Ankle Deformity Correction Research Articles

Distal Tibial Dome Osteotomy With Ilizarov Fixation in Correction of Ankle Deformity Resulting From Malunited Ankle Fusion

Background: Distal tibial osteotomy is used in the treatment of ankle deformities. Many methods of fixation of this osteotomy were described, including plates, pins, and ilizarov. Dome osteotomy is a cylindrical osteotomy with no bone loss, with the axis of bone is rotated around the center of the circle. We conducted a case series of treatment of ankle deformity due to malunited ankle fusion with distal tibial dome osteotomy. Methods: Eight patients with a history of poliomyelitis with ankle deformity due to a malunited ankle fusion underwent distal tibial dome osteotomy with ilizarov fixation for deformity correction. Postoperative follow up was done up to 12 months postoperatively. We intended to follow up the union of the osteotomy, the axis of the limb, the external clinical appearance, and patient satisfaction. Results: Deformity correction was achieved in all patients regarding the clinical alignment, with no apparent clinical residual deformity in coronal, sagittal plane, or rotational deformity, the limb was cosmetically straight with a plantigrade foot satisfactory to the patients with improving quality of gait. The osteotomy fully united in all patients in a period of 8 to 11 weeks with an average of 9.3 weeks, after which frame was removed. No patient had nonunion or delayed union of the osteotomy. Three patients had pin tract infection during the period of the fixator which was treated by local dressings and antibiotics. Conclusion: Distal tibial focal dome osteotomy fixed by ilizarov is an effective treatment option in malunited ankle fusion deformities.

Management of post-traumatic ankle deformities in children.

The objective of this clinical appraisal was to assess the clinical-radiological results of ankle deformity correction secondary to physeal injury, utilizing the methods based on the age of the child, site & severity of the deformity, remaining growth potential, condition of the soft tissue envelop and integrity of neurovascular status. Fifteen subjects ≤ 16 years of age, with angular deformities of the ankle secondary to physeal injury, were included. Deformities secondary to infection and pathological fractures were excluded. Demographic data, type of injury, treatment method, and follow-up were recorded from the case files. Treatment categories included osteotomies for acute correction (> 10 years) and growth modulation (≤ 10 years). Male to female ratio was 7:8, with an average age of 11.8 ± 2.31 years (range 9-16 years). The right and left ratio was 7:8. Mean duration of follow-up was 1 year and 4 months. Gradual deformity correction was done in 2 cases utilizing the principle of growth modulation, while acute correction by osteotomy was done in 13 cases. The average pre-operative ankle deformity was 20.8 ± 3.11 degrees (Range -25 to 24 degrees). Radiological union was attained at a mean of 11 weeks (8-24). Nine patients achieved neutral ankle alignment. The mean residual varus was 2.3°, and the valgus was 4°. There was a statistically significant improvement of the AOFAS score by 17 points from a mean pre-operative score of 57 (44-84) to 74 (56-100) points at the final follow-up (p-value < 0.001). The average pre-operative shortening was 2.36 ± 0.21 cm, which was completely corrected in 9 individuals. Management of angular deformities around the ankle calls attention to correcting the resultant angular deformity and/or limb length disparity, utilizing acute or gradual correction. A successful outcome depends on early recognition and patient-specific treatment of paediatric ankle fracture patterns. Correlating the results of our study with the available literature, we feel that both acute or gradual correction for angular deformities around the ankle is a feasible solution as long as principles of deformity correction are adhered to. Techniques for salvaging and restoring the viability of injured physeal plate warrant additional research.

