title: Foot and Ankle Function at Maturity After Ilizarov Treatment for Atrophic-Type Congenital Pseudarthrosis of the Tibia: A Comprehensive Outcome Comparison with Normal Controls.
abstract: BACKGROUND
  The purpose of this study was to evaluate clinical outcomes and the biomechanical function of the foot and ankle at skeletal maturity of patients treated for atrophic-type congenital pseudarthrosis of the tibia (CPT) compared with healthy young adult controls.
  
  
  METHODS
  Twenty-four patients (mean age of 19.1 years) who had undergone Ilizarov treatment for unilateral atrophic-type CPT were compared with twenty-four controls (mean age of 19.6 years). All participants were evaluated using validated outcome questionnaires, radiographs, physical examination, instrumented motion analysis including a multisegmental foot model, and pedobarographic measurement.
  
  
  RESULTS
  Within the CPT group, the mean score of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale was 89.9 (range, 76 to 100), and the mean score of the Oxford Ankle Foot Questionnaire (OAFQ) was 42.8 (range, 15 to 60). Motion analysis and pedobarographic measurement showed differences in biomechanical function of the foot and ankle on the side affected by CPT: a slower walking speed due to the short stride length; decreased dorsiflexion in hallux motion; increased hindfoot pronation in the presence of forefoot supination; diminished ankle push-off power; delayed time to heel-rise; and decreased forefoot pressure relative to hindfoot pressure. However, sagittal motion of the hindfoot and forefoot on the affected side was relatively well preserved. Subgroup analysis demonstrated no significant differences in terms of clinical outcome scores and most biomechanical parameters between the tibiofibular synostosis group and the intact-fibula group.
  
  
  CONCLUSIONS
  Children with atrophic-type CPT can obtain satisfactory foot and ankle function at maturity after successful Ilizarov treatment. Early stabilization of the ankle mortise by fibular stabilization and preservation of ankle mobility during and after treatment is thought to be crucial to maintaining function of the ankle in patients with CPT.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea sgseo@amc.seoul.kr.
authors.forename: Sang Gyo
authors.initials: SG
authors.lastname: Seo
authors.affiliation: Division of Pediatric Orthopedics, Seoul National University Children's Hospital, Seoul, South Korea leedy@snu.ac.kr.
authors.forename: Dong Yeon
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Division of Pediatric Orthopedics, Seoul National University Children's Hospital, Seoul, South Korea bandlf07@naver.com.
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Pediatric Orthopedics, Seoul National University Children's Hospital, Seoul, South Korea yoowj@snu.ac.kr.
authors.forename: Won Joon
authors.initials: WJ
authors.lastname: Yoo
authors.affiliation: Division of Pediatric Orthopedics, Seoul National University Children's Hospital, Seoul, South Korea tjcho@snu.ac.kr.
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cho
authors.affiliation: Division of Pediatric Orthopedics, Seoul National University Children's Hospital, Seoul, South Korea inhoc@snu.ac.kr.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D005528:Foot / Q000503:physiopathology; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D011542:Pseudarthrosis / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires; D013977:Tibia / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome