A neonate is born with bilateral dorsiflexion of the feet with limited plantar flexion and inversion. Exam shows free mobility of the foot to passive manipulation. The nurse practitioner should recognize that

• A. The neonate has clubfoot
• B. Talipes equinovarus is present
• C. The neonate should be evaluated for developmental dysplasia of the hip
• D. The neonate should be evaluated for cerebral palsy

Answer: (D)

The situation highlights how to distinguish a fixed orthopedic deformity from a neuromotor pattern in a newborn. A clubfoot (talipes equinovarus) is a fixed, rigid deformity where the foot is typically inverted and plantarflexed and cannot be corrected with passive manipulation. In this case, the foot is dorsiflexed with limited plantar flexion and inversion, but it moves freely when gently manipulated, indicating there isn’t a fixed bony deformity. That mobility points away from a true clubfoot and toward a neuromuscular issue to consider.

When a newborn shows abnormal posture or tone that is not explained by a fixed foot deformity, it raises concern for central nervous system involvement. Cerebral palsy can present with atypical motor patterns and abnormal tone early in life, even though a formal diagnosis is made later. Therefore, evaluating for cerebral palsy—through a thorough neuromotor examination, monitoring tone, reflex persistence, symmetry, and subsequent motor development—is appropriate.

Developmental dysplasia of the hip would more likely present with hip-specific signs such as limited hip abduction or asymmetrical thigh folds and not the described foot mobility. So the best course here is to consider neurologic evaluation for CP rather than attributing the finding to an orthopedic hip deformity.