Distal Tibial Epiphyseal Separation during Ponseti Casting in a Non-idiopathic Clubfoot- ACase Report

INTRODUCTION: Non-idiopathic clubfeet are more rigid compared to idiopathic clubfeet and usually require operative correction. Recent reports favor Ponseti casting in these feet. Iatrogenic fractures during and after casting have been reported in the literature but epiphyseal separation and subperiosteal ossification have not been reported earlier. CASE REPORT: A3-year-old female child presented with untreated bilateral clubfeet and lumbosacral myelomeningocele. She was treated by Ponseti casting. During the casting session, we noticed swelling and deformity in the left leg and feet. After X-ray, distal tibial, fibular epiphyseal separation, and displacement were noticed. She was treated by manipulation and casting and final correction achieved by bilateral tendoachilles tenotomy. CONCLUSION: Ponseti casting for non-idiopathic clubfeet may develop epiphyseal displacement of distal tibia and fibula; hence, any abnormal swelling and deformity need to be evaluated by radiograph.