Publication:

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

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.