Application of the Ilizarov technique to the correction of neurologic equinocavovarus foot deformity.
BACKGROUND
The treatment of rigid equinocavovarus foot deformities caused by neurologic disorders is often difficult and relapse is common.


OBJECTIVE
We asked whether the Ilizarov technique could be used for correction of neurologic equinocavovarus foot deformities resulting in improved foot and ankle function and patient satisfaction.


METHODS
The neurologic equinocavovarus foot deformities of 26 patients (mean age, 18.7 years; 29 feet) were treated using the Ilizarov technique. Nine feet were treated by distraction histiogenesis only with limited soft tissue release, whereas 20 feet needed additional osteotomy and/or tendon transfer/lengthening. Minimum followup was 12 months (mean, 72.9 months; range, 12-155 months).


RESULTS
The mean time required for deformity correction was 27.1 days (range, 14-47 days) and the mean time for stabilization in the apparatus was 23.2 days (range, 7-53 days). A painless, stable, and plantigrade result was obtained by 22 patients (24 feet). Mild residual foot deformity was observed in the remaining five feet of four patients. Six patients (six feet) experienced postoperative complications. Three patients (four feet) experienced recurrence of the deformity requiring surgical correction.


CONCLUSIONS
Ilizarov soft tissue distraction with or without callotasis of tarsal bone(s) allows a greater degree of correction of neurologic equinocavovarus foot deformities. However, to reduce the risk of recurrence after fixator removal, it may be necessary to overcorrect the deformity while in the fixator, to use nighttime splinting, and most importantly, to eliminate neuromuscular imbalance, if necessary, by combining arthrodesis with or without tendon transfer.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Lee
Dong Yeon
DY
Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, 110-744, Korea.
Choi
In Ho
IH
Yoo
Won Joon
WJ
Lee
Soong Joon
SJ
Cho
Tae-Joon
TJ
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004863:Equinus Deformity / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods; D010027:Osteotomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult