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).