Published: 2019-02-23

A prospective study of neglected and resistant clubfoot cases treated using Joshi’s external stabilization system

Rajat Gupta, Krishan Kumar, Panshul Jugran


Background: Clubfoot is a common congenital deformity occurring in 1 to 2 per thousand live births. In relapsed or neglected clubfoot the deformities become fixed and treatment using conservative methods often fails. JESS (Joshi’s external stabilizing system) is a simple construct for the correction of deformity in these patients. The present study was taken up to assess the results of JESS fixator in correction of deformities in neglected, resistant or relapsed cases of clubfoot and deformities in the late presented patients.

Methods: The present study was conducted on randomly selected patients of clubfoot in the department of Orthopaedics, ESI Hospital, Basaidarapur, New Delhi between June 2014 and December 2017. A total of 22 feet (of 16 patients) suffering from neglected, resistant or relapsed clubfoot under the age of 7 years, were included in the study.

Results: Excellent results were obtained in 52% of cases, while 19% had good, 14.5% had fair and 14.5% had poor results. Complications encountered were temporary oedema in 10 feet, superficial pin tract infection in 5 feet, pin loosening in 3 feet, skin necrosis 2 feet and flexion contracture of toes in 2.

Conclusions: JESS application is an excellent technique for treatment of recurrent and neglected clubfoot. This procedure is ideally suited for children in whom the clubfoot deformities remain uncorrected by POP casts and manipulation, as well as for recurrent clubfoot cases.


CTEV, Clubfoot, JESS

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Lehman WB. The Clubfoot. J.B. Lipincott Company; 1980.

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.

Turco VJ. Resistant congenital clubfoot. One stage posterromedial release with internal fixation. A Follow up report of a 15-year experience. J Bone Surg (Am). 1979;61:805.

ASAMI group. Operative principles of llizarov. Williams and Wikins; 1991.

Grill F, Frankie J. The llizarov ditraction for correction of relapsed or neglected clubfoot. JBJS. 1987;69:693-7.

Paley D. Complex foot deformity correction using the lizarov circular external fixator with distraction but without osteotomy. The Clubfoot the present and a view of the future. Ed. Simons, G.W. Springer Verlag; 1994.

Joshi BB, Laud NS, Warrier S, Kanaji BG, Joshi AP, Dabake H. Treatment of CTEV by Joshi’s external stabilization system (JESS). In: Kulkarni GS, editor. Textbook of orthopaedics and trauma, 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 1999.

Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital clubfoot. J Bone Joint Surg Am. 2002;84(2):290-308.

Suresh S, Ahmad A, Sharma VK. Role of Joshi’s external stabilization system fixator in the management of idiopathic club foot. J Orthop. 2003;11:194-201.

Oganesian OV, Istomina IS. Talipes equinocavovarus deformities corrected with the aid of a hinged-distraction apparatus. Clin Orthop Relat Res. 1991;266:42-50.

Bradish CF, Noor S. The Ilizarov method in the management of relapsed club feet. JBJS (Br). 2000;82:387-91.

Anwar Marthya H, Arun B. Short term results of results of correction of CTEV with JESS Distractor. J Orthop. 2004;1:3.