Simultaneous lateral column shortening along with differential distraction by Joshi's external stabilization system for rigid neglected clubfoot correction.

Abstract

Correction of rigid clubfoot in an older child by gradual differential distraction using the Ilizarov's device or Joshi's external stabilization system (JESS) is a time-consuming procedure. We simultaneously combined the lateral column shortening by cuboid wedge resection along with the differential distraction by application of JESS fixator for the treatment of severe, rigid, neglected, or relapsed congenital talipes equinovarus (CTEV) foot deformity in 30 feet in 18 children with mean age of 5.3 years and mean follow-up of 27.6 months. The mean pretreatment Pirani score was 5.3 which improved to mean Pirani score after treatment of 1.4. Excellent results were obtained in 22 (71.33%) feet, good results in four (13.33%) feet, and poor results in four (13.33%) feet. The average period for distraction in our series was 6.3 weeks, and total average period of fixator in place was 11.2 weeks. To conclude, lateral column shortening with JESS application simultaneously gives early good to excellent short-term results, and the combination of techniques permits rapid correction of deformity, and thus reducing the time for which the fixator is in place and hence has better acceptance by the patient.