - congenital talipes equinovarus

Ultrasound is the investigation of choice. Half the cases may be associated with other congenital anomalies likespina bifida, trisomy 13, trisomy 18 and several other conditions. 50% of cases may have isolated congenital talipas equinovarus deformity. No fetal karyotyping is advisable in cases with isolated casesclub foot³.

Epidemiology

Epidemiological studies report a prevalencePrevalence of 0.1% or 1 in 1000 live births for congenital clubfoot¹. Males are twice more affected than females. Higher prevalence rates have been observed within lower socio-economic strata, genetic factors and environmental conditions².

The bilateral club foot is clearly visible in ultrasound images and videos. Both feet are medially rotated and appear in the same plane as the tibia and fibula. In normal feet, the sole of the feet should be perpendicular to the long axis of the leg. Both feet also show fanning of the toes. Moreover, therelationship between feet and legs remained constant on several occasions ruling out transient and false positive positional club foot. The fetus had multiple congenital anomalies including open spina bifida, meningomyelocele in the thoracic region and double vessel cord.

Congenital club foot is best diagnosed by ultrasound between 18 to 24^th weeks of gestation. In 50% of cases, the condition may be bilateral. CarefulFalse positive reports seen in nearly 20-25% of cases,careful examination of feet on several occasions by experienced observers may help reduce the chances of false positive results, which may otherwise be seen in nearly 20-25% of caseserrors ³. Club foot occurs because of short tendons of the feet. Early intervention produces good results in most cases.

Diagnosis of club foot should preferably not be made before 12 weeks of gestation because the transient club foot-like position is present during the early normal development of feet⁴. In the present case, the fetus had multiple congenital anomalies including lemon sign, banana sign, open spina bifida, meningomyelocele, oligohydramnios, double vessel cord and musculoskeletal defects like persistent scissoring of legs.