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| LETTER TO EDITOR |
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| Year : 2019 | Volume
: 5
| Issue : 3 | Page : 196-197 |
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Tripping over deformed feet: Neglected aspect of neglected deformities
Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
| Date of Submission | 18-Jan-2019 |
| Date of Decision | 09-Feb-2019 |
| Date of Acceptance | 15-Feb-2019 |
| Date of Web Publication | 24-Dec-2019 |
Correspondence Address:
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/IJAM.IJAM_1_19
How to cite this article:
Dharmshaktu GS. Tripping over deformed feet: Neglected aspect of neglected deformities. Int J Acad Med 2019;5:196-7 |
To the Editor,
Congenital foot disorders may subsequently lead to severe deformity and subsequent morbidity that significantly affects the quality of life. Better plaster methods have decreased the burden of persistent deformity by excellent nonsurgical correction at the earliest. Despite widespread availability of treating facilities, many cases remain untreated for various reasons. Old, untreated adult cases living with various dreadful sequelae and suboptimal quality of life are prevalent in developing countries. Tripping over the deformed feet in daily life is an underappreciated clinical problem in such cases.
Neglected long-standing deformities have serious late complications that may adversely affect the quality of life. Clubfoot or congenital talipes equinovarus has been a common congenital deformity presenting with striking inward bent feet with characteristic deformities in unilateral or bilateral form. Most of the cases with this deformity are treated and managed since birth with proper plaster casting. The deformity if managed early has high success rate with improved and accepted methods of corrective casting like Ponseti technique.[1] Untreated or neglected deformity not only affects gait and quality of life but also may lead to severe painful arthritis in advanced age. There are a handful of cases which are misdiagnosed or untreated, especially in developing countries with lack of training in primary health centers.[2] There, however, are limited data available on neglected clubfoot cases with regard to clinicoradiological features and complications over time and its long-term effects. There is a paucity of information about the incidence of fractures in these surviving adult cases, and the authors could not find one.
A 70-year-old female presented with pain, swelling, and superficial abrasions over the right leg following tripping while walking over the deformed feet. She had bilateral neglected clubfeet with a history of no treatment till date [Figure 1]a. Ignorance and nonavailability of health care was the reason of neglected deformity. She had no other associated disorder, and she adapted herself to perform activities of daily living by herself. Radiographs, though could not be done in true lateral and anteroposterior views, revealed minimally displaced fracture of both bones of the leg in the middle third region, representing low-energy fracture [Figure 1]b and [Figure 1]c. She was managed with anterolateral distal tibia locking plate with no remarkable perioperative complications. Active knee and ankle physiotherapy were started while fracture united in gradual follow-up [Figure 2]a and [Figure 2]b with optimal return of preinjury status of mobility and function. The patient declined any management of her long-standing clubfeet despite the fact that the deformity now gave her a painful ambulation. | Figure 1: The untreated bilateral clubfoot deformity in a septuagenarian female (a) with radiograph showing fracture of both bones of the leg (b and c)
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Neglected or untreated clubfoot is a major problem in developing countries with sizeable number of people living with clubfoot.[3] These cases may not only affect gait but also may expose feet to various injuries. The pain, overlying skin problems, disability, joblessness, and discrimination are other issues related to long-standing deformity.[4] Literature, however, is scant regarding fractures in adult cases of clubfoot. The other thing that poses challenge in managing the cases of fractures is the abnormal shape of foot creating problems in the standard application of plaster splints and due compliance. The pressure ulcers that are potential complication in long-standing clubfoot were fortunately absent in our case. There have been reported attempts of surgical interventions including osteotomies in the correction of adult clubfoot cases.[5] There are few reports of fractures in association with clubfoot, but only during treatment in children.[6] Fractures in elderly case with long-standing deformity is not reported in the literature. A good study, however, is required to assess true burden of such cases and their problems, especially from developing nations in the future.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am 1992;74:448-54.  |
| 2. | Dharmshaktu GS, Dar AJ, Bhandari SS. Are we still misdiagnosing clubfoot? Are we still misdiagnosing clubfoot? A study of non-clubfoot cases labeled or referred as clubfoot from primary care centres in Uttarakhand. Indian J Child Health 2018;5:249-52. |
| 3. | Akintayo OA, Adegbehingbe O, Cook T, Morcuende JA. Initial program evaluation of the ponseti method in Nigeria. Iowa Orthop J 2012;32:141-9. |
| 4. | Adegbehingbe OO, Adetiloye AJ, Adewole L, Ajodo DU, Bello N, Esan O, et al. Ponseti method treatment of neglected idiopathic clubfoot: Preliminary results of a multi-center study in Nigeria. World J Orthop 2017;8:624-30. |
| 5. | Sobel E, Giorgini R, Velez Z. Surgical correction of adult neglected clubfoot: Three case histories. J Foot Ankle Surg 1996;35:27-38. |
| 6. | Volz R, Paulsen M, Morcuende J. Distal tibia/fibula fractures following clubfoot casting – Report of four cases. Iowa Orthop J 2009;29:117-20. |
[Figure 1], [Figure 2]
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