Triple Arthrodesis for Neglected Congenital Talipes Equinovarus: A Prospective Study of Functional Outcomes

Background: Neglected congenital talipes equinovarus (CTEV) in adolescents and young adults is associated with rigid deformity, pain, gait abnormalities, difficulty with footwear, and significant functional impairment. Triple arthrodesis is a well-established salvage procedure aimed at achieving a stable, plantigrade, and painless foot. However, evidence regarding its functional and radiological outcomes in neglected CTEV remains limited, particularly in developing countries where delayed presentation is common.

Objective: To evaluate the functional and radiological outcomes of triple arthrodesis in patients with neglected congenital talipes equinovarus.

Methods: A prospective observational study was conducted in the Department of Orthopaedics of a tertiary care teaching hospital between April 2022 and October 2023. Sixteen patients with neglected or old CTEV underwent triple arthrodesis involving fusion of the talonavicular, subtalar, and calcaneocuboid joints. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Visual Analog Scale (VAS) for pain. Radiological evaluation included measurement of the lateral calcaneal pitch angle (CPA), lateral talar–first metatarsal angle (T1stMTA), anteroposterior talar–first metatarsal angle, and talonavicular coverage angle (TNCA). Patients were followed for 5–6 months postoperatively.

Results: A total of 16 male patients with a mean age of 16.5 ± 1.71 years were included. The mean AOFAS hindfoot score improved significantly from 37.00 ± 4.32 preoperatively to 89.19 ± 2.17 at final follow-up (p = 0.00001). Mean VAS score decreased from 9.19 ± 0.65 to 0.50 ± 0.73 (p = 0.00001), indicating substantial pain relief. Radiological assessment demonstrated significant correction of deformity parameters. The mean calcaneal pitch angle improved from 8.00 ± 2.10° to 12.88 ± 1.86° (p = 0.00001), lateral talar–first metatarsal angle from 10.88 ± 3.50° to 4.06 ± 1.34° (p = 0.00001), anteroposterior talar–first metatarsal angle from 15.44 ± 4.18° to 2.88 ± 1.31° (p = 0.00001), and talonavicular coverage angle from 14.50 ± 7.28° to 1.19 ± 0.75° (p = 0.00001). At final follow-up, 81.2% of patients achieved excellent outcomes and 18.8% achieved good outcomes.

Conclusion: Triple arthrodesis is a reliable and effective salvage procedure for neglected congenital talipes equinovarus in adolescents and young adults. The procedure provides significant pain relief, substantial improvement in functional outcomes, and excellent radiological correction of deformity, resulting in a stable and plantigrade foot. Triple arthrodesis remains a valuable treatment option for rigid neglected clubfoot deformities.