The Ilizarov method in pediatric clubfoot

Abstract

BackgroundThe goal of treatment for clubfoot is to achieve a pain-free, plantigrade foot that allows walking comfortably with normal shoes. The aim of the study was to assess the relapse rate after having achieved correction of the deformity in patients with clubfoot treated with the Ilizarov method and to analyze associated prognostic factors.MethodsRetrospective cohort study of prognostic factors. Forty-eight patients (70 feet) treated with the Ilizarov method were evaluated since 1988. Patients in whom correction of the deformity with the external fixator failed (residual deformity or incomplete correction) were excluded from the study. The study variable was relapse.ResultsEtiology was idiopathic in 77% of the 70 feet. Only 18 feet had not been treated previously. All patients were children. Mean age at surgery was 7.9 years. Patients were divided into three groups according to treatment: Ilizarov fixator alone (40.2%), in combination with soft-tissue release (38.5%), or associated with osteotomies (21.3%). Mean post-operative follow-up was 10.6 years (range: 5.5-22 years). Outcome was poor in 71% of the feet, which relapsed after a mean of 38 months, requiring additional surgeries to achieve a plantigrade foot.ConclusionsThis is a large series of neglected or relapsed clubfeet treated with the Ilizarov method with good initial results, but a high rate of recurrence of the deformity after a long follow-up period (71%). We did not find statistically significant differences among the subgroups comparing age, diagnosis, previous treatments, and associated procedures and no prognostic factors for relapse could be identified. Currently, we do not consider the Ilizarov method the technique of choice to treat neglected or relapsed clubfoot as our results were not very promising.