Abstract
Introduction Diseases related to the lesions of upper or lower motor neurons, such as spina bifida, myopathy, and residual polio, often cause severe deformities of the foot and ankle. The treatment goal is to convert a deformed and rigid foot into a plantigrade foot. Matherial and method We treated 51 neurological feet from 2001 to 2018 with the Ilizarov method. They were polio outcomes in 27 cases, 17 feet were affected by spina bifida, 6 other patients had Charcot-Marie-Tooth disease. Results Results were assessed by comparing appearance and function before and after surgery described by Dimeglio, and modified by Dong Y.L. et al. Before surgery, there were 33 moderate and 28 severe deformities (average preoperative scores, 6.3). The mean time required to correct a deformity was 37.1 days (range, 22–58 days) and the mean time for stabilization was 67.2 days (range, 45–98 days). At latest follow-up (mean 7.42 years, from 13 month to 16 years), clinical outcomes and patient satisfaction were considered acceptable. 28 patients achieved an excellent outcome and 21 patients had a good outcome, two feet were classified as having a poor result. Nearly 86 % of patients (44 patients) were satisfied with their outcomes and replied they would repeat their procedure. Complications include infection in 15 % of K-wire tracts, Dysesthesia in 5 cases, superficial necrosis in 3. One patient developed knee contracture. 2 patients were re-operated with V osteotomy. Conclusions The Ilizarov method represents a great resource in the treatment of severe neurological deformities of the foot.
Highlights
Diseases related to the lesions of upper or lower motor neurons, such as cerebral paralysis, spina bifida, myopathy, and residual polio, often cause severe deformities of the foot and ankle [1–3]
We have treated 51 neurological feet from 2001 to 2018 with the Ilizarov method. They were polio outcomes in 27 cases, with different foot deformities: 12 with equinus-varus, 5 with equinus-valgus, 2 with equinus-varus- adductus, 5 with equinuscavus-varus, 3 feet with talus and valgus. Six of these patients were treated with “closed method” without bone osteotomy; V-shaped osteotomy was performed in 5 cases; 2 cases we have treated with supramalleolar osteotomy, 10 cases with triple arthrodesis and 3 cases with ankle arthrodesis, arthrodesis of Chopart in 1 case
The Ilizarov method combined with soft tissue release and/or osteotomy enabled good correction of rigid neurologic equino-cavo-varus deformities in all feet
Summary
Diseases related to the lesions of upper or lower motor neurons, such as spina bifida, myopathy, and residual polio, often cause severe deformities of the foot and ankle. Diseases related to the lesions of upper or lower motor neurons, such as cerebral paralysis, spina bifida, myopathy, and residual polio, often cause severe deformities of the foot and ankle [1–3]. The complexity of these deformities with stiffness or instability often require more radical procedures such as triple primary arthrodesis or talectomy in difficult cases [5, 6–8] Potential disadvantages of these disabling procedures include reducing foot height, lowering the malleoli, and high rates of complications, which suggest the need to find other options and alternative treatment
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