Congenital deformity corrections
Complex multiplanar foot and ankle deformities: congenital conditions (clubfoot and congenital vertical talus), neurological lesions (such as poliomyelitis, cerebral palsy, postmeningitis and Charcot Marie Tooth disease), traumatic injuries, osteomyelitis, non-unions or mal-unions, leg length discrepancy, burn and other soft tissue contractures should be proformed by skilled .
These deformities affect gait and can cause compensatory changes in other joints leading to knee, hip and low back problems. The deformities prevent normal shoe wear and in neurological conditions may necessitate specially designed foot and ankle orthoses. The abnormal contact pressures cause skin problems from callosities to skin ulcerations, which in turn can be complicated by infection and osteomyelitis. These problems add to the psychological distress experienced by these patients.
The goals are to correct the deformity and offer the patient a stable, painless, plantigrade, cosmetically acceptable and near normal foot that allows normal shoe wear and improves gait and the ability to perform activities of daily living. The classic treatment of these deformities utilises soft tissue releases, tendon transfers, osteotomies or arthrodesis. These have drawbacks in severe deformities and are at risk of neurovascular injury, soft tissue problems and shortening of the foot. The neurovascular structures are at risk of traction injuries from immediate correction. The amount of skin may also be insufficient to achieve a full correction. In the event of large closing wedge osteotomies, so much shortening is produced as to make the correction inappropriate.
The Ilizarov method enables correction in all planes at a rate that can be tailored to the type and degree of deformity. It achieves this without shortening of the foot and allows the surgeon to manipulate the rate and direction of correction. This presents an opportunity to treat complex foot and ankle deformities without the constraints of more traditional methods. It offers a degree of versatility in correction of the most challenging deformities, even in the presence of co-morbidities such as infection and poor skin conditions.
