Functional Outcomes of Minimally Invasive Percutaneous Surgical Correction of Late-Presenting Severely Deformed Foot in a Patient with Myelomeningocele.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.