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Abstract
Complex foot deformity can be described as a foot
with multiplanar abnormalities with or without shortening of
the foot. Conventional surgical treatment may not be able to
correct these deformities. There are many drawbacks to using
conventional approaches for the treatment of complex foot
deformities like the increased risk of the neurovascular
injury, soft tissue injury and shortening of the foot. An
alternative approach that that can eliminate these problems is
Ilizarov method(58).
The Ilizarov method permits accurate force application
to individual parts of the foot using combination of
compression and distraction forces to gradually correct the
deformity. Distraction directly stimulates new bone
formation while musculo – tendinous units stretch to
accommodate the correction (58).
Osteotomies can also be used for distraction
osteogenesis. Younger children rarely require foot
osteotomies since physeal distraction is still possible. Older
children and adults frequently require an osteotomy for
correction with Ilizarov device. Concurrent planter
fasciotomy may also be necessary. Oftentimes, the wire
placement distributes the forces across multiple joints,
gaining gradual correction at many locations(59).
The modalities of treatment used in deformity
correction are physiotherapy, splintage, corrective devices,
capsulotomy, corrective plaster cast and traction. Ilizarov
ring fixator which allows flexibility and adjustment at one or
more levels for correction of multi – directional, multi –
Summary
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planar and multi – level axial deformities is superior to other
conventional method(60).
The principle of compression – distraction histogenesis
of bone and soft tissue is the basis of treatment of the Ilizarov
ring fixator. Distraction histogenesis generates new bone and
soft tissue under gradual distraction. Although distraction is
important for maturation, which includes neocorticalisation
and remodeling, the apparatus is removed once the newly
formed bone achieves adequate strength to resist physiologic
loading (61).
The Ilizarov apparatus is rigid and the minimal nature
of the surgical intervention create the optimal biologic and
mechanical environment for soft tissue correction and early
functional rehabilitation. By the use of the Ilizarov apparatus
it is possible to treat severely deformed foot non invasively,
without bone resection and without shortening of the foot.
The Ilizarov method allows simultaneous correction of all
components of any deformity and it is not necessary to wait
for completion of skeletal growth. The Ilizarov method
avoids disturbing a child life during a very active and
important period of development(62).
The disadvantages of the Ilizarov technique are
obviously those of the external fixation device and in
particular those of pin site problems. In addition, the Ilizarov
method requires a lengthy treatment time with prolonged
joint immobilization and is frequently associated with mild to
moderate pain during the distraction period(63).
Although, Ilizarov technique is requiring long
treatment time, long follow up duration and the apparatus is
Summary
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expensive but it has earned a distinct place in the orthopedic
surgery by providing better alternative solutions(63).