【Abstract】 Objective To observe the effectiveness of limited operations and Ilizarov techniques for correction of congenital clubfoot (CCF) in adolescents, and to explore the new methods and new ideas for functional reconstruction of CCF. Methods Between September 2003 and July 2010, 25 adolescent patients (40 feet) with CCF were treated. Of the 25 patients, 14 were male (20 feet) and 11 were female (20 feet) with an age range from 12 to 25 years (mean, 15.7 years). The left feet were involved in 4 cases, the right feet in 6 cases, and both feet in 15 cases. According to Qin’s clubfoot deformity scale, 9 feet were rated as degree I, 17 feet as degree II, and 14 feet as degree III. In these cases, 9 feet were accompanied by internal rotation deformities of crus and 1 case by subluxation of right hip joint. After soft tissue release and osteotomy, 9 feet (degree I) were fixed by composite external fixation instruments, 31 feet by Ilizarov external fixation instruments. The deformity was corrected from 5 to 7 days after operation with distraction of 0.5-1.0 mm/d, then distraction stopped when the ankle was corrected at a hyperextension of 5 to 10° and light valgus. The affected limb might undergo weight bearing walking with external fixation at corrected position for 4 to 6 weeks. If one had both feet deformity, staged operation should be performed with a surgery interval of 3 to 6 months (mean, 4 months). Results The fixation time was 6-12 weeks (mean, 8 weeks) in 9 feet fixed by composite external fixation instruments, and it was 6-17 weeks (mean, 13 weeks) in 31 feet fixed by Ilizarov external fixation. All 25 patients were followed up 8 months to 6 years with an average of 37 months. During distraction process, slight pin track infection occurred in 6 cases (6 feet), which were cured after expectant management. One patient had recurrence of the deformity at 2 years postoperatively, who obtained satisfactory correction after Ilizarov external fixation for 4 weeks. The satisfactory correction and foot function were achieved in the other feet with walking on full weight-bearing. According to International Clubfoot Study Group (ICFSG) score, the results were excellent in 28 feet, good in 10 feet, and fair in 2 feet, with an excellent and good rate of 95% at last follow-up. Conclusion Combined limited operation with Ilizarov technique for correcting adolescent CCF is accord with biology principle and minimally invasive surgical principle, so it is a safe，minimally invasive, and effective method. It also can broaden the operative indications and correct degree III talipes equinovarus which is unattainable by traditional orthopedic surgery.
Objective To investigate the effectiveness of applying a standardized rehabilitation process in correction of adult clubfoot with the Ilizarov technique. Methods Thirty-eight adult patients who underwent orthopedic treatment with Ilizarov technique for clubfoot between August 2022 and December 2024 were retrospectively analyzed. The patients were divided into a study group and a control group with 19 cases in each group according to the different rehabilitation management processes and methods. The differences in baseline data such as gender, age, side, and preoperative Holden walking function grading between the two groups were not significant (P>0.05). In both groups, most of the clubfoot deformities were surgically corrected first, and the residual deformities were corrected by dynamic slow retraction with Ilizarov ring-type external fixation frame. The study group adopted standardized rehabilitation process management mode, including preoperative lower limb muscle strength training, postoperative pain and swelling management, weight-bearing management, gait and lower limb stability training. The control group adopted the conventional postoperative rehabilitation management mode. The occurrence of complications was recorded, including pin tract infection, ankle stiffness and pain, and deformity recurrence. Holden walking function grading was used to evaluate the walking ability of the patients. Clinical efficacy was evaluated by the QIN Sihe Deformity Correction Disability Repair and Functional Reconstruction Postoperative Efficacy Evaluation Scale. Patient satisfaction was evaluated by Likert score. Results Patients in both groups successfully completed surgery and rehabilitation and were followed up. The follow-up time ranged from 8 to 29 months, with a mean of 18.5 months. Among them, the follow-up time was (18.8±5.5) months in the study group and (18.2±5.7) months in the control group, and the difference between groups was not significant (t=0.316, P=0.754). The postoperative incidences of pin tract infection, ankle stiffness and pain, and deformity recurrence in the study group were 10.53%, 5.26%, and 5.26%, respectively, and in the control group were 21.05%, 36.84%, and 15.79%, respectively. And the difference between groups in the incidence of ankle stiffness and pain was significant (P=0.042). At last follow-up, both groups showed an improvement in Holden walking function grading compared to preoperative levels (P<0.05), and the grading of the study group was significantly higher than that of the control group (P=0.006). According to the QIN Sihe Deformity Correction Disability Repair and Functional Reconstruction Postoperative Efficacy Evaluation Scale, the grade difference between groups was not significant (P=0.089), and the excellent and good rates of clinical efficacy in study group and control group were 89.47% (17/19) and 73.68% (14/19), respectively. Patient satisfaction in study group was significantly better than that in control group (P=0.036). Conclusion Standardized rehabilitation process can effectively promote the postoperative functional recovery of adult clubfoot treated with Ilizarov technique, reduce the risk of complications and improve effectiveness.
Objective To investigate the effectiveness of Ilizarov technique in treatment of rigid congenital clubfoot in older children. Methods A clinical data of 55 patients (69 feet) with rigid congenital clubfoot (Diméglio grade Ⅳ) between September 2005 and September 2015 were retrospectively analyzed. There were 33 boys and 22 girls with an average age of 11 years (range, 6-14 years). There were 41 cases of unilateral clubfoot and 14 cases of bilateral clubfeet. The degree of foot deformity was rated as fair in 24 feet and as poor in 45 feet according to International Clubfoot Study Group (ICFSG) score before operation. Sixty-nine feet were treated by Ilizarov external fixator combined with limited soft tissue release, and 21 feet were combined with individualized V-shaped osteotomies. Results All patients were followed up 2-10 years ( mean, 4.2 years). The incisions healed well after operation. Five cases of needle tract infection occurred and were cured by local dressing change. The effectiveness was excellent in 39 feet, good in 21 feet, and fair in 9 feet according to ICFSG score, with the excellent and good rate of 87.0%. During the follow-up, X-ray films showed that no blood supply disorder or necrosis of talus, scaphoid, cuneiform, metatarsal, calcaneus, and cuboid occurred. No osteomyelitis occurred. Conclusion Ilizarov technique combined with limited soft tissue release or V-shaped osteotomy for the older children with rigid congenital clubfeet is safe and can obtain significant orthopedic effectiveness.
ObjectiveTo discuss the effectiveness of Ilizarov technology combined with tarsal V-shape osteotomy for the treatment of traumatic clubfoot. MethodsBetween August 2011 and August 2014, 14 patients with traumatic clubfoot were treated. There were 10 males and 4 females, aged 13 to 61 years (mean, 31 years). Of 14 cases, 11 had open fractures of the tibia and ankle, and 3 had closed fracture of the ankle joint. The interval from trauma to operation was 7-78 months (mean, 36 months). The plantar flexion of the ankle was 44-89° (mean, 57°). After invasive foot soft tissue release and tarsal V-shape osteotomy, the Ilizarov external fixator with elastic stretching rod was used. At 5-12 weeks after operation, the neutral position of the ankle joint was restored. Then the neutral position of the ankle joint was maintained for 8 to 12 weeks. After removal of external fixator, protective walking brace was used for 8 to 12 weeks. ResultsInfection occurred in 9 cases, and was cured after symptomatic treatment. The patients were followed up 10-36 months (mean, 15 months). After treatment, 14 patients had normal appearance of the ankle joint, and X-ray films showed normal structure of the ankle. The ankle dorsal extension was 10° in 9 patients, who had normal walking function; it was 5° in 4 patients, who could walk; in 1 case of neutral position, the foot had no function of up and down stairs. One case had pain during correction because of poor tolerance, and delay traction was given, the function was recovered to normal after active rehabilitation training. According to the International Clubfoot Study Group (ICFSG) score standard, the results were excellent in 9 cases, good in 4 cases, and fair in 1 case; the excellent and good rate was 92.9% at last follow-up. ConclusionIlizarov external fixation combined with V-shape osteotomy is effective for the treatment of traumatic clubfoot, with the advantages of less trauma, reliable fixation, satisfactory correction of the deformity, and good function recovery of the ankle.
ObjectiveTo investigate the effectiveness of the Ilizarov technique for the treatment of traumatic talipes equinovarus so as to provide the evidence for the clinical practice. MethodsBetween February 2011 and April 2012,42 patients with traumatic talipes equinovarus received treatment by Ilizarov technique,including 29 males and 13 females aged 17-55 years (mean,34.3 years).The left side was involved in 24 cases,and the right side in 18 cases.The disease duration was 6 months to 6 years (mean,2.7 years).According to the principles of Ilizarov,a ring external fixator was applied on the affected foot and lower leg.The threaded rods and screw nuts were revolved according to the tolerance of patients at 3-7 days after fixation.At first,forefoot varus or foot inversion was corrected,and then drooping feet deformity was corrected.The patients were encouraged to begin weight-bearing walking after correction.X-ray films were taken regularly to observe the ankle joint and avoid its dislocation.The external fixator was maintained in neutral position for 8-12 weeks after achieving satisfactory correction.An walking ankle-foot orthosis and a sleeping ankle-foot orthosis were used for more than 16 weeks after removal of the fixator.The outcome was assessed with American Orthopaedic Foot and Ankle Society (AOFAS) comprehensive scoring system and visual analogue scale (VAS) pain score. ResultsForty-two patients were followed up 14.3 months on average (range,10-24 months).All the patients achieved 0° dorsiflexion at 4-13 weeks (mean,6.8 weeks) after treatment with Ilizarov apparatus.The fixator was maintained for 10.7 weeks on average (range,10-16 weeks) after correction.No dislocation of the ankle joint and no damage to nerves and blood vessels occurred.The deformity of plantar flexion (10°) was found in 3 patients.At last follow-up,the patients could walk normally.AOFAS score was significantly increased to 93.4±8.0 from 52.7±10.1 at preoperation (t=-7.035,P=0.008);according to AOFAS scoring system,24 cases were grades as excellent,14 as good,2 as moderate,and 2 as poor,and the excellent and good rate was 90.5%.The VAS score of the foot significantly decreased to 3.51±1.44 from 7.55±1.39 at preoperation (t=-0.564,P=0.025). ConclusionIlizarov technique combined with non-fusion has satisfactory effectiveness in correction of traumatic talipes equinovarus.It is a safe,effective,and minimally invasive method.
