The treatment of recurrent arthrogrypotic club foot in children by the Ilizarov method

Abstract

Between 1994 and 1997 we used the Ilizarov apparatus to treat 12 recurrent arthrogrypotic club feet in nine patients with a mean age of 5.3 years (3.2 to 7). After a mean of three weeks (two to seven) for correction of the deformity and 1.5 weeks (one to four) for stabilisation in the apparatus, immobilisation in a cast was carried out for a mean of 14 weeks (7 to 24). The mean follow-up period was 35 months (27 to 57). Before operation there were one grade-II (moderate), eight grade-III (severe) and three grade-IV (very severe) club feet, according to the rating system of Dimeglio et al. After operation, all the club feet except one were grade I (benign) with a painless, plantigrade platform. Radiological assessment and functional evaluation confirmed significant improvement. Two complications occurred in one patient, namely, epiphysiolysis of the distal tibia and recurrence of the foot deformity. These results suggest that our proposed modification of the Ilizarov technique is effective in the management of recurrent arthrogrypotic club foot in young children.

Early Results of the Ponseti Method for the Treatment of Clubfoot in Distal Arthrogryposis

“…The ultimate measure of success associated with the use of the Ponseti method for the treatment of distal arthrogrypotic clubfoot will be the long-term maintenance of correction and quality-of-life outcomes. Several authors have reported late clubfoot relapses in arthrogrypotic patients who initially were managed with extensive soft-tissue-release operations as infants [30][31][32] , and these relapses have been reported to occur until skeletal maturity 30 . Although the clubfeet in the present study were well corrected after two years of follow-up, longer followup is necessary to assess the continued risk of recurrence and to allow for more accurate recommendations regarding the length of time necessary for brace wear.…”

Correction of Arthrogrypotic Clubfoot With a Modified Ponseti Technique

“…Earlier articles detailed the difficulty obtaining a satisfactory result, with three to four procedures performed per foot [16,23]. Much of the recent literature still highlights the high recurrence rate, describing procedures to treat failed feet [11,36].…”

“…Secondary procedures include repeat soft tissue release, talectomy, cancellectomy of the talus and cuboid (Verebelyi-Ogston procedure) [22,46], gradual correction using an Ilizarov external fixator [6,11,19,21], triple arthrodesis [16,23,33], and combined cuboid/cuneiform osteotomies [40]. Most of these procedures usually produce a plantigrade foot, but one with poor range of motion and recurrence of the deformity is common despite consistent orthotic wear [7,16,37,44,52].…”

Taylor spatial frame in severe foot deformities using double osteotomy: technical approach and primary results

“…Also, the deformity is not corrected, and early arthritis is frequent. The common operative procedures include soft tissue operations, osteotomies, bonewedge resections, arthrodesis or even talectomy [1,2,9]. As a result of the stiff soft tissues and prolonged joint deformity, the complication rate of operative therapy is high.…”

“…Previously published studies demonstrated good results in children because they have a greater healing capacity than adults. It is a valuable tool for correcting multiplanar deformities [1,2,9,10,16].…”