The patient came to the clinic 29-July-2017 complaining of both feet deformity since birth, more pronounced in the right foot with pes equina varus with tendency to fall due to wrong steppage in the right foot. He is the 4th baby in the family with no family history for such condition. He was born prematurely through Caesarian section and was in incubator for one month with jaundice. He has delayed milestones, and squint left eye, wearing glasses. He started walking at 3 years age with frequent fall due to feet deformity. 

On examination, the patient has normal higher brain functions, with normal upper limbs down to normal knees, but spastic lower limbs and gross pes equina varus both feet more the right, with limited dorsiflexion of the foot and tendency to fall due to right foot deformity.

The patient was sent for investigations. MRI of the brain performed 01-August-2017 showing periventricular ischemic changes, normal MRI of the whole spine.

 Z-plasty elongation of the right Achill's tendon. The insertion of the the right tibialis tendon was exposed in the right foot. Exposure of the same tendon at the lower third of the right foreleg. The tendon was split in 2 parts. The lateral part was transferred to the cuboid of the right foot using the C-arm and was fixed to the tunnel created in the cuboid bone with 2 zero Ethicon fixed at the bottom of the right foot. Routine closure of the wounds and n above knee cast applied with maximum dorsiflexion of the foot.

Smooth postoperative recovery. The patient was sent to the ward.

The patient has residual of cerebral palsy with spastic diplegia with club feet, more the right causing him falling during walk. Surgical correction of the deformed foot is the best way to correct this deformity by elongation the stretched tendons and transferring the others.