【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.
ObjectiveTo evaluate the effectiveness of Ilizarov technique combined with soft tissue release and muscle strength balance in the treatment of spastic clubfoot in adolescents with cerebral palsy.MethodsA retrospective analysis of clinical data of 29 cases (33 feet) of cerebral palsy spastic clubfoot deformity conformed to the selection criteria between June 2011 and September 2016. Among them, 17 were male (20 feet) and 12 were female (13 feet) with an age range from 13 to 28 years (mean, 17.6 years). According to Diméglio classification, 19 feet were rated as gradeⅡ and 14 feet as grade Ⅲ. All patients were treated with soft tissue release and muscle balance, while using Ilizarov technique to correct varus deformity. Began to gradually adjust the external fixator after 5-7 days of operation, until to reach satisfactory foot ankle form. Orthopedic brace was used after removal of external fixator, and the wearing time gradually reduced to completely abandon the brace.ResultsAll 29 patients (33 feet) were followed up 12-22 months with an average of 18 months. All patients restored line plantar foot without needle infection and nerve or vessel injury. One foot had a mild relapse of deformity at 6 months after removal of external fixator, and the gait restored to normal after symptomatic treatment. The rest of 32 feet had no deformity recurrence during the follow-up. At last follow-up, International Club Foot Study Group (ICFSG) score (5.21±3.91) was significantly lower than the preoperative score (36.73±4.80), and the difference was significant (t=47.227, P=0.000). The results were excellent in 27 feet, good in 3 feet, and fair in 3 feet, and the excellent and good rate was 90.91%. The patients were very satisfied in 27 feet and satisfied in 6 feet by self-evaluation of effectiveness.ConclusionIlizarov technique is effective in treatment of clubfoot. And it is also a feasible method to treat spastic clubfoot in adolescents with cerebral palsy when combined with appropriate soft tissue surgery according to the patient’s symptoms and signs.
Talipes equinovarus is a very common con-genital foot deformity. From 1985 till 1989,tatalof 30 feet in 23 Patients had been operated by theauthor using subtalar realigment procedure afterall the necessayr release with neurovascular bundleprotected. The position was kept by 2 Kirschner swires,one through talonavicular joint into the talus and other through calcaneous vertically upward into the talus without penetrating into the anklejoint. The total period of plaster immobilizationranged from 8 to 12 weeks. The average age at surgery 6 months old.The results were excellent in 24 feet, good in 5 and less satisfactory in 1 due to overcorrection.
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 explore the biomechanical characteristics and clinical application effects of three-dimensional (3D) printed osteotomy guide plate combined with Ilizarov technique in the treatment of rigid clubfoot. Methods A retrospective analysis was performed on the clinical data of 11 patients with rigid clubfoot who met the inclusion criteria and were admitted between January 2019 and December 2024. There were 6 males and 5 females, aged 21-60 years with an average of 43.2 years. Among them, 5 cases were untreated congenital rigid clubfoot, 4 cases were recurrent rigid clubfoot after previous treatment, and 2 cases were rigid clubfoot due to disease sequelae. All 11 patients first received slow distraction using Ilizarov technique combined with circular external fixator until the force lines of the foot and ankle joint were basically normal. Then, 1 male patient aged 24 years was selected, and CT scanning was used to obtain imaging data of the ankle joint and foot. A 3D finite element model was established and validated using the plantar stress distribution nephogram of the patient. After validation, the biomechanical changes of the tibiotalar joint under the same load were simulated after triple arthrodesis and fixation. The optimal correction angle of the hindfoot was determined to fabricate 3D-printed osteotomy guide plates, and all 11 patients underwent triple arthrodesis using these guide plates. The functional recovery was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) score, International Clubfoot Study Group (ICFSG) score, and 36-Item Short Form Survey (SF-36) score before and after operation. Results Finite element analysis showed that the maximum peak von Mises stress of the tibiotalar joint was at hindfoot varus 3° and the minimum at valgus 6°; the maximum peak von Mises stress of the 3 naviculocuneiform joints under various conditions appeared at lateral naviculocuneiform joint before operation, and the minimum appeared at lateral naviculocuneiform joint at neutral position 0°; the maximum peak von Mises stress of the 5 tarsometatarsal joints under various conditions appeared at the 2nd tarsometatarsal joint at hindfoot neutral position 0°, and the minimum appeared at the 1st tarsometatarsal joint at valgus 6°. Clinical application results showed that the characteristics of clubfoot deformity observed during operation were consistent with the preoperative 3D reconstruction model. All 11 patients were followed up 8-24 months with an average of 13.1 months. One patient had postoperative incision exudation, which healed after dressing change; the remaining patients had good incision healing. All patients achieved good healing of the osteotomy segments, with a healing time of 3-6 months and an average of 4.1 months. At last follow-up, the AOFAS score, SF-36 score, and ICFSG score significantly improved when compared with those before operation (P<0.05). ConclusionThe 3D-printed osteotomy guide plate combined with Ilizarov technique has favorable biomechanical advantages in the treatment of rigid clubfoot, with significant clinical application effects. It can effectively improve the foot function of patients and achieve precise and personalized treatment.
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.
For the evaluation of the result from McKay operation in the correction of rigid clubfoot, 71 patients (103 feet) were followed up postoperatively for 2 to 9 years. According to the criteria concerning the functional recovery of the foot, the external appearance of the foot after correction and the roentgenographic findings, the result was evaluated as excellent in 55 patients (78 feet), good in 11 patients (16 feet), fair in 5 patients (9 feet) and with no recurrence. It was considered that the favorable time for operation was when the child being 6 to 18 months old. In 7 patients (12 feet), there were morphological changes of the calcaneal and navicular bones in 12 feet, limitation of ankle movement in 9 patients and resultant flatfoot deformity in 5 patients (7 feet). The factors influencing the functional recovery of the foot and the relationship between the corrective result and the age of patient when the operation being given were discussed in details.
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.