Correction of Rigid Equinovarus Deformity Using a Multiplanar External Fixator

Abstract

Background:

The rigid equinovarus foot deformity is a challenging condition treated by the orthopaedic foot and ankle surgeon. Rapid surgical correction of the deformity may lead to skin and neurologic complications. Gradual correction of the deformity with a multiplanar external fixator may decrease these complications. The purpose of this study was to present the results of a group of patients with rigid equinovarus deformities corrected using a multiplanar external fixator.

Materials and Methods:

We retrospectively reviewed the results of correction of a rigid equinovarus deformity using multiplanar external fixation in a small group of patients. All patients underwent open Achilles lengthening, posterior capsule release, tibialis posterior tendon lengthening, flexor digitorum longus and flexor hallux longus lengthening, followed by application of a multi-planar external fixator with gradual correction of the deformity over a period of several weeks. Preoperative and postoperative deformity and AOFAS ankle-hindfoot scores were assessed.

Results:

A total of eight rigid equinovarus deformities in six patients were treated with a multiplanar external fixator. The average patient age at the time of surgery was 37.2 (range, 17 to 59 ± 15.0) years. Causes of the deformity included trauma in three patients, traumatic brain injury in two patients, and long-standing rheumatoid arthritis in one patient. The average preoperative AOFAS ankle-hindfoot score was 28.3 (range, 12 to 38 ± 7.7). The average postoperative AOFAS ankle-hindfoot score was 68.1 (range 38 to 86 ± 15.5) at an average followup of 71.9 (30 to 120 ± 36.2) weeks. All deformities were gradually corrected to a plantigrade foot using a multiplanar external fixator over an average time of 5 (range, 4 to 6 ± 0.8) weeks. After correction of the deformity, the external fixator was left in place for a time period equal to or twice the length of time it took to achieve correction. The average duration of external fixation was 10.8 (range, 8 to 16 ± 2.8) weeks. Seven of eight deformities maintained correction at final followup. There was one case of recurrence.

Conclusion:

Correction of a rigid equinovarus deformity using a multiplanar external fixator was a viable treatment option. It allowed for correction of the deformity in a controlled manner, helping to reduce the risk of neurovascular complications that may result from single stage surgical correction. The risk of wound complications still exists with the correction of such a complex deformity.

Level of Evidence: IV, Retrospective Case Series

Keywords

Equinovarus External Fixation Foot and Ankle Deformity Correction

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References

Botte

Bruffey

Copp

Colwell

: Surgical reconstruction of acquired spastic foot and ankle deformity. Foot Ankle Clin. 5(2):381–416, 2000.

David

Lewandrowski

Josten

: Surgical correction of talipes equinovarus following foot and leg compartment syndrome. Foot Ankle Int. 17(6):334–339, 1996.

De La Huerta

: Correction of neglected club foot by the ilizarov method. Clin Orthop. 301:89–93, 1994.

Grill

Franke

. The Ilizarov distractor for the correction of relapsed or neglected clubfoot. J Bone Joint Surg Br. 1987; 69B:593–597.

Haritidis

Kirkos

Provellegios

Zachos

: Long-term results of triple arthrodesis: 42 cases followed for 25 years. Foot Ankle Int. 15(10):548–551, 1994.

Keenan

Gorai

Smith

Garland

: Intrinsic toe flexion deformity following correction of spastic equinovarus deformity in adults. Foot Ankle. 7(6):333–337, 1987.

Kocaoglu

Eralp

Atalar

Bilen

: Correction of complex foot deformities using the ilizarov external fixator. J Foot Ankle Surg. 41(1):30–39, 2002. https://dx-doi-org.web.bisu.edu.cn/10.1016/S1067-2516(02)80007-2.

Lamm

Paley

Testani

: Tarsal tunnel decompression in leg lengthening and deformity correction of the foot and ankle. J Foot ankle Surg. 46(3):201–206, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1053/j.jfas.2007.01.007.

Mirzayan

Early

Matthys

Thordarson

: Single-stage talectomy and tibiocalcaneal arthordesis as a salvage of severe, rigid equinovarus deformity. Foot Ankle Int. 22(3):209–213, 2001.

10.

Paley

: The correction of complex foot deformities using Ilizarov's distraction osteotomies. Clin Orthop. 293:97–111, 1993.

11.

Paley

Herzenberg

. Ankle and foot considerations. In: Principles of Deformity Correction. pp. 571–646, New York, NY, Springer, 2002.

12.

Philbin

: Rigid equinovarus deformity corrected with a multi-planar external fixator. Foot Ankle Spec. 1(4):247–249, 2008. https://dx-doi-org.web.bisu.edu.cn/10.1177/1938640008321024.

13.

Redfern

Thordarson

: Achilles lengthening/posterior tibial tenotomy with immediate weightbearing for patients with significant comorbidities. Foot Ankle Int. 29(3):325–328, 2008. https://dx-doi-org.web.bisu.edu.cn/10.3113/FAI.2008.0325.

14.

Sammarco

Taylor

: Cavovarus foot treated with a combined calcaneus metatarsal osteotomies. Foot Ankle Int. 22(1):19–30, 2001.

15.

Wukich

Dial

: Equinovarus deformity correction with the taylor spatial frame. Oper Tech Orthop. 16:18–22, 2006. https://dx-doi-org.web.bisu.edu.cn/10.1053/j.oto.2006.02.002.

16.

Yamamoto

Okumura

Morita

Obata

Furuya

: Surgical correction of foot deformities after stroke. Clin Orthop. 282:213–218, 1992.

17.

Younger

Hansen

Jr. : Adult cavovarus foot. J Am Acad Orthop Surg. 13(5):302–315, 2005.