Presentation
Bilateral clubfoot associated with multiple congenital anomalies in a fetus at 22 weeks of gestation on routine anomaly scan.
Patient Data
The bilateral club foot on ultrasound. 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, the relationship 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.
Case Discussion
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. Repeated ultrasound examinations were performed to rule out positional false positive diagnoses of scissoring and club foot. False positive reports of clubfoot may be seen in 20-25% of cases, and careful examination of feet on several occasions by experienced observers may reduce errors 1.
Half the cases may be associated with other congenital anomalies like spina bifida, trisomy 13, trisomy 18 and several other conditions.
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