Recurrence after correction of acquired ankle equinus deformity in children using Ilizarov technique

Abstract

To describe our Ilizarov technique for the treatment of acquired equinus deformity in children and to determine if compliance with continuous use of an ankle foot orthosis (after removal of the fixator and until skeletal maturity) can influence the severity of recurrence. A cohort of 26 children with post-traumatic or post-burn contractures producing an equinus deformity was followed up for a minimum of 2 years after skeletal maturity. Cases with a bony deformity and/or nerve injury were excluded from this study. All patients were managed by a percutaneous tendo-Achilles lengthening followed by application of an Ilizarov external fixator. Post-operative treatment was in the form of gradual correction at a rate of 0.5 mm per day. Correction started from the second postoperative day until an over-correction of 15 degrees dorsiflexion was achieved. Ankle range of movement was encouraged 4 weeks prior to removal of the external fixator. On removal of the fixator, a posterior splint was applied until substituted by an ankle foot orthoses (AFO). The AFO was used continuously during the first 2-3 months and at nighttime thereafter until skeletal maturity. Fifteen children were compliant with the use of the AFO until skeletal maturity and 11 non-compliant. We compared the recurrence and the size of deformity between the two groups. The rate of recurrence, degree of equinus at recurrence and number of episodes of external fixation surgery showed statistical significant differences (P \ 0.01) between the groups. The Ilizarov technique for treatment of acquired equinus deformity secondary to soft tissue scarring is a safe and effective technique. The use of an AFO until skeletal maturity can decrease the risk and degree of recurrence.

Distraction Histogenesis in Ankle Burn Deformities

“…Distraction histogenesis using the Ilizarov technique is a safe and effective method of treatment for such complex problems. 10,11 It allows the correction of several postburn foot and ankle deformities, including equinus, rocker-bottom, cavus, and toe dislocations. 5,12 We present three cases of severe postburn ankle contractures treated successfully with minimally invasive surgery and soft-tissue distraction with the Ilizarov apparatus.…”

One-Stage Reconstruction of Complex Lower Extremity Deformity Combining Ilizarov External Fixation and Sural Neurocutaneous Flap

“…1 These deformities may affect gait and prevent normal shoe wear and, in neurological conditions, may necessitate specially designed foot and ankle orthoses. 5 The neurovascular structures are at risk of traction injuries from immediate correction and the amount of skin may also be insufficient to achieve full correction. These problems add to the psychological distress these patients experience.…”

“…These deformities include equinocavovarus-supinated foot, flat-valgus-pronated foot, and more complex deformities. 5 The complete removal of scar tissue and lengthening of the soft tissue is the most important goal of reconstruction; and recently, developments in plastic surgery and distraction correction technology have offered alternative therapies for severe deformities. Traditional treatment options involve complex and difficult management because the correction procedures are time consuming and success is not guaranteed.…”

Treatment of Posttraumatic Equinus Deformity and Concomitant Soft Tissue Defects of the Heel

“…Numerous methods using the Ilizarov apparatus have been reported for treating equinus contracture by a gradual distraction technique and have produced favorable results. [2][3][4][5][6][7][8] The advantage of gradual correction is a reduced risk of injury to the neurovascular structures, particularly the tibial nerve and posterior tibial vessels. However, attention should be paid to the possibility of complications, such as subluxation of the talus or compression of the anterior joint space.…”

“…[1][2][3][4][5][6][7][8] Gradual correction using the Ilizarov frame is an excellent alternative to open surgical correction because gradual correction can be achieved without performing multiple osteotomies and extensive soft tissue release.…”