Am Fam Physician. 2016 Aug 15;94(4):314-316.
A female infant was born at 35 weeks' gestation by spontaneous vaginal delivery, following induction of labor for premature rupture of membranes. The pregnancy was otherwise uncomplicated. The newborn required three minutes of positive pressure ventilation, but transitioned well on room air over the next hour and did not require further treatment in the neonatal intensive care unit.
At the time of birth, physical examination showed that the newborn's right foot was grossly externally rotated (Figure 1). There was no crepitus on palpation of the foot, ankle, or leg, and a bilateral hip examination was unremarkable. The newborn spontaneously dorsiflexed and plantar-flexed the foot. The foot could be easily moved into normal alignment with gentle traction but returned when released. Her legs were equal in length. There were no dysmorphic features, no evidence of sacral dimple, and no signs of spina bifida. The remainder of the physical examination, including musculoskeletal and neurologic findings, was normal.
Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?
A. Congenital vertical talus.
B. Paralytic calcaneus foot deformity.
C. Posteromedial bowing of the tibia.
D. Talipes calcaneovalgus.
E. Talipes equinovarus.
REFERENCESshow all references
1. Widhe T, Aaro S, Elmstedt E. Foot deformities in the newborn— incidence and prognosis. Acta Orthop Scand. 1988;59(2):176–179....
2. Sarwark JF. Essentials of Musculoskeletal Care. 4th ed. Rosemount, Ill.: American Academy of Orthopaedic Surgeons; 2010:1042–1044.
3. Graham JM, Sanchez-Lara PA. Smith's Recognizable Patterns of Human Deformation. 4th ed. Philadelphia, Pa.: Elsevier; 2016:30–33.
4. Westcott MA, Dynes MC, Remer EM, Donaldson JS, Dias LS. Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics. 1998;12(6):1155–1173.
5. Keret D, Ezra E, Lokiec F, Hayek S, Segev E, Wientroub S. Efficacy of prenatal ultrasonography in confirmed club foot. J Bone Joint Surg Br. 2002;84(7):1015–1019.
6. Bridgens J, Kiely N. Current management of clubfoot (congenital talipes equinovarus). BMJ. 2010;340:c355.
This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.
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