Relapsed Equinovarus Complex deformity with Long Term Follow up
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Relapsed Equinovarus Complex deformity with Long Term Follow up


Managing  relapsed Clubfoot  with complex Equino varus components   can be extremely challenging. Usually most  of the equinovarus deformities respond well  to standard treatment protocol specially Ponsetti method and is widely accepted as well.  However a small percentage of  relapsed  complex equinovarus deformities are sometimes  extremely difficult to manage. Prior to managing,    proper evaluation is essential as while treating  these some difficulties are   inevitable. The radiological evaluation of foot  is must to decide extent of correction required. Such  extrinsic (relapsed, neglected )clubfoot,  intrinsic clubfoot  have rigid hind foot virus and  equines components .If not treated early then bony changes are faster specially deformation of talus, calcaneum  and metatarsals. Ligamentotaxsis lessens the pressure on these malpositioned, deformed tarsal  and is observed that distraction done before 6-7 years have got better results and prognosis. Fortunately there is a gradual decline in the incidence of neglected clubfoot here in  India after the child age of   eight to nine years. However in management of such cases the correction by ligamentotaxsis, arthrodiastasis is further better achieved when it is combined with bony procedures at a later stage if required. In the Long term follow up of 10 years, it was assessed that after the correction of deformity a proper static phase in the assembly  is essential  in order to prevent any further  reoccurrences. Significant radiological correction should be accessed after the removal of assembly  (Talocalcaneal AP ,Lat view along with talo first metatarsals angle).