The Gradual Correction of Rigid Pes Cavus Using Midfoot Osteotomy Combined with Ilizarov Methods

Abstract

Objective: Midfoot osteotomy combined with Ilizarov methods of correction is a rarely reported treatment that is particularly well-suited for severe rigid pes cavus. The study aimed to assess the radiological and clinical results of patients who had been treated for rigid pes cavus using this method.

Methods: The study retrospectively analyzed the clinical and radiological data of 15 pes cavus in 12 patients who were corrected by midfoot osteotomy with Ilizarov external frame in our department from March 2020 to September 2022. Radiologic outcomes were measured using the Meary angle (MA), talus-first metatarsal angle (TM1A), calcaneal varus angle (CVA) and foot length with weight-bearing radiographs. Functional assessments were evaluated in terms of pain, function, and quality of life by using the visual analogue scale (VAS), the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), and 36-item Short Form Health Survey (SF-36). Additionally, the postoperative satisfaction of patients was investigated by a questionnaire. The clinical and radiological results were evaluated by a paired t-test.

Results: All patients received plantigrade feet and pain relief. The mean follow-up was 33.1 ± 5.0 months (range from 25 to 41 months). The etiology included poliomyelitis (4), idiopathic (3), trauma (2), spina bifida (2) and tethered cord syndrome (1). The duration of gradual correction was 30.4 ± 10.6 days, and the external fixation time was 116.3 ± 33.3 days. The bony union rate was 100%. The VAS, AOFAS, and SF-36 scores significantly improved (p < 0.05). The MA, TM1A, and CVA were close to or reached the normal range postoperative (p < 0.01). The length of each foot was well preserved, which was increased more than 0.8 cm than preoperative. No major complications were reported except two cases of mildly hindfoot varus deformity. The results of the questionnaire showed that patients’ satisfaction was 92% (11/12).

Conclusion: Midfoot osteotomy combined with Ilizarov external frame proved to be a reasonable procedure with satisfying mid-term results for the gradual correction of rigid pes cavus.

Keywords

Ilizarov external frame / midfoot osteotomy / pes cavus / tendon transfer

References

[1] Akoh CC, Phisitkul P. Clinical examination and radiographic assessment of the Cavus foot. Foot Ankle Clin. 2019; 24: 183–193.

[2] Bai L-B, Wang Z-J, Wang Z-T. Telescopic rod technique to reverse anterior subluxation of the talus during the correction of equinocavovarus deformity with the Ilizarov fixator. J Orthop Transl. 2020; 25: 43–46.

[3] de la Huerta F. Correction of the neglected clubfoot by the Ilizarov method. Clin Orthop Relat Res. 1994; 301: 89–93.

[4] Pavone V, Chisari E, Vescio A, Lucenti L, Sessa G, Testa G. The etiology of idiopathic congenital talipes equinovarus: a systematic review. J Orthop Surg Res. 2018; 13: 206.

[5] Sanpera I, Villafranca-Solano S, Muñoz-Lopez C, Sanpera-Iglesias J. How to manage pes cavus in children and adolescents? EFORT Open Rev. 2021; 6: 510–517.

[6] James Welck M, Haldar A. Hindfoot fusions in the Cavovarus foot: what is the key for a successful outcome? Foot Ankle Clin. 2023; 28: 805–818.

[7] Zide JR, Myerson MS. Arthrodesis for the cavus foot: when, where, and how? Foot Ankle Clin. 2013; 18: 755–767.

[8] Myerson MS, Myerson CL. Managing the complex Cavus foot deformity. Foot Ankle Clin. 2020; 25: 305–317.

[9] Grady JF, Schumann J, Cormier C, LaViolette K, Chinn A. Management of Midfoot Cavus. Clin Podiatr Med Surg. 2021; 38: 391–410.

[10] Ergun S, Yildirim Y. The Cole Midfoot osteotomy: clinical and radiographic retrospective review of five patients (six feet) with different etiologies. J Am Podiatr Med Assoc. 2019; 109: 180–186.

[11] Cole WH. The classic. The treatment of claw-foot. By Wallace H. Cole. 1940. Clin Orthop Relat Res. 1983; 181: 3–6.

[12] Ferreira RC, Costa MT, Frizzo GG, Santin RA. Correction of severe recurrent clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int. 2007; 28: 557–568.

[13] Kucukkaya M, Kabukcuoglu Y, Kuzgun U. Management of the neuromuscular foot deformities with the Ilizarov method. Foot Ankle Int. 2002; 23: 135–141.

[14] Ferreira RC, Costo MT, Frizzo GG, da Fonseca Filho FF. Correction of neglected clubfoot using the Ilizarov external fixator. Foot Ankle Int. 2006; 27: 266–273.

