Comprehensive Analysis and Surgical Management of Neglected Congenital Talipes Equinovarus Using the Joshi's External Stabilizing System: A 3-Year Longitudinal Case Study and Biomechanical Review.

INTRODUCTION

Neglected congenital talipes equinovarus (CTEV) presents a formidable challenge in pediatric orthopedics, characterized by rigid soft-tissue contractures and adaptive bony changes that occur when the deformity remains untreated past the walking age. While neonatal clubfoot is successfully managed via the Ponseti method, delayed presentations require interventions that can address fixed skeletal remodeling without the morbidity of extensive posteromedial releases. This report analyzes a single case of a child with neglected CTEV treated with the Joshi's external stabilizing system (JESS), following the patient from the pre-operative state through a 3-year follow-up period.

CASE REPORT: A 3.5-year-old female presented with an uncorrected, unilateral, neglected idiopathic clubfoot. The clinical examination revealed a rigid, non-reducible deformity with a Pirani score of 6.0 and a Dimeglio score of 18 (Grade IV). Severe equinus, varus, cavus, and forefoot adduction were present, complicated by a large lateral-border callosity. Treatment involved the surgical application of the JESS fixator using a three-stage frame assembly. A protocol of fractional differential distraction was initiated postoperatively, distracting the medial side at twice the rate of the lateral side (1 mm/day vs. 0.5 mm/day) over 6 weeks, followed by a 6-week static stabilization phase.

CONCLUSION

By the 3-year follow-up, the patient achieved a painless, plantigrade, and functional foot with significantly improved radiological indices. The talocalcaneal angles in both anteroposterior and lateral views normalized, and the patient demonstrated excellent range of motion compared to historical outcomes of open soft-tissue procedures. This case underscores JESS as a versatile, minimally invasive, and effective modality for managing the complex biomechanical demands of neglected clubfoot in low-resource and delayed-presentation settings.