Management of Relapsed, Residual, and Resistant Idiopathic Congenital Talipes Equinovarus

Congenital talipes equinovarus (CTEV) is a common pediatric deformity, with conservative management being the primary method of management. Even with appropriate management of CTEV, relapses can still occur, and some cases may present with residual deformities or prove resistant to treatment. The cause of these conditions is multifactorial, and there exists a difference of opinion regarding the management of such cases. The study aimed to provide clinically relevant outcome data in this specific and less frequently encountered population. The relatively small sample reflects the rarity of idiopathic relapsed, residual, and resistant CTEV and provides valuable preliminary data to guide future larger studies.

This prospective, descriptive, observational study included 33 clubfeet in 25 patients presenting with relapsed, residual, or resistant CTEV between July 2022 and June 2024. Patients were treated with either Ponseti's method, including serial manipulation, casting, and tendo-achilles tenotomy, or Joshi's external stabilization system (JESS), a minimally invasive external fixation technique. Pre- and post-correction outcomes were assessed using the Pirani and Dimeglio scoring systems. Data on treatment compliance, complications, and outcomes were analyzed.

The mean age of patients was 44.6 months, ranging from 9 months to 8 years. Among 33 feet, 19 were classified as relapsed (59%), 9 as residual (28%), and 5 as resistant CTEV (13%). Ponseti's method was used for 45.45% of feet, and JESS for 54.55%. Post-correction Pirani scores improved significantly (mean pre-correction 4.11, post-correction 0.55; P < 0.001). Similarly, Dimeglio's scores improved (mean pre-correction 13.22, post-correction 2.88; P < 0.001). Complications were minimal and manageable, including cast slippage and pin-tract infections. JESS demonstrated superior outcomes for older children with more severe deformities.

Both Ponseti's method and JESS are effective for managing relapsed, residual, and resistant CTEV, with JESS particularly beneficial for older children. Recurrence is commonly associated with inadequate bracing and follow-up. Comprehensive management, including early treatment, patient education, and consistent follow-up, is crucial for achieving and maintaining correction.