[15] Kocaoğlu M, Eralp L, Atalar AC, Bilen FE. Correction of complex foot deformities using the Ilizarov external fixator. J Foot Ankle Surg. 2002; 41: 30–39.

[16] El-Mowafi H, El-Alfy B, Refai M. Functional outcome of salvage of residual and recurrent deformities of clubfoot with Ilizarov technique. Foot Ankle Surg. 2009; 15: 3–6.

[17] El Barbary H, Abdel Ghani H, Hegazy M. Correction of relapsed or neglected clubfoot using a simple Ilizarov frame. Int Orthop. 2004; 28: 183–186.

[18] Oganesyan OV, Istomina IS, Kuzmin VI. Treatment of equinocavovarus deformity in adults with the use of a hinged distraction++ apparatus. J Bone Joint Surg Am. 1996; 78: 546–556.

[19] Kirienko A, Peccati A, Abdellatif I, Elbatrawy Y, Mostaf ZM, Necci V. Correction of poliomyelitis foot deformities with Ilizarov method. Strategies Trauma Limb Reconstr. 2011; 6: 107–120.

[20] Boquan Q, Yi R, Tingjiang G, Xi L, Hui Z. Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release. J Orthop Surg Res. 2020; 15: 492.

[21] Turco VJ. Surgical correction of the resistant club foot. One-stage posteromedial release with internal fixation: a preliminary report. J Bone Joint Surg Am. 1971; 53: 477–497.

[22] Tullis BL, Mendicino RW, Catanzariti AR, Henne TJ. The Cole midfoot osteotomy: a retrospective review of 11 procedures in 8 patients. J Foot Ankle Surg. 2004; 43: 160–165.

[23] Hosny GA. Correction of foot deformities by the Ilizarov method without corrective osteotomies or soft tissue release. J Pediatr Orthop B. 2002; 11: 121–128.

[24] Mun KR, Chun S, Hong J, Kim J. The relationship between foot feature parameters and postural stability in healthy subjects. Hum Factors. 2019; 61: 1077–1085.

[25] Paley D. The correction of complex foot deformities using Ilizarov’s distraction osteotomies. Clin Orthop Relat Res. 1993; 293: 97–111.

[26] Choi IH, Yang MS, Chung CY, Cho TJ, Sohn YJ. The treatment of recurrent arthrogrypotic club foot in children by the Ilizarov method. A preliminary report. J Bone Joint Surg Br. 2001; 83: 731–737.

[27] Paley D, Lamm BM. Correction of the cavus foot using external fixation. Foot Ankle Clin. 2004; 9: 611–624. x.

[28] Birch JG, Samchukov ML. Use of the Ilizarov method to correct lower limb deformities in children and adolescents. J Am Acad Orthop Surg. 2004; 12: 144–154.

[29] Du H, He XT, Yin XH, Gu JM, Zhou YX, Yang J, et al. The gradual correction of adult severe rigid Equinus deformity using minimal invasive U-osteotomy with Taylor spatial frame. Foot Ankle Int. 2023; 44: 62–70.

[30] Küçükkaya M, Karakoyun O, Armağan R, Kuzgun U. Correction of complex lower extremity deformities with the use of the Ilizarov-Taylor spatial frame. Acta Orthop Traumatol Turc. 2009; 43: 1–6.

[31] Shalaby H, Hefny H. Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique. Strategies Trauma Limb Reconstr. 2007; 2: 21–30.

[32] Segev E, Ezra E, Yaniv M, Wientroub S, Hemo Y. V osteotomy and Ilizarov technique for residual idiopathic or neurogenic clubfeet. J Orthop Surg (Hong Kong). 2008; 16: 215–219.

[33] Lee K, Cho JH, Lee WC. The indications and technique for surgical correction of pes cavus with external fixation. Foot Ankle Clin. 2013; 18: 743–753.

[34] Kirienko A, Gradov L, Malagoli E, Tacci F, Lucchesi G. Correction of a complex foot deformity with V and Y osteotomy and Ilizarov method. J Foot Ankle Surg. 2022; 61: 1209–1220.

[35] Stapleton JJ, DiDomenico LA, Zgonis T. Corrective midfoot osteotomies. Clin Podiatr Med Surg. 2008; 25: 681–690, ix.

[36] Lamm BM, Gourdine-Shaw MC, Thabet AM, Jindal G, Herzenberg JE, Burghardt RD. Distraction osteogenesis for complex foot deformities: Gigli saw midfoot osteotomy with external fixation. J Foot Ankle Surg. 2014; 53: 567–576.

[37] Sharma A, Cherian RJ, Pandey RA, Khatter H, Paul R, John B. Clinico-radiological and functional outcome of difficult Talipes Equinovarus deformity corrected with an Ilizarov fixator. J Foot Ankle Surg. 2022; 61: 719–725.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.