Management of Neglected Congenital Talipes Equinovarus: A Report from Practical Experience in Sokoto, Nigeria

Abstract

Backgrou nd: Early-presenting Congenital Talipes Equinovarus (CTEV) is usually corrected non-operatively with the Ponseti method, achieving excellent outcomes. Neglected CTEV (NCTEV), however, is challenging and often requires surgery. Ob jectives: These are to: 1) describe clinical profiles, reasons for neglect, and treatments among NCTEV presenting after walking age; 2) assess functional satisfaction, anatomical outcomes, and quality of life after treatment; 3) examine effects of age at presentation, deformity rigidity, and anaesthesia choice on outcomes; and 4) document common surgical complications. Method s: A retrospective descriptive cross-sectional review was conducted on NCTEV cases treated surgically at Usmanu Danfodiyo University Teaching Hospital, Sokoto (July 2018-June 2025). Patients included in the study were aged ≥2 years, had primary NCTEV with surgical treatment, complete records, and ≥9-month follow-up. Exclusion criteria were incomplete data, secondary clubfoot, and non-surgical care. Data (demographics, causes of neglect, Pirani score, prior care, operative details, post-operative care, complications, outcomes like plantigrade foot, ambulation, and cosmesis) were extracted using a structured form and analysed in SPSS version 25 (p < 0.05). Confidentiality was maintained; consent was waived per institutional ethics for retrospective studies. Results: Of 126 surgical clubfoot patients, 58 (46%) met criteria, aged 3 - 23 years (mean = 13.9). Females were 65.5% (F:M = 1.9:1). A total of 103 feet were affected: 45 bilateral, 9 left, and 4 right. All presented with poor Pirani score (≥5.5). All had abnormal gait: 62.1% crawled; 37.9% walked on the dorsum. Deformities included equinus, cavus, varus, and adduction, with rigid hypoplastic feet being common. Main reasons for neglect were multi-factorial, with poor awareness (82.8%), socioeconomic barriers (79.3%), insecurity (62.8%), and limited access to care (72.4%). All had initial but failed non-operative care and underwent surgery and by 6 months, all walked erect largely with support; by 9 months, all walked independently. Subarachnoid block was accepted by 67% (≥8 years). Challenges included financial constraints (84.5%), long travel distance (63.8%), insecurity (69.0%) and low parental education (70.7%). Complications were infrequent and manageable. Conclusion: Tailored surgical management of NCTEV yields excellent functional and psychosocial outcomes. Age influences deformity severity and shared decision-making. Multi-factorial neglect necessitates early case finding, public education, and strengthened primary orthopaedic services to reduce NCTEV.