Foot joints arthrodesis and successive progressive distraction

AIM. The purpose of the study was to report the results of the Ilizarov treatment in severe foot malfunction, which, requires the sort of stability and progressive correction of deformity with lengthening that can be gained through arthrodesis. METHOD. The study group included 54 patients. The average age was 44.5 years. These patients have a common problem of the complex foot deformity with pain or instability that requires the foot joints arthrodesis to restore plantigrade foot. Aetiology of deformity were: post-traumatic foot deformity and arthritis in 19 patients, 4 patients with polio, 5 with neurologic Charcot-Marie Touth disease, 4 with idiopathic flat foot, 6 with mielomeningocele, 6 with spastic hemiplegia, 3 with idiopatic cavus-varus foot, 1 with emimelia, 1 with syringomielia, 1 with paralytic foot, 1 diabetic-foot with the dislocation of Chopard-joint. Application includes correction of equinus foot; vertical calcaneus with varus or valgus of the hindfoot; abduction and supination or adduction and pronation of forefoot; anterior or mixed cavus; equino-cavo-varus deformity. Types of arthrodesis include arthrodesis of the tibio-talar joint with distraction, subtalar arthrodesis associated with vertical osteotomy of the calcaneus, subtalar arthrodesis associated with horizontal osteotomy of the calcaneus, corrective triple arthrodesis (subtalar and Chopart joint), arthrodesis of the Lisfranc joint with distraction, corrective panarthrodesis. Furthermore, deformity correction of the lower limb, such as lengthening, correction of axial deviation, pseudoarthrosis, infection, and bone loss was combined with arthrodesis. RESULT. Functional evaluation obtained by clinical evaluation gave excellent result in 42 patients, good in 8 and fair in 4, mean 73 point of Ankle-Hindfoot Scale of AOFAS. The mean treatment time was 4,2 months. There were 23 complication in 21 patients, all of which were treated successfully. No nerve or vascular damage was seen. The follow up period was from 9 month to six years. In all cases an arthrodesis and plantigrade position of the foot was achieved. CONCLUSION. The Ilizarov method improves callus formation between the bony surfaces with initial compression after the cartilage removed and good bone contact is made. Moreover, it is possible to correct axial deviation of the foot, address loss of articular substance; and without having to resort to bone resection. This achieves by gradual distraction and formation of bone regenerate at the level of arthrodesis or in the side of adjacent osteotomy of the foot bones.