Correction of a Severe Poliomyelitic Equinocavovarus Foot Using an Adjustable External Fixation Frame

Abstract

One-stage surgical correction of severe equinocavovarus deformity can result in complications ranging from skin necrosis to tibial nerve palsy. Fewer complications have been reported when severe deformities were treated by gradual correction using external frames such as the Ilizarov external fixator or the Taylor spatial frame. We describe a case of a 64-year-old woman with severe poliomyelitic equinocavovarus whose deformity required her to ambulate using the dorsum of her right foot as a weight-bearing surface. We treated the deformity with gradual correction using a Taylor spatial frame, followed by ankle arthrodesis. At the most recent postoperative evaluation, 20 months after the initial surgery, the patient was pain-free and ambulating on the sole of her right foot.

A Case of Lipomyelomeningocele Causing Equinovarus is Reported

“…Equinovarus is mainly divided into two types: congenital and acquired;Congenital Equinovarus caused by bad growth is mainly due to the Achilles tendon and shortening of the triceps surae, acquired the Equinovarus mainly because the ankle back extensor group, the outer most or complete loss of muscle strength, Triceps of the lower leg and most of the varus muscles strength is normal, lead to the Achilles tendon contracture, strephenopodia continuously, which in turn leads to the ankle, talonavicular joint, subtalar joints, with roll displacement of joints, foot ankle joints, ligaments and other soft tissue contracture of the joint capsule around, adhesion, secondary deformity.It is mainly caused by the following reasons, such as congenital musculoskeletal malformation, infection, osteomyelitis [3], congenital equinovarus failure in treatment, traumatic fracture and other reasons leading to the sequela of crus osteofascial compartment syndrome [4].Extensive scar on the ankle caused by burns [5], nervus peroneus communis injury [6], lumbosacral spina bi da and poliomyelitis sequela [7].Clinical manifestations are mainly: the talus pancake, the neck of talus shorter distortion, cartilage degeneration and the metapedes plantar exion, varus and intorsion [8], navicular bone deformation dislocation after full high arch, supination deformity, propodeon adduction [9], the medial plantar and back skin, subcutaneous tissue, the fascia, tendon, articular capsule, blood vessels, nerves, such as soft tissue contracture, ankle lateral corresponding soft tissue hypoplasia, relaxation or destroy [10].…”

Minimally Invasive Surgery Using the Circular External Fixator to Correct Neglected Severe Stiff Equinocavus Foot Deformities

“…3,9,25,26,28,33 Such procedures are associated with a high risk of vascular and soft tissue complications, because deep scarring and retraction involving the posterior-medial neurovascular bundle of the foot and ankle from previous surgeries are common. 3,22,27,33 Arthrodesis with deformity correction usually involves extensive dissection of soft tissue, multiple osteotomies removal of large bone wedges, with increased risk of skin and bone necrosis and/or infection, 10,24,25,27 as well as excessive shortening of the foot and limb, leading to imbalance on the contralateral side. 2,3,5,20,25 Stiff equinovarus deformities (ECDs) of the foot are mostly caused by neglected trauma, 14,29 burns, 19,27 compartment syndrome of the leg, 5,14,16 peripheral nerve injury, 31 and central nervous system lesions.…”

“…Moreover, because of the equinus position, these deformities are often associated with chronic metatarsalgia and/or forefoot plantar ulcers, especially in those patients with reduced sensitivity, increasing the risks of infection and amputation. 17,31 This is particularly true in cases where there is scarring, shortening, and adhesions of the posteromedial neurovascular bundle of the foot, such as after severe lower extremity trauma, compartment syndrome, 1,5,[14][15][16] burns, 19,27 previous surgeries, 5,19 late effects of paralytic disease, 9,17,20,24,30,32 and chronic vascular disease. 1,6,25 Poor skin quality/multiple scars, joint stiffness secondary to arthrofibrosis, shortening of the foot, claw toes, and neglected or mistreated childhood osteoarticular deformities can further complicate efforts to achieve a plantigrade foot.…”

“…1,6,25 Poor skin quality/multiple scars, joint stiffness secondary to arthrofibrosis, shortening of the foot, claw toes, and neglected or mistreated childhood osteoarticular deformities can further complicate efforts to achieve a plantigrade foot. 1,2,3,5,[10][11][12][13]18,19,22,[23][24][25][26]28,29 Gradual and progressive correction of these severe deformities, using the distraction-osteogenesis principle proposed by Ilizarov 21 delivered through an external circular fixator, is a less invasive, yet highly effective, alternative in such cases. 5,12,13,15 According to Ilizarov, both soft tissue and bone can grow in response to gradual progressive controlled distraction force.…”

“…1,6,25 Poor skin quality/multiple scars, joint stiffness secondary to arthrofibrosis, shortening of the foot, claw toes, and neglected or mistreated childhood osteoarticular deformities can further complicate efforts to achieve a plantigrade foot. 1,2,3,5,10 -13,18,19,22,23 -26,28,29…”