A study on functional outcomes of ‘Joshi’s external stabilization system distractor’ in the correction of deformities in neglected, resistant or relapsed cases of congenital talipes equinovarus

Rajesh Kumar Sharma; Anuradha Upadhyay

doi:10.18203/issn.2455-4510.IntJResOrthop20250463

Authors

Rajesh Kumar Sharma Department of Orthopaedics, P.D.U. Medical College and D.B. Hospital, Churu, Rajasthan, India https://orcid.org/0000-0002-3336-3006
Anuradha Upadhyay Department of Physiology, S. K. Govt. Medical College, Sikar, Rajasthan, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20250463

Keywords:

Congenital talipes equino varus, Club foot, Joshi’s external stabilization system distractor, Pirani score

Abstract

Early intervention by an optimal treatment modality in the management of congenital talipes equinovarus (CTEV) or club foot is of paramount importance in order to preserve the functional efficacy of foot. Neglected, resistant, or relapsed cases of clubfeet are even more challenging to treat, as with time the deformities become fixed and the feet develops secondary adaptive bony changes. Joshi’s external stabilization system (JESS) distractor is an effective treatment modality for such kind of deformities with a precise viability and efficacy. This case series study was conducted to evaluate the functional outcomes of JESS distractor in the correction of the deformities in neglected, resistant or relapsed cases of CTEV and to assess the complications associated with the procedure. Total 22 club feet (15 patients) included in this case series considering inclusion and exclusion criteria. JESS distractor was applied and distraction done as per distraction schedule, followed by its removal and corrective cast application. Functional outcome was based on the Pirani score with one year follow-up. The statistically significant (p value <0.05) improvement was found in all clinical and radiological parameters after the procedure in all the post-operative patients. Pirani score improved to good score (0-2) in comparison to its pre-operative poor score (5-6) without any significant complication. Considering the parents compliance, JESS distractor is a good alternative for neglected, resistant or relapse cases of club feet, as it avoids soft tissue as well as bony procedures to correct the deformity of CTEV while preserving the normal foot anatomy.

Metrics

Metrics Loading ...

References

Atar D, Lehman WB, Grant AD. Excision of the posterior tibial tendon during clubfoot release. Foot & Ankle. 1993;14(3):123-4. DOI: https://doi.org/10.1177/107110079301400302

Dimeglio A. Classification of talipes equinovarus. In The clubfoot: the present and a view of the Future. New York, NY: Springer New York. 1994: 92-93. DOI: https://doi.org/10.1007/978-1-4613-9269-9_18

Pirani S. A method of evaluating the virgin clubfoot with substantial inter-observer reliability. POSNA Miami, Florida, 1995: 85.

Ikeda K. Conservative treatment of idiopathic clubfoot. Journal of Pediatric Orthopaed. 1992;12:217-23. DOI: https://doi.org/10.1097/01241398-199203000-00012

Grill F, Franke J. The ilizarov distractor for the correction of relapsed or neglected clubfoot. J Pediatr Orthop. 1988;8(1):120. DOI: https://doi.org/10.1097/01241398-198801000-00033

Makhdoom A, Qureshi PAL, Jokhio MF, Siddiqui KA. Resistant clubfoot deformities managed by Ilizarov distraction histogenesis. Indian J Orthop. 2012;46(3):326–32. DOI: https://doi.org/10.4103/0019-5413.96385

Ponseti IV, Smoley EN. Congenital clubfoot-the results of treatment. The J Bone and Joint Surg. 1963;45(2):134–41. DOI: https://doi.org/10.2106/00004623-196345020-00004

Irani RN, Sherman MS. The pathological anatomy of idiopathic clubfoot. Clin Orthop Relat Res. 1972;84:14–20. DOI: https://doi.org/10.1097/00003086-197205000-00004

Diaz VA, Diaz VJ. Pathogenesis of Idiopathic Clubfoot. Clin Orthop. 1984;185:14–24. DOI: https://doi.org/10.1097/00003086-198405000-00004

Herzenberg JE, Carroll NC, Christofersen MR, Lee EH, White S, Munroe R. Clubfoot analysis with three-dimensional computer modeling. J Pediatr Orthop. 1988;8(3):257–62. DOI: https://doi.org/10.1097/01241398-198805000-00001

Crawford AH, Gupta AK. Clubfoot controversies: complications and causes for failure. Instr Course Lect. 1996;45:339–46.

Pous JG, Dimeglio A. Neonatal surgery in clubfoot. Orthopaedic Clinic of NA. 1978;9(1):233. DOI: https://doi.org/10.1016/S0030-5898(20)30894-4

Lovell WW, Hancock C. Treatment of congenital talipes equinovarus. Clinical Orthop 1970;70:9. DOI: https://doi.org/10.1097/00003086-197005000-00009

Turco VJ. Surgical correction of the resistant clubfoot. One stage posteriomedial release with internal fixation. A preliminary report. J Bone Joint Surg (Am). 1971;53:477. DOI: https://doi.org/10.2106/00004623-197153030-00005

Turco VJ. Resistant congenital clubfoot. One stage posteromedial release with internal fixation. A Follow up report of a 15-year experience. J Bone Joint Surg (Am). 1979;61:805. DOI: https://doi.org/10.2106/00004623-197961060-00002

Grill F, Frankie J. The Ilizarov distraction for correction of relapsed or neglected clubfoot. JBJS. 1987;69:593-7. DOI: https://doi.org/10.1302/0301-620X.69B4.3611163

Paley D. Complex foot deformity correction using the Ilizarov circular external fixator with distraction but without osteotomy. In The Clubfoot: The Present and a View of the Future. New York, NY: Springer New York. 1994: 297-318. DOI: https://doi.org/10.1007/978-1-4613-9269-9_57

Sharma RK, Sharma AK, Dhawan HL, Balawat AS. A prospective study of management of infected non-union of tibia using ilizarov technique: our results and complications. Natl J Clin Orthop. 2020;4:100-4. DOI: https://doi.org/10.33545/orthor.2020.v4.i1b.207

Zuber M, Jahan I, Kumar S. Management of congenital talipes equinovarus by Ponseti method. J Evol Med Dental Sci. 2014;3(53):12344-58. DOI: https://doi.org/10.14260/jemds/2014/3631

Shinde A, Kamble S, Shah S, Shinde R. A clinical study of ligamentoaxis using an external fixator, modified frame in the management of a neglected, relapsed, resistant older congenital Talipes Equino varus child. Med j Dr D Patil Univ. 2013;6(3):274. DOI: https://doi.org/10.4103/0975-2870.114661

Cantin MA, Fassier F, Morin KB. The Ilizarov External fixator in severe foot deformities. Preliminary results. The clubfoot. The present and the view of the future. Ed. Simons G. W. Springer Verlag.1994: 293-297. DOI: https://doi.org/10.1007/978-1-4613-9269-9_56

Bradish CFS, Noor S. The Ilizarov method in the management of relapsed club feet J Bone Joint Surg. 2000;82:387-91. DOI: https://doi.org/10.1302/0301-620X.82B3.0820387