Radiological Outcomes of Management of Congenital Clubfoot Using JESS

Background: Joshi’s external stabilizing system (JESS) is a useful option to correct the deformities in patients who present to the orthopedic department with neglected congenital talipes equinovarus, plaster of Paris drop out cases, or failed surgical procedures. Anteroposterior talocalcaneal angle, lateral talocalcaneal angle, and talocalcaneal index (TCI) are useful tools to assess the outcome of such corrective operations. Materials and Methods: A total of 16 children underwent 20 JESS procedures at the Department of Orthopaedics, J.J.M. Medical College, affiliated to Chigateri Government Hospital, Davangere and Bapuji Hospital, Davangere, during the period from September 2008 to September 2010. Patients were followed up regularly, and three dimensional corrections were achieved. Talocalcaneal angles (TCA) were measured from pre-operative and post-operative radiographs for each foot in anterior-posterior, and lateral views from which talocalcaneal indices were calculated. Results: Excellent results were obtained in 15 feet, good results in 2 feet, fair in 1 foot, and poor in 1 foot. The average preoperative and post-operative talocalcaneal indices were 29° and 53°, respectively. However, there was no correlation between the radiological parameters and the clinical outcome of each foot. Conclusion: TCA and TCI are simple parameters to compare pre-operative and post-operative radiographs but cannot be used to comment on the clinical severity of each case.