Subtalar arthroereisis for treatment of children with flexible planovalgus foot deformity and analysis of CT data in long-term period.

The aim of the study is to analyze the long-term results of the subtalar arthroereisis of the feet according to Grice in children with flexible symptomatic planovalgus foot deformity. METHODS: 29 children (58 feet) were treated with symptomatic flexible planovalgus foot deformity. RESULTS: The average value of AOFAS increased from 63 (51-84) to 92 (53-96) points. According to CT size of the bone graft corresponded to 83% of the size of the subtalar sinus. CONCLUSION: In compliance with all the technical features of this operation, it is effective for correction of flexible planovalgus foot deformity with pronounced verticalization of talus. LEVEL OF EVIDENCE: IV.

Cleft foot: A case report and review of literature.

BACKGROUND: Cleft foot is a very rare congenital anomaly, which is characterized by central rays deficiency of the foot. It is also known as split foot or ectrodactyly of the foot, and it is very often combined with splitting of the hands. The defect develops due to insufficient activity of the median apical ectodermal ridge, which leads to an increase in cell death or a decrease in cell proliferation. Due to the rarity of the pathology, there are few papers on the surgical treatment of this congenital foot disease, and publications to date concern the treatment of children. CASE SUMMARY: We present a clinical case of congenital splitting of the feet and hands in a 31-year-old woman and a long-term result of foot treatment using the minimal arrangement of the Ilizarov apparatus. The patient had paternal inheritance of the trait. After the surgical treatment, cosmetic view and functional condition of the foot were improved and persisted two years after intervention. There were no complications in the treatment process. CONCLUSION: The possibility of dosed control and stable fixation of the foot rays made it possible to create favorable conditions for the healing of the central wound and the closure of the segment splitting without complications. The long-term outcome of the treatment of foot congenital splitting using the proposed Ilizarov apparatus arrangement has shown its effectiveness. Our approach should be considered as an option of treatment in similar cases.

Management of severe congenital flexion deformity of the knee using Ilizarov method.

The aim of this study was to examine the effectiveness of Ilizarov method in severe congenital flexion deformity of the knee. This was a retrospective study of eight consecutive bilateral cases (five girls and three boys, with mean age of 4 years, involving 16 knees) with minimum 2-year follow-up. Four patients had multiple congenital contractures and two patients each had popliteal pterygium syndrome and complete tibial hemimelia. All patients were treated with Ilizarov fixator and gradual correction (additional soft tissue releases in three knees). Six patients had bilateral foot and ankle deformity treated with the same fixator, and cases with tibial hemimelia had centralization of fibula and quadriceps reconstruction. Flexion deformity could be corrected in all cases. Mean duration of dynamic phase was 78.5 (55-108) days, that of static phase was 42.4 (7-100) days, and total duration of external fixation was 120.9 (87-186) days. At mean follow-up of 34.5 (23-60) months, flexion deformity improved from the preoperative value of 74.9° (50°-130°) to 13.7° (10°-16°), and passive arc of motion of knee improved from the preoperative value of 38.8° (20°-55°) to 83.6° (55°-110°). Both were statistically significant (P < 0.0001). All patients (previously nonambulatory) were ambulatory with brace and support. All patients faced pin-tract and skin complications that were successfully managed. Ilizarov method is effective in severe congenital flexion deformity of the knee in improving ambulatory status. Realignment of quadriceps mechanism and limb mechanical axis (including ankle and foot deformities) must be given due importance. Minor recurrences of deformity must be expected in all cases.

Vertical Wire Forefoot Fixation: An Advanced Technique for the Dynamic External Fixation Apparatus.

External fixation is used for the correction of select foot and ankle deformities. We have found the traditional forefoot crossing wire technique to be insufficient in terms of both individual metatarsal control and forefoot manipulation when using a dynamic ring fixator to correct forefoot deformities. We developed a forefoot fixation technique at the University of Cincinnati Medical Center, using 5 vertical wires to gain greater forefoot control while performing more precise skeletal manipulation for multiplanar deformity correction. The associated risks of infection, neurovascular injury, and other soft-tissue injury should be further investigated. This proposed vertical wire construct is an advanced method with which the foot and ankle surgeon can correct complex lower limb deformities.