Ryan Fitzgerald, DPM PRESENT RI Associate Editor Washington Hospital Center Washington, DC

Case Study:
Congenital Deformity in a Pediatric Patient

HPI: The patient is a happy, healthy 16 month old male who presents because his grandmother is concerned that he does not walk well, and is concerned about his feet “pointing in.”  The patient is nonverbal, but appears in no apparent distress.

VS: Temp: 98.2, HR: 100, RR: 18, BP: 104/82 Weight:  14 kg
PMH: noncontributory, normal pregnancy and delivery without
complication, age appropriate vaccinations.
FMH: father was born with clubfoot deformity
MEDS:  none
ALL: NKDA
SOCIAL: the patient lives with his family, and three older brother

RADIOGRAPHS: Non weight-bearing Radiographs obtained demonstrate 3 views of the feet bilaterally. (Figs.1, A-B below) The patient is noted to be skeletally immature with numerous cartilaginous anlages observed. There is age appropriate ossification of the lateral cuneiforms and initial ossificationof the medial cuneiforms noted. 

PHYSICAL EXAM: Upon physical exam, the patient is noted to be neurovascularly intact with pedal pulses palpable and graded +2/4 bilaterally.  The patient demonstrates a bilateral metatarsus adductus deformity noted which is worse on the left than the right. (Figs.2, A-B below) This deformity is noted to be reducible with manipulation.  There is no equinus noted.  Muscle strength appears to be within normal limits, and the patient does not demonstrate a Babinski reflex.  The patient demonstrates no knee or hip abnormalities.

Figure 3 (above): With weight bearing, the patient demonstrates bilateral clinical metatarsus adductus that is noted to be worse on the left than the right.  This deformity is reducible with gentle manipulation.

WHAT DO YOU THINK?
Considering the history, physical exam, and radiographs and images presented, how would you proceed with this case? Join in on the live eTalk discussion on PRESENT Podiatry.

We'll see you next week. Best wishes!

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