Bilateral Clubfoot in Nail-Patella Syndrome: A Rare Syndromic Case Successfully Treated with the Ponseti Method

Nail-patella syndrome (NPS) is a rare autosomal dominant disorder characterized by nail dysplasia, hypoplastic or absent patellae, elbow anomalies, and iliac horns. Its association with congenital talipes equinovarus, or clubfoot, is extremely uncommon and rarely documented.

We describe a 1.5-year-old male child, born of a 2° consanguineous marriage, who presented with bilateral clubfoot and complete absence of fingernails. Great toenails were absent bilaterally, whereas the remaining toenails were preserved. The patellae were non-palpable clinically, and ultrasound confirmed the absence of ossification centers bilaterally. Radiographs revealed bilateral iliac horns. Ponseti casting was initiated at 2 months of age, and full correction was achieved after five casts, followed by bilateral percutaneous Achilles tenotomy. At 6-month follow-up, the patient exhibited plantigrade, pain-free feet with good dorsiflexion and no recurrence.

NPS can occasionally be associated with flexible clubfoot, which may respond well to conservative management. The Ponseti method, when initiated early, remains an effective option in such rare syndromic presentations.