Design of Composite Parallel External Fixator for Multisegment Foot and Ankle Deformity Correction: A Correction Requirement- Dominated Approach

Foot and ankle deformity is a common complaint in orthopedic surgery, among which the multisegment concurrent types are even more severe. As a key medical device for multisegment deformity correction, the composite parallel external fixator (PEF) design has a profound impact on the correction outcomes. However, existing PEFs share a single configuration and have inadequate adaptation to various deformity types, leading to problems, such as complex structural composition, excessive adjustment parameters, and uncomfortable wearing experience. To overcome these problems, this article proposes a novel correction requirement-dominated design approach for composite PEF. Multisite frame mounting modes and multitype struts are introduced to form required PEF configurations. Lower mobility struts can constrain the unwanted degrees-of-freedom, thus enabling the device to precisely match the requirement-function relationship. Taking the double-segment deformity as research object, clinical cases, and composite PEF assembly simulations are provided. Experiments are carried out on the mechanical prototype. The mounting test proves the interconverting ability and deformity-targeting property of the derived composite PEFs. Moreover, the motion test verifies that the device can distract patients of different weights to complete the correction path, and the stability test demonstrates that the device can resist external bumps, thus indicating the feasibility of the approach.

A 3-DOF electromotor-driven external fixator for foot and ankle deformity correction based on X-ray digital measurement.

The use of external fixators to treat foot and ankle deformities remains a challenge in orthopedic surgery due to their diversity. We hope to improve the automation and accuracy of the correction process. A three-degree-of-freedom (3-DOF) electromotor-driven external fixator for uniplanar foot and ankle deformities was proposed. Computer-assisted correction software was developed to help surgeons use digital technology to measure the required parameters from patients' X-ray radiographs. The correction trajectory and the prescriptions were generated in the software based on the proposed correction strategy. Two clinical cases were simulated to verify the correction ability of the developed external fixator. The results showed that the angular and displacement deformities were well corrected. The developed external fixator can accurately and automatically correct foot and ankle deformities with the help of computer-assisted correction software, which significantly reduces the burden on surgeons and patients.

Towards collision detection in foot and ankle deformity correction using parallel external fixator: A novel analytical approach

Gradual correction using external fixator has been advocated as a minimally invasive solution for limb deformity and is widely used in the clinic. This treatment manner requires a long-term distraction process, which is guided by a preplanned correction path. However, bone cross-section (BCS) collision and soft tissue (ST)-distraction rod (DR) collision may occur on the path and then affect the continuity of the process. Thus, collision detection should be carried out before performing distraction. Existing detection solutions do not simultaneously consider these two types of collisions, and primarily target long-bone deformity. To solve these issues, taking more complex foot and ankle deformity as the research object, a novel analytical detection approach is proposed in this paper. By modelling the contours of BCS, ST, and DRs as convex envelope planes/bodies using different spatial line styles, the spatial posture relations of their boundaries can be reproduced on the correction path, and collision detection can be transformed into the mathematical problem of calculating point-plane and point-line distances. Subsequently, two algorithms are proposed for BCS and ST-DR collision detections, and adjustment strategies are provided to resolve algorithm anomalies. Clinical case simulation proves the effectiveness and applicability of the approach. Since the detection is used for pre-distraction prediction rather than real-time monitoring, the correction path with potential collision risk can be re-planned before distraction, and finally, guarantees the safety of gradual correction.

Accuracy of CT Derived Patient Specific Instrumentation for Total Ankle Arthroplasty: The Impact of the Severity of Preoperative Varus Ankle Deformity

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Significant preoperative varus tibiotalar deformity was once believed to be a contraindication to performing total ankle arthroplasty (TAA). While correction of ankle deformity has been shown to be possible, the ability to restore neutral alignment in more severe ankle arthritis is still a concern. Preoperative CT derived navigation is gaining popularity for its ability to accurately restore neutral alignment in TAA, in addition to decreasing operative and fluoroscopic times. The primary goal of this study was to evaluate whether accuracy and reproducibility of final implant positioning using patient specific guides were influenced as varus deformity became more severe in patients undergoing TAA.Methods:A retrospective review of 32 patients with varus end-stage ankle arthritis who underwent TAA utilizing total ankle implants with CT derived patient-specific guides was conducted. Preoperative computed tomography (CT) scans were obtained to assess coronal plane deformity, mechanical and anatomic alignment, and build patient-specific guides that referenced bony anatomy. Preoperative weightbearing radiographs were used to measure the tibiotalar and talar tilt angles to assess coronal plane deformity severity and congruency, respectively. Patients were subcategorized into varying degrees of deformity based on their tibiotalar angles (<0-5° neutral, 6-10° mild, 11-15° moderate, and >15° severe). The first postoperative weightbearing radiograph following surgery was used to measure coronal plane alignment of the tibial implant relative to the target axis determined by the preoperative CT template.Results:The average preoperative varus deformity, as determined by the tibiotalar angle, was 6.06° (range: 0.66- 16.3°) for the entire cohort. Average preoperative varus deformity was 2.63° for the 'neutral' group, 7.64° for the mild group, 11.5° for the moderate group and 16.3° for the severe group. Postoperative weightbearing alignments for 96.9% (30/31) of patients demonstrated neutral implant alignment (< 5°). Relative to the CT derived target axis, the average tibial implant coronal deviation for all patients was 1.54° (range: 0.17-5.7°). The average postoperative coronal alignment relative to the target axis was 1.61° for the neutral group, 1.78° for the mild group, 0.94° for the moderate group, and 1.41° for the severe group. There was no statistically significant difference in final implant alignment relative to the target axis between deformity subgroups (p= 0.256).Conclusion:The results of our study further support that neutral postoperative TAA alignment can repeatably be obtained using preoperative CT derived patient specific instrumentation (PSI). Furthermore, the accuracy and reproducibility of achieving neutral postoperative radiographic alignment with PSI does not appear to be impacted by worsening varus ankle deformity. All but one patient (96.9%) achieved neutral postoperative alignment relative to the predicted target axis, with the only outlier being from the mild deformity subgroup. Future studies are warranted assessing the effect that even greater coronal plane deformity (>20 °) has on the accuracy of TAA implantation using PSI.

Compression of A Midfoot Osteotomy Using A Circular External Fixator: What is the Ideal Pin Configuration?

Category:Midfoot/Forefoot; Diabetes; TraumaIntroduction/Purpose:Foot and ankle deformity correction through midfoot osteotomy can be implemented in a wide variety of clinical situations. Use of a circular ring fixator for osteotomy fixation is particularly useful for patients with poor soft tissue envelopes and/or active infection as can occur in diabetes and Charcot arthropathy. The foot pins in a ring fixator can be configured to apply compression at the osteotomy site. However, the optimal pin configuration and force has yet to be determined. The purpose of this study was to quantify compressive forces achieved across midfoot osteotomies with various wire configurations in a circular ring fixator construct.Methods:Nine through-knee amputation cadavers were stabilized with a standard circular external fixation carbon frame. A midfoot osteotomy through the transverse tarsal joint was performed using an oscillating saw. A 4mm bone wedge was removed from the osteotomy site for placement of a Tekscan pressure sensor. A two-ring frame was applied in the standard fashion and three parallel 1.8mm smooth wires were placed parallel to each other through the foot distal to the osteotomy: wire #1 proximally through the cuneiforms, wire #2 through the base of the metatarsals, wire #3 through the metatarsal shafts. After baseline pressure readings, wires were sequentially attached (wire #1 alone, wire #1-2, wire #1-3) to the ring fixator and tensioned to 90kg. Pressure readings were recorded at the osteotomy site for each sequential wire tensioning both at the hole location where the wire naturally crossed, 'neutral', and again at one hole 'proximal' (e.g., toward the osteotomy).Results:Average compressive load at neutral hole positioning for wire #1 was 382 N. The addition of wire #2 increased the compressive load to 439 N on average. The addition of wire #3 decreased compressive force to 372 N. Similar trends were seen in proximal hole positioning where average compressive force increased following tensioning of wire #2 from 580 N to 600 N but compressive force decreased on wire #3 addition to 425 N. Therefore, tensioning forefoot thin wires in the proximal hole position increases compressive forces by 50% compared to neutral position, and adding a second wire increased compressive force by up to 15% compared to a single forefoot wire.Conclusion:In a circular frame midfoot fusion model, the greatest compressive force was achieved with two wires tensioned in the proximal hole position. The addition of a third wire led to force decrease likely due to off-axis forces that may distract the osteotomy site given the difficulty of passing all wires perfectly parallel in all planes. Ideal positioning and tensioning of forefoot pins may optimize construct stability and compression and improve healing of the midfoot osteotomy.

Unprecedented tibial bone lengthening of 33.5\u2009cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review

BackgroundWe present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function.Case presentationA 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient’s right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia.ConclusionUpon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.

Hindfoot Alignment Change After Total Ankle Arthroplasty for Varus Osteoarthritis.

In patients with end-stage varus ankle osteoarthritis (OA), hindfoot varus malalignment resulting from the varus deformity of the ankle joint is common. Although total ankle arthroplasty (TAA) performed to correct varus deformity of the ankle joint has the effect of correcting hindfoot alignment, no reports to date have described how much hindfoot alignment correction can be achieved. The purpose of this study was to identify correlation between ankle deformity correction and hindfoot alignment change after performing TAA in patients with end-stage varus ankle OA. A total of 61 cases that underwent TAA for end-stage varus ankle OA and followed up for at least 1 year were enrolled for this study. Correlation between changes of tibial-ankle surface angle (TAS), talar tilt (TT), and tibiotalar surface angle (TTS) and changes of hindfoot alignment angle (HA), hindfoot alignment ratio (HR), and hindfoot alignment distance (HD) measured preoperatively and at postoperative year 1 was analyzed. TAS, TT, and TTS changed from 83.9 ± 4.1 degrees, 5.8 ± 5.0 degrees, and 78.1 ± 5.9 degrees, respectively, before operation to 89.2 ± 2.1 degrees, 0.4 ± 0.5 degrees, and 88.7 ± 2.3 degrees, respectively, after operation. HA, HR, and HD also changed from -9.2 ± 4.6 degrees, 0.66 ± 0.18, and -11.2 ± 6.9 mm to -3.7 ± 4.1 degrees, 0.48 ± 0.14, and -5.0 ± 5.3 mm. All the changes were statistically significant (P < .001, respectively). The regression slope of correlation was 0.390 (R2 = 0.654) between TTS and HA; 0.017 (R2 = 0.617) between TTS and HR; and 0.560 (R2 = 0.703) between TTS and HD. In patients with end-stage varus ankle OA, changes of hindfoot alignment could be predicted based on degree of ankle deformity corrected with TAA. Level IV, case series.

Calcaneal osteotomies

: Alteration of hindfoot alignment is a cornerstone of orthopaedic foot and ankle deformity correction. Hindfoot and forefoot loading are influenced by the alignment of the hindfoot and by the calcaneus configuration. Calcaneal osteotomies allow multi plane modification of the calcaneal axis and deformity correction, which results in improved biomechanics of the foot. Multiple calcaneal osteotomies incorporating numerous techniques, have been described to address the varied pathologies that produce varus and valgus hindfoot deformity. Although no clear evidence supports the superiority of one calcaneal osteotomy over the other, recent studies compare the biomechanical properties of different osteotomies. The aim of this review is to outline the of history and current concepts of calcaneal osteotomies.

Talectomy as Part of Chronic Foot and Ankle Deformity Correction Procedure: A Retrospective Study

