An external fixator and limited release in the treatment of neglected, recurrent, relapsed and resistant talipes equinovarus deformity of the feet
Aditya K Agrawal1, Manish R Shah1, Malkesh D Shah1, Neel H Patel2, Takshay Gandhi2, Sarvang M Desai1, Jagdish J Patwa1
1 Department of Orthopaedics, Dhiraj Hospital, Smt. BK Shah Medical Institute and Research Centre, Sumandeep, Vidyapeeth, Deemed to be University, Piparia, Waghodia, Vadodara, Gujarat, India
2 LG Hospital, Ellisbridge, Ahmedabad Gujarat, India
Dr. Aditya K Agrawal
MS Ortho, MCh (UK), Associate Professor, Department of Orthopaedics, Dhiraj Hospital, Smt. BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia Waghodia Vadodara - 391 760, Gujarat
Source of Support: None, Conflict of Interest: None
Introduction: The existence of resistant and neglected talipes equinovarus deformity of the foot is still prevalent in many parts of the world, serving as a challenge to an orthopedic surgeon to convert this complex deformity into a normal functioning foot. Our study aims to evaluate the results of our mid-path treatment in neglected, resistant, relapsed, and rigid clubfoot. Our treatment protocol's objectiveswere (1) the foot must become plantigrade at the end of the treatment. (2) Patient must be able to wear normal shoes. Patients and Methods: Our study included 35 feet belonging to 29 patients (six cases of bilateral congenital talipes equinovarus) aged between 2 years and 8 years with an average age of 4.8 ± 2.5 years. Our protocol includes soft-tissue release and frame fixation using a mini external fixator at the same time. After frame removal, an above-knee cast was given for 3 weeks. The average follow-up period was 3.8 ± 1.2 years. Results: We achieved excellent results in 30 cases, 3 cases had a fair result, and 2 cases had a poor result using Pirani score. Two cases had superficial infection and two cases required additional procedures. The average fixator duration was 10 weeks. Conclusion: Our mid-path protocol for managing neglected and rigid talipes equinocavovarus deformity has excellent outcomes with satisfactory patient compliance to the treatment with added advantages of rapid correction and decreased pain during and reduced external fixator duration. Level of Evidence: Level IV.