Title: High recurrence after calf lengthening with the Ilizarov apparatus for treatment of spastic equinus foot deformity
Authors: Rainer Biedermann, MD, Gerhard Kaufmann, MD, Julian Lair, MD, Christian Bach, MD, Roland Wachter, MD, and Leo Donnan, MD.
Source: Journal of Pediatric Orthopedics 2007 16: 125-128.
PODIATRIC RELEVANCE:
The treatment of spastic equinus is most commonly achieved with either lengthening the gastrocnemius aponeurosis or the Achilles tendon. High recurrence rates of equinus can occur after either procedure, especially when performed under the age of 8 years. Lengthening of the triceps surae by external fixation may be a valuable alternative for selected cases.
METHODS:
Ten ambulatory patients with fixed foot deformity with a mean age of 12.3 years were treated for calf lengthening with the Ilizarov apparatus. Five had spastic hemiplegia and five had spastic diplegia. One patient was treated bilaterally and one hemiplegic patient was treated on two occasions due to recurrence (n=12). Straight leg passive range of dorsiflexion (PRD) and calcaneal gait were evaluated preoperatively and at follow-up examinations after removal of the apparatus.
RESULTS:
The Ilizarov device was removed after an average of 33.5±16 days. Mean observation period was 24.8 months. No cases of neurovascular injury, pin-site-related problems, or infection were recorded. The mean PRD of all patients before correction was -17.8±8.2° (plantarflexion) and increased to 8.2±6.3° (dorsiflexion) after correction and removal of frame. The mean correction was 27° (5–40). The PRD decreased to 4.7±4.6° after 6 months and 1.3±7.7° after 1 year. After 14 months, mean passive dorsiflexion was neutral. Three years after the operation, mean improvement of position in these patients was still 20.4±4.6° in comparison with the preoperative value. A fifty-eight percent recurrence rate was found.
COMMENTS:
Continuous passive stretch by external fixation seems to be a valuable alternative with the potential to achieve high degrees of correction and a long-lasting effect from growth of muscle and tendons. However, the recurrence rate of the Ilizarov technique is much higher than most of the operative methods. The technique may be an alternative method for selected cases, when it is important to avoid scarring and weakness of muscle particularly in patients less than 8 years of age who will often require repeated surgery, or alternatively as a salvage method in patients who have persisting equinus despite prior surgical interventions.
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Disclaimer:
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