title: Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device.
abstract: BACKGROUND
  Severe recurrent clubfoot deformities are challenging to treat. The Ilizarov method offers a safer alternative; however, the management of the device is complex.
  
  
  METHODS
  A simplified standard setting of the Ilizarov device was used to treat 29 patients (35 feet) with a mean age of 14 years with severely stiff recurrent clubfoot deformities and large scars caused by one or more previous surgeries. This simplification involved a correction in two stages: first a gradual correction of the equinus, varus, cavus, and adduction deformities and later an acute correction of the supination deformity. All feet underwent percutaneous Achilles tenotomy and plantar fasciotomy; 11 feet required an additional midfoot osteotomy. The final outcome was scored as good (complete correction and no pain); fair (partial correction with plantigrade foot and occasional pain); or poor (nonplantigrade foot and continuous pain during walking).
  
  
  RESULTS
  After a mean followup of 56 months, the results were good in 27 feet (77%), fair in five feet (14%), and poor in three feet (9%). Early complications were complete dislocation of the first metatarsophalangeal joint in two feet and partial dislocation of the distal tibial epiphysis in two feet. Late complications were recurrence of the deformity (11 feet), spontaneous ankylosis (16 feet), and symptomatic foot and ankle arthritis (7 feet). Arthrodesis was performed in 13 feet at an average of 21 months after the index surgery to treat symptomatic arthritis or correct disabling residual deformities.
  
  
  CONCLUSIONS
  The Ilizarov device allowed correction of all the complex deformities of severe recurrent clubfoot with minimal operative intervention. Complications were numerous but manageable and for the most part did not compromise overall patient satisfaction in this very difficult to treat clinical condition.
authors.affiliation: Department of Orthopaedics, Santa Casa School of Medicine and Hospitals of São Paulo, Brazil, Rua Mirando Guerra, 876-casa 2, Parque Petrópolis, Sao Paulo, SP 04640-001, Brazil. ceckley@unisys.com.br
authors.forename: Ricardo Cardenuto
authors.initials: RC
authors.lastname: Ferreira
authors.forename: Marco Túlio
authors.initials: MT
authors.lastname: Costa
authors.forename: Gastao Guilherme
authors.initials: GG
authors.lastname: Frizzo
authors.forename: Roberto Attilio Lima
authors.initials: RA
authors.lastname: Santin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000473:pathology / Q000601:surgery*; D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome