Management of Neurologic Deformity of the Ankle and Foot With Concurrent Osteomyelitis With the Ilizarov Method.

Abstract

The combination of neurologic deformity of the ankle and foot with osteomyelitis is a therapeutic challenge. We investigated the role of Ilizarov with regard to eradication of infection, correction of deformities and improvement of patient function. We retrospectively reviewed 77 patients (77 feet) with neurologic deformity of the ankle and foot with osteomyelitis treated sequentially in 3 stages by Ilizarov method. The 3 stages were (1) active debridement and Ilizarov stabilization, (2) further strengthening of Ilizarov fixator and active osteosynthesis consisting of strategies like arthrodesis, osteotomy distraction, bone transport, or combination thereof, (3) consolidation of fusion/regeneration achieved in second stage. Patients with Charcot arthropathy were not included in the study. There were 43 males and 34 females with mean age of 34.4 (range, 18 to 70) years. All patients had a minimum of 1 year follow-up and 49 patients had 5 years follow-up. Mean duration of external fixation was 179.9 (range, 128 to 413) days. The success of infection eradication was 90.9% and 91.9% at the end of 1 and 5 years, respectively. We achieved plantigrade feet in all cases with no recurrence of deformity. The American Orthopaedic Foot & Ankle Score (AOFAS) improved from a median preoperative value of 74 (interquartile range, 65 to 75.25) to 81 (interquartile range, 77 to 88) ( P < .0001). The improvement of the score was by 7 points only considering the painless nature of the pathology, and the fact that pain contributed to 40% of total score. A total of 39 complications occurred in 30 patients which were managed successfully by alteration of rehabilitation and carefully chosen interventions. Ilizarov external fixation was an effective technique to address problems associated with neurologic foot and ankle deformity with infection. It allowed eradication of infection and achievement of a stable plantigrade foot. It had some disadvantages like lengthy duration of treatment, pin-tract infections, need for operative expertise, and supervised rehabilitation, but we feel these were definitely outweighed by its benefits. Level IV, retrospective case series.