Hypothesis 2

There could have been crushing injury to the phalangeal bones along with matacarpal fracture, induced by trauma  and chain pressure during delivery.  This would cause disruption to the involved joints (metacarpal- phalangeal and interphalangeal joints), both in terms bone maturation and growth and inflammation of the joint capsule.  Uneven pressure resulting from the injury and accumulation of fluid in joint capsules  could cause uneven growth in the metacarpal bone (pathologic compression inhibiting growth on the lateral aspect of the metacarpal bone).  This, in combination with restriction of the bones in an abnormal position during bandaging caused development of iatrogenic valgus deformity.    

The superficial wounds on the skin look  very much like they resulted from pressure necrosis.  The excessive pressure that caused those lesions would also have compromised blood flow to the area, increasing the potential for septic infection.  Systemic sepsis may have resulted with secondary septic infection of the joint.  We have evidence of a septic process going on in the area because of the purulent discharge and draining tracts.  The elevated TPR are supportive of sepsis. 

The fibrotic bands, helping to pull the foot into an abnormal position, are most likely extensor tendons that have have contracted due to lack of weight bearing.  Local inflammation would lead to fibrin deposition, producing adhesions between the tendons and tissues on dorsum of the foot.