Conclusion

Severe rigid equinovarus deformity is a clinically significant, under-recognized complication of CS that can render affected children non-ambulatory. This case demonstrates that safe, effective surgical correction via bilateral fractional Achilles tendon elongation is achievable even with significant hepatic dysfunction, provided management follows a structured multidisciplinary perioperative strategy with the strict avoidance of hepatotoxic agents and conservative titration of anesthetic and analgesic drugs. This report offers a practical clinical template for orthopedic surgeons and a foundation for future collaborative studies aimed at evidence-based surgical guidelines for this vulnerable population.