History:

Patient came for prenatal ultrasound scan at 20 weeks

Ultrasound Findings:

• Both feet are seen in an abnormal inward rotation with the sole of the foot facing medially, often described as “equinovarus” deformity.
• Abnormal orientation of the talus and calcaneus is seen, with a lack of normal alignment between these bones.
• The ankle joints show restricted movement, which can be seen as reduced dorsiflexion.

Diagnosis:  Bilateral congenital talipes equinovarus (CTEV).

Differential Diagnosis:

1. Positional Clubfoot: Feet appear turned inward but without structural bone abnormalities, usually due to intrauterine compression, and resolve spontaneously after birth.
2. Syndromic CTEV (e.g., Spina Bifida): Clubfoot associated with neurological or spinal abnormalities, such as spina bifida, which may present with other anomalies on ultrasound.
3. Arthrogryposis Multiplex Congenita: Characterized by joint contractures, including clubfoot, along with abnormalities of other limbs.

Discussion:

Bilateral congenital talipes equinovarus is a common congenital anomaly and can occur as an isolated condition or be associated with other congenital syndromes. Early detection via ultrasound allows for parental counseling and consideration of postnatal treatment options, which typically involve serial casting or corrective surgery.

Conclusions:

Ultrasound findings of inward foot rotation, restricted ankle movement, and abnormal bone orientation are characteristic of bilateral congenital talipes equinovarus. Prenatal identification enables early intervention to achieve functional correction after birth.