Shurbaji Suliman Abdullah, Abdulaziz Abdulaziz Ahmed, Alsuwat Obaidallah Buraykan, Abu Adas Saleh Mohammad, Alotaibi Khalid Ayidh, Alahmari Ali Mohammed
Orthopedics Department, Security Force Hospital, Makkah, Saudi Arabia.
Orthopedics Department, King Faisal Medical Complex Taif, Taif, Saudi Arabia.
Orthop Res Rev. 2025 Jun 27;17:275-280. doi: 10.2147/ORR.S504536. eCollection 2025.
Congenital talipes equinovarus (CTEV), continues to rank among the most common congenital musculoskeletal deformities. The management of CTEV, particularly when it is part of a syndromic presentation or associated with conditions such as myelomeningocele (MMC), presents a significant challenge due to the deformity's tendency to be stiffer and more complex. Most children with CTEV may require surgical intervention. The current case report highlights the functional outcome of minimally invasive percutaneous surgical correction in a late-presenting, rigid, and severe foot deformity in an MMC patient, aiming to have accepted residual deformity that gave better function with less surgical complication.
A case involving an eight-year-old girl having a deformity in her left foot secondary to low lumbar level MMC was referred for management. The Pirani score total was 6, signifying a severe deformity according to received initial assessments. Upon review of treatment alternatives, minimally invasive percutaneous surgical correction was performed consisting of percutaneous plantar fascia release followed by Achilles tendon lengthening and flexor digitorum tenotomy. We followed up with the patient for one year for wound healing and functional outcomes. An early weight bearing in cast was achieved 1 week with walker frame. Removal of cast and application of custom walker orthosis for walking on the 6th week post-operation. Following up to one year, she is a walker, and residual deformity of the foot did not affect her mobilization.
As of the one-year follow-up, she is self-ambulatory, thanks to her custom walking orthosis. Residual deformity did not affect her functional outcome. We recommend further follow-up, and future surgery may be necessary if her deformity worsens.
The functional outcome, the social and economic status of the family, and the psychological impact on the patient significantly influence the selection of the most suitable method.
先天性马蹄内翻足（CTEV）仍然是最常见的先天性肌肉骨骼畸形之一。CTEV的治疗，尤其是当它作为综合征表现的一部分或与脊髓脊膜膨出（MMC）等疾病相关时，由于畸形往往更僵硬、更复杂，因此面临重大挑战。大多数CTEV患儿可能需要手术干预。本病例报告强调了在一名MMC患者晚期出现的、僵硬且严重的足部畸形中，微创经皮手术矫正的功能结果，旨在接受残留畸形，以获得更好的功能且减少手术并发症。
一名8岁女孩因低位腰椎水平的MMC导致左脚畸形，前来就诊。根据最初的评估，皮拉尼评分总计为6分，表明存在严重畸形。在评估了各种治疗方案后，实施了微创经皮手术矫正，包括经皮足底筋膜松解术，随后进行跟腱延长术和趾长屈肌腱切断术。我们对患者进行了一年的随访，观察伤口愈合情况和功能结果。术后1周使用助行架实现早期负重石膏固定。术后第6周拆除石膏，佩戴定制的助行矫形器行走。随访至一年时，她可以行走，足部的残留畸形并未影响她的活动能力。
截至一年随访时，由于佩戴定制的行走矫形器，她能够自行行走。残留畸形并未影响她的功能结果。我们建议进一步随访，如果她的畸形恶化，未来可能需要进行手术。
功能结果、家庭的社会经济状况以及对患者的心理影响显著影响最合适方法的选择。
