Adapting Joshi External Stabilization System for Congenital Talipes Equinovarus Correction: A Practical Solution for Unavailable Distractor Sizes
Surgical Technique | Volume 12 | Issue 2 | May-August 2026 | Page: 44-46 | Md Zafar Iqbal, Anil Agarwal, Shivank Khurana
DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.282
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2026; The Author(s).
Submitted: 17/01/2026; Reviewed: 10/02/2026; Accepted: 25/05/2026; Published: 10/08/2026
Authors: Md Zafar Iqbal [1], Anil Agarwal [1], Shivank Khurana [1]
[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India.
Address of Correspondence
Md Zafar Iqbal,
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi – 110031, India.
E-mail: docmdzafariqbal@gmail.com
Abstract
Congenital talipes equinovarus is a complex foot deformity that is principally corrected by gradual manipulation. The Joshi external stabilization system (JESS) fixator uses this principle of gradual correction by ligamentotaxis. The principal component of the JESS system is the distractor applied at multiple planes to achieve soft-tissue stretching, enabling gradual correction of the deformity. As recommended, the size of the JESS should be at least 2/3rd of the limb to get maximum outcome. However, situations may arise where the exact size of the distractor is unavailable, posing a challenge to achieving optimal correction. This article describes a practical solution involving the use of an additional Z-rod or L-rod, allowing the application of a smaller size distractor. This adaptation ensures continued correction of the deformity, ultimately benefiting patients with optimal outcomes.
Keywords: Clubfoot, Joshi external stabilization system fixator, distractor, adaptation, surgical tip, children.
References
1. Ponseti IV, Smoley EN. The classic: Congenital club foot: The results of treatment. Clin Orthop Relat Res 2009;467:1133-45.
2. Joshi BB, Prabhoo R, Kanaji BG, Kaushik. Management of Clubfoot by Joshi’s External Stabilization System (JESS). Uttar Pradesh: Jaypee; 2010.
3. Singh A. Evaluation of neglected idiopathic ctev managed by ligamentotaxis using jess: A long-term followup. Adv Orthop 2011;2011:218489.
4. Altaf KA, Shah SB, Ahmad S, Mumtaz U, Mantoo SA. Results of JESS (Joshi’s external stabilizing system) in relapsed, neglected and neurogenic clubfoot in an age group of 2-10 years. Ortop Traumatol Rehabil 2020;22:121-9.
5. Suresh S, Ahmed A, Sharma VK. Role of Joshi’s External Stabilisation System Fixator in the Management of Idiopathic Clubfoot. J Orthop Surg 2003;11:194-201.
| How to Cite this Article: Iqbal MZ, Agarwal A, Khurana S | Adapting Joshi External Stabilization System for Congenital Talipes Equinovarus Correction: A Practical Solution for Unavailable Distractor Sizes | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 44-46. |
