International Journal of Research in Orthopaedics

Kumar NS et al. Int J Res Orthop. 2020 May;6(3):521-524

http://www.ijoro.org

Original Research Article

DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20201558

Complex foot deformity and Illizarov technique: a record-based study

Naveen Kumar S.1, Anirudh C. Kulkarni1*, Arun K. Nayak1, Roshan Kumar1, Alvin Sajan1, Anant A. Takalkar2

1Department of Orthopaedics, Navodaya Medical College and Hospital, Raichur, Karnataka, India

2Department of Community Medicine, MIMSR Medical College and YCRH, Latur, Maharashtra, India

Received: 24 March 2020

Revised: 08 April 2020

Accepted: 09 April 2020

*Correspondence:

Dr. Anirudh C. Kulkarni,

E-mail: dranirudh.kulkarni@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Complex foot deformities may occur as a result of trauma, poliomyelitis, osteomyelitis, burn contractures, neuromuscular diseases or may present as a resistant congenital contracture such as clubfoot. The Ilizarov fixator is new and more efficient method in the treatment of orthopedic foot problems. The aim of the study was to assess the outcome of Illizarov technique.

Methods: This is a hospital record-based study conducted in 32 patients of foot deformity at orthopedic ward of Navodaya Medical college and Hospital, Raichur. The record- based data was collected in January to July 2019. Data analysis done with SPSS 24.0 version IBM USA.

Results: Majority of the subjects were from 0 to 5 years age group i.e. 14 (43.8%). Mean age was 26.2±4.9 years. Majority in our study were males i.e. 71.9%. In majority of the cases, the cause of foot deformity was neglected and relapsed club foot i.e. 12 (37.5%). Treatment period was 22±7 weeks.

Conclusions: The Ilizarov method can successfully correct complex foot deformities. Success rate was 90.6%.

Keywords: Foot deformity, Illizarov technique, Ilizarov fixator

INTRODUCTION

Complex foot deformity can be defined as a multiplanar deformity which that present with foot shortening. The deformity may be accompanied by other chronic problems such as poor soft tissue coverage due to recurring or neglected cases, leg length discrepancies, lower leg deformities, osteomyelitis, and nonunion. Such deformities may occur as a result of trauma, poliomyelitis, osteomyelitis, burn contractures, neuromuscular diseases or may present as a resistant congenital contracture such as clubfoot.1,2 There are several modern treatment techniques for management of relapsing and neglected deformities. Problems are common for persistent deformities and defective cases.1-6 Abnormally tight ligaments and tendons hinder further growth and result in complicated deformities.7-13 The Ilizarov fixator is new and more efficient method in the treatment of orthopedic foot problems. It is capable of altering the form and dimensions of the bones through proper application of loads (compression and distraction) on various parts of the foot. It may also correct the components of the deformities by combining a number of functional units (uniplanar or multiplanar hinges and traction equipment), enabling the treatment of infantile, adolescent and adult patient deformities.14

The study was done with the aim to assess the outcome of Illizarov technique.

METHODS

This is a hospital record-based study conducted in 32 patients of foot deformity at orthopedic ward of Navodaya Medical college and Hospital, Raichur. The record-based data was collected in January to July 2019. All cases during last 8 years were studied from the record section. All patients received preoperative evaluation of both lower extremities. This evaluation consisted of range-of-motion measurements, neurovascular assessment, standing footprints, two plane and posterior tangential radiographs, computed tomography (CT) and 3D reconstruction, photography, and doppler ultrasonography.

Inclusion criteria

Patients having nonunion with no signs of clinical, radiological and biomechanical evidence of infection were included in the study.

Exclusion criteria

Patients with history of other injuries, those aged above 50 or under 13, and those suffering from rheumatoid arthritis, diabetic mellitus, and fracture in the other limb were all excluded from the study.

Statistical analysis

The data analysis was carried out in SPSS 24.0 version and presented in the form of percentages.

RESULTS

We included 32 patients in our study. Majority of the subjects were from 0 to 5 years age group i.e. 14 (43.8%). This is followed by 11 patients i.e. 34.4% from 6 to 18 years age group and least were from above 18 years age i.e. 21.9% (Table 1). Majority in our study were males i.e. 71.9% whereas 28.1% were females (Figure 1).

Table 1: Distribution according to age group.
Table reproduced from source PDF page 2
Figure 1: Distribution according to gender. | 71.9% 28.1% Male Female
Figure 1: Distribution according to gender.
Table 2: Distribution according to etiology.
Table reproduced from source PDF page 2
Table 3: Distribution according to foot deformity.
Table reproduced from source PDF page 2
Table 4: Outcome of the procedure.
Table reproduced from source PDF page 2
Figure 2: Preoperative.
Figure 2: Preoperative.

In majority of the cases, the cause of foot deformity was neglected and relapsed club foot i.e. 12 (37.5%). In 11 patients i.e. 34.4%, the cause was trauma. In 5 (15.6%) the cause was burns and in 4 (12.5%) was poliomyelitis (Table 2).

In 12 patients (37.5%) supra-malleolar osteotomy was done. In 9 i.e. 28.1% midfoot osteotomy was conducted (Table 3). Success rate of the procedure was 90.6% (Table 4).

Figure 3: Illizarov technique.
Figure 3: Illizarov technique.
Figure 4: Post-operative.
Figure 4: Post-operative.

DISCUSSION

The Ilizarov external fixator is suitable for the management of the correction and fixation of foot deformities by its very three-dimensional nature. The Ilizarov method permits the stepwise correction of all components of deformities without further shortening of osseous structures of the foot. The adaptation of bones and soft tissues to these mechanical forces are indeed striking. Ilizarov explains this with his tension-stress method built from his basic and clinical studies.1,9,10,12,15,16 The process leading to the biological plasticity is the stepwise correction.

The goals of foot deformity treatment should be the attainment of foot that is normal in size, pain free, plantigrade, and functional.17 There are two ways in which foot deformities can be corrected using the Ilizarov method: with and without osteotomy.18,19 In the non-osteotomy method, deformities are corrected through joints rather than the bone substance. Soft-tissue distraction treatment is recommended for patients who have a congruous joint with no significant fixed bony deformities and for children younger than 8 years of age.20-22

Incidence of deformity recurrence in our cases is lower than the reported literature. We observed only one case of deformity recurrence. This lower incidence of deformity recurrence in our cases is most likely related to following the principles regarding the use of osteotomy.

CONCLUSION

This method is particularly advantageous in treating complex foot deformities. The Ilizarov method can successfully correct complex foot deformities. Rate of success was 90.6%.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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