Case Study

Club Foot

  • case-study-club-foot-01
  • case-study-club-foot-02
  • case-study-club-foot-03
  • case-study-club-foot-04
  • case-study-club-foot-05
  • case-study-club-foot-06

Case Narrative

Sarah was our last patient of the day. She came with her husband, a military officer, and they were excited to see their baby on screen. This is her first pregnancy and they had only seen the baby one time before at 10 weeks along. She was now 22 weeks and eager to find out the sex. All of our students took turns scanning and as we were reviewing head measurements, abdominal circumference, placenta, etc… I noticed that the foot was in an odd position. The baby was breech so I assumed it was because the feet were crossed and pressing up against the lower uterine segment. We moved on and discovered they are having a boy! Dad was so proud. He stood up tall and said, “I knew it.” The joy didn’t last long as I instructed our 2nd year resident to look closely at the baby’s feet. He did and I knew immediately that it was a bilateral clubfoot otherwise known as talipes equinovarus. I began asking mom questions and she calmly mentioned that her brother and grandfather both had a clubfoot. We confirmed the findings when I scanned and the baby stretched. Mom was extremely calm and confident that this is a very fixable problem. Dad, however, had entered into an entirely new territory. He felt the panic that only a parent understands. It begins with pregnancy and continues through different phases of their lives. The realization of the shear love you have for this human being and the powerlessness you have. It is the intersection of love, fear, joy, and panic. Welcome to parenthood!

Featured Course

Intermediate OB Ultrasound
This course provides and in depth evaluation of the 2nd trimester gestation.
VIEW TRAINING COURSE

Case Study Details

Patient Information
Patient Information
Age 26
Gender Female
Ethnicity Caucasian
Symptoms (described) No symptoms. 2nd Trimester pregnancy
Additional Symptoms (observed)
Health Status Healthy
Evaluation
Evaluation
Prior tests ordered 10wk ultrasound only
U/S ordered 2nd Trimester Exam performed
Additional testing ordered
U/S performed by OnSite Students/Julie Gaston BS, RDMS, RVT
U/S was read by n/a
Scanning Protocol
Scanning Protocol
Describe (where, when, how): Basic 2nd trimester screening protocol including measurements, placenta assessment, cervical length, outflow tracts, and anatomy.
What equipment was used? Zonare
What technique did you feel was most important for this exam? If I did not look at the lower leg bones and check the feet I could have easily missed this finding. It shows the importance of being vigilant and not cutting corners.
Outcome
Outcome
Results Bilateral clubfoot -Patient being referred to Stanford for further testing.
Note Will follow up.
Diagnosis Talipes Equinovarus or Clubfoot, to be confirmed with a full diagnostic ultrasound.
Risk factors include:

  • Sex. Clubfoot is more common in males.
  • Family history. If you, your spouse or your other children have had clubfoot, your baby is more likely to have it as well.
  • Smoking during pregnancy. If a woman with a family history of clubfoot smokes during pregnancy, her baby’s risk of the condition may be 20 times greater than average
Treatment
Newborn’s bones and joints are flexible; treatment for clubfoot usually begins soon after birth.

Treatment options include:

  • Stretching and casting (Ponseti method)
  • Stretching and taping (French method)
  • Surgery

Even with treatment, clubfoot may not be totally correctable. But in most cases when treatment happens early, these children grow up to wear normal shoes and lead normal, active lives. In this case, the specific treatment method is unknown. It will likely be decided by the volunteer, her spouse and their medical team.

Follow-up
Patient’s OB/Gyn was notified of the finding on Monday via phone. Patient is being referred for additional testing and follow up is pending the test results.
Patient Outcome
Pending

Tell Us Your Story

We want to hear how you are using Ultrasound to improve patient care. Email Us Your Story