Severe foot and ankle deformities can be associated with high complication rates and impaired quality of life in patients. Surgical correction using a talectomy procedure has previously been described in many lower extremity pathologies and is a powerful tool for the correction of severe foot and ankle deformity. This study aimed to describe the role of talectomy and the outcomes of this procedure in patients presenting with severe foot and ankle deformity. A review of 45 patients undergoing talectomy by a single surgeon was completed. Data extracted included the cause of deformity, history of infection, body mass index, and relevant comorbidities. Outcome measures of interest were minor or major complications and limb functionality at final follow-up. Statistical analysis was performed by using a Wilcoxon rank sum test and a Fisher exact test looking at variables affecting selected outcome measures. Limb salvage occurred in 38 of 45 patients (84.4%). Patients with an infection history had 89% lower odds of a functional limb at final follow-up (p = .0389). Six of 7 patients (85.7%) who ultimately underwent amputation had a history of prior infection. Women had 8.25 times higher odds of having a functional limb compared with men (p = .047). All 13 patients with major complications had neuropathy (p = .024). Patients with chronic lower extremity deformities can successfully be treated with a talectomy as a part of the reconstructive procedure. This is a challenging patient population that is associated with a high complication rate. Patients with a history of infection should be counseled on the possibility of requiring major amputation.

Distal tibial distraction osteogenesis\u2014an alternative approach to addressing limb length discrepancy with concurrent hindfoot and ankle reconstruction

BackgroundLimb length discrepancy (LLD) in the setting of concurrent hindfoot and ankle deformity poses an added level of complexity to the reconstructive surgeon. Regardless of etiology, a clinically significant LLD poses additional challenges without a forthright and validated solution. The purpose of the current study is to determine whether reconstructive hindfoot and ankle surgery with concurrent lengthening through a distal tibial corticotomy is comparable to other treatment alternatives in the literature.Patients and methodsA retrospective review of hindfoot and ankle deformity correction utilizing Ilizarov circular external fixation with concurrent distal tibial distraction osteogenesis from July 2009 to September 2014 was conducted.ResultsThis study included 19 patients with a mean age of 47.47 ± 13.36 years with a mean follow up of 576.13 ± 341.89 days. The mean preoperative LLD was 2.70 ± 1.22 cm and the mean operatively induced LLD was 2.53 ± 0.59 cm. The mean latency period was 9.33 ± 3.47 days and distraction rate was 0.55 ± 0.16 mm/day. The mean distraction length was 2.14 ± 0.83 cm and mean duration of external fixation was 146.42 ± 58.69 days. The time to union of all hindfoot and ankle fusions was 121.00 ± 25.66 days with an overall fusion rate of 85.71%.ConclusionsThe successful treatment of hindfoot and ankle deformity correction in the setting of LLD using the technique of a distal tibial corticotomy and distraction osteogenesis is reported and illustrates an additional treatment technique with comparable measured outcomes to those previously described. We urge that each patient presentation be evaluated with consideration of all described approaches and associated literature to determine the current best reconstructive approach as future studies may validate or replace the accepted options at present.

Pedobarographic analysis of body weight distribution on the lower limbs and balance after ankle arthrodesis with Ilizarov fixation and internal fixation

BackgroundA number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads.MethodsRetrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform.ResultsIn group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant.ConclusionsBalance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients’ balance.

Tissue Expansion for Severe Foot and Ankle Deformities: A 16-Year Review.

Tissue expansion in the lower extremity is controversial, with studies reporting complication rates as high as 83%. Few studies have looked at tissue expansion prior to orthopaedic correction of severe foot and ankle deformities, and those available are restricted to clubfoot in the pediatric population. Here, we report the largest case series on the use of tissue expanders for the reconstruction of severe foot and ankle deformity and the only report in adults. This is a retrospective chart review of the senior author's practice over a 16-year study period. All patients over 18 years of age who underwent tissue expansion prior to definitive orthopaedic correction of a severe foot and ankle deformity were included. Patient demographics, etiology of deformity, rate of expansion, and complications were recorded. Major complications were defined as those which required surgical intervention. Data were analyzed using descriptive statistics. Nineteen cases were performed on 16 patients. Our overall complication rate was 31.6% (6/19), with major complications occurring in 21.1% (4/19) of cases, and minor complications occurring in 10.5% (2/19) of cases. Despite this, 94.7% (18/19) of cases went on to receive definitive orthopaedic correction after tissue expansion. No demographic parameters were associated with occurrence of complications. This represents the largest report on lower extremity tissue expansion for severe foot and ankle deformity correction. While