Comparative study of complete subtalar release and Joshi's external stabilization system in the management of neglected and resistant idiopathic clubfoot

Abstract

Background: Various procedures have been used for the management of neglected and resistant clubfoot. The aim of our study was to assess the clinical and radiological correction by Joshi's external stabilization system (JESS fixator) and Simons subtalar release in resistant and neglected idiopathic congenital talipes equinovarus in children between the ages of 1 and 2 years.

Methods: A total of 50 resistant and neglected clubfeet were randomly divided into two equal groups of 25 feet each. Group I was treated with JESS fixator and group II was treated with complete subtalar release as described by Simons. Assessment of correction achieved was done both clinically and radiologically. Functional outcome was assessed with Ponseti scale.

Results: The change in clinical deformity and radiological correction of deformity were statistically significant within each group, but not significant when compared to each other. In group I excellent results were obtained in 17 (68%) and good in 8 (32%) of the feet. In group II, excellent results were found in 16 (64%) and good in 9 (36%) feet out of the 25 feet. Pin-site infections were seen in two cases in group I and serious skin problems occurred in two feet in group II.

Conclusion: We conclude that there were no statistical significant differences between the outcomes of the two techniques in this short-term follow-up of 2.4 years. Thus, functional distraction using JESS can be utilized as an alternative method in cases of neglected and resistant clubfoot.

Keywords: Clubfoot; External fixator; Ilizarov; JESS; Surgery.