ObjectiveTo investigate the effectiveness of Ilizarov technique in treatment of the clubfoot after burns.MethodsBetween March 2012 and February 2017, 12 patients (17 feet) with clubfoot after burns were treated with Ilizarov technique. There were 10 males (14 feet) and 2 females (3 feets) with an average age of 38 years (range, 18-52 years). There were 3 cases of left foot, 4 cases of right foot, and 5 cases of both feet. According to the Qin’s classification of clubfoot deformity, there were 5 feet of degreeⅠ, 9 feet of degreeⅡ, and 3 feet of degree Ⅲ.ResultsAll clubfeet were completely corrected without local skin necrosis, needle tract infection, or acroanesthesia. All patients could walk with a heavy load. Pationts were followed up from 4 months to 3 years (mean, 10 months). At last follow-up, according to the International Clubfoot Study Group (ICFSG) score, the effectiveness was rated as excellent in 7 feet, good in 7 feet, and fair in 3 feet, with the excellent and good rate of 82.4%.ConclusionUsing Ilizarov technique can gradually correct the clubfoot deformity with the advantages of minimal invasion, safeness, and simpleness.
Objective To compare the long-term results between theMckay procedure and the musclestrength balancing procedure in treatment of congenital clubfoot (CCF).Methods Thirty-seven children with 54 clubfeet were treated by the muscle-strength balancing procedure (31 feet) or the Mckay procedure (23 feet).There were 27 males (38 feet) and 10 females (16 feet). The average age at the time of surgery was 1.2 years (range, 5 months to 3.5 years). The deformity occurred on the left side in 7 patients, on the right side in 13, and on both sides in 17. During the musclestrength balancing procedure, the anterior tibial tendonwas transplanted to the middle or the lateral cuneiform, and the Achilles tendon was lengthened. During the Mckay procedure, the complete releasing of the softtissues and the lengthening of the tendons were performed routinely; in addition, the abductor hallucis was also excised. The clinical outcomes were evaluated with the Diméglio classification method. According to the Diméglio scoring system, 3 clubfeet were at Grade Ⅱ (score, 6-10); 26 clubfeet at Grade Ⅲ (score, 11-15); 25 clubfeet at Grade Ⅳ (score, 16-20). Based on the Diméglio grading system, all the patients were divided into two groups before operation. Group Aconsisted of 29 feet at Grade Ⅱ or Ⅲ (score, 12.55±1.84); Group B consistedof 25 feet at Grade Ⅳ (score, 17.20±1.08). The score in the group undergoingthe musclestrength balancing procedure was 14.16±2.83, and the score in the group undergoing the Mckay procedure was 15.43±2.63. Results All the patients were followed up for an average of 8.2 years (range, 5.0-10.5 years). According to the Diméglio grading system, 32 patients were at Grade Ⅰand 22 patients at Grade Ⅱ, and none of the patients at Grade Ⅲ or Ⅳ. Two patients undergoing the Mckay procedure developed the postoperative incision infection, but the incision wound healed after the dressing changes. The Diméglio score was 4.07±1.25 in Group A and 6.52±1.74 in Group B after operation, with a significant difference when compared with before operation (Plt;0.05). In Group A the two procedureshad no significant difference in effectiveness (Pgt;0.05); however, in Group B they had a significant difference (Plt;0.05). Judging by the correction degrees for the deformity on the different planes, the two procedures had no significant difference for correcting the equinus of hind foot (Pgt;0.05); however, in the correction degrees for the cross-foot and supination or adduction of the anterior foot, the Mckay procedure was significantly finer than the muscle-strength balancing procedure. It has a good biocompatibility. The mechanical test has showed that the Mckay procedure had the best result in the correction of the forefoot adduction. Conclusion For treatment of congenital clubfoot at Grades Ⅰ-Ⅲ, the musclestrength balancing procedure can achieve an excellent correction result; for treatment of congenital clubfoot at Grade Ⅳ, the Mckay procedure should be performed. No matter whichprocedure, the abductor hallucis excision is recommended to prevent poor correction for the anterior foot adduction.
Objective To summarize the methods of ankle hinge position design in the correction of clubfoot deformity by Ilizarov method, and to explore its application value in the prevention of ankle dislocation. Methods A retrospective study was conducted including 28 patients with rigid clubfoot deformity (34 feet) who met the selection criteria and admitted between September 2021 and December 2024. There were 19 males and 9 females with an average age of 31.8 years (range, 19-47 years). According to Dimeglio classification, there were 21 feet of degree Ⅲ and 13 feet of degree Ⅳ. The causes were traumatic sequelae in 9 cases, congenital foot deformity in 15 cases, spina bifida sequelae in 1 case, peripheral neuropathy in 1 case, and cerebral palsy sequelae in 2 cases. The malformation lasted from 6 to 46 years, with an average of 29.3 years. All patients were treated with Ilizarov circular external fixator, and the hinge position of ankle joint was planned according to the standard lateral X-ray film of foot and ankle and the principle of Ilizarov limb deformity correction center of rotation angulation (CORA) before operation. The 2008 International Clubfoot Study Group (ICFSG) scoring system was used to evaluate the efficacy. ResultsThe deformity of rigid clubfoot was completely corrected in all patients, and the patients could walk with plantar weight-bearing, and the ankle weight-bearing walking significantly improved when compared with that before operation. There was no complication such as ankle dislocation, talus impact or extrusion, local skin necrosis, needle tract infection, or numbness of extremities during the correction process. All patients were followed up 5-39 months, with an average of 18.1 months. At last follow-up, according to the ICFSG scoring system, 23 feet were excellent, 10 feet were good, and 1 foot was fair, and the excellent and good rate was 97%. Conclusion Designing the position of the ankle hinge according to the principle of CORA can effectively avoid ankle dislocation, talus impingement, tibiotalar joint extrusion, and other ankle adverse events in the process of correcting clubfoot deformity, which has good application value in clinical practice.
Objective To evaluate the effectiveness of correcting post-traumatic equinovarus deformity using Ilizarov external fixation technique combined with limited osteotomy. MethodsA retrospective analysis was conducted on clinical data from 29 patients with post-traumatic equinovarus deformity treated between July 2018 and March 2023. The cohort included 18 males and 11 females, with ages ranging from 15 to 57 years (mean, 24.3 years). All patients exhibited ankylosed ankle joints with equinovarus deformity. During surgery, external fixators were installed according to Ilizarov pinning principles, and minimally invasive osteotomy was performed at the ankle joint. Concurrently, soft tissue release was achieved via minimally invasive Achilles tendon lengthening. Postoperatively, multiplanar deformity correction was accomplished through gradual adjustment of the external fixator. The fixator was removed after bony union at the osteotomy site, followed by bracing. The surgical duration, intraoperative blood loss, fixator wear time, and complications were recorded. Postoperative outcomes included assessment of deformity correction and bony union at the osteotomy site. Functional improvement and pain relief were evaluated using pre- and post-operative scores from the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) score. Results All 29 patients were followed up 12-24 months (mean, 18 months). The mean surgical duration was 85.6 minutes, with a mean intraoperative blood loss of 110 mL. Full deformity correction was achieved within 26-80 days (mean, 40.7 days) through progressive fixator adjustments. At correction completion, all ankles restored to a neutral or 5°-10° dorsiflexed position with plantigrade foot function. Superficial pin tract infections occurred in 3 patients (10.3%), resolved with local wound care, enhanced nursing, and oral antibiotics. No deep or systemic infections was observed. One patient sustained a calcaneal half-pin fracture due to a fall during fixator wear, but no bone fragment displacement occurred. No vascular or neurological complication was reported. Complete bony union was achieved at all osteotomy sites without nonunion. At last follow-up, the AOFAS ankle-hindfoot score improved from preoperative 42.7±8.7 to postoperative 65.7±9.3, and the VAS score decreased from preoperative 4.5±1.3 to postoperative 2.5±1.1, with significant differences (P<0.05). Functional outcomes were rated as excellent in 14 cases, good in 13 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 93.1%. ConclusionThe progressive correction strategy combining Ilizarov external fixation technique with limited foot osteotomy effectively corrects post-traumatic equinovarus deformity while preserving soft tissue integrity. This method is associated with minimal, largely controllable complications and achieves alignment stability and fusion outcomes comparable to traditional open surgery, making it an effective treatment for complex foot and ankle deformities.