Correction of complex foot deformities after skeletal maturity using the Ilizarov external fixator

ABSTRACT

There are many drawbacks to the use of conventional approaches in treating complex foot deformities especially after skeletal maturity, like the increased risk of neurovascular injury, soft-tissue injury, major skin problems, and the shortening of the foot. An alternative approach that can eliminate these problems is the Ilizarov method. In the current study, a total of 13 severely deformed feet in 12 patients [all had equines, varus and metatarsus adductus] were treated using the Ilizarov method. The etiologic factors were neglected and relapsed clubfeet, post traumatic cases and poliomyelitis. The patient's mean age was 24.5 [20-39] years. We performed corrections without osteotomies or soft tissue releases using a bloodless technique. The mean duration offixator application was 4.6 [3.5-6] months. At the time offixator removal, a plantigrade foot was achieved in all feet however additional bony corrective procedures after frame removal included one case of tibial osteotomy and one tibiotalar arthrodesis in another case. During our follow up we took into consideration previos daily activity which was mandatory as one of our patients had the walking distance much decreased due to pain. Follow-up time after cast removal averaged 32 months [26-40]. Complications other than pin-tract infections were toe contractures in two feet, metatarsophalangeal subluxation from flexor tendon contractures in one foot, mild relapse of equines deformity in three feet and pain due to different causes. We consider the Ilizarov method to be an effective alternative means of correcting complex foot deformities, especially in feet that had undergone several previous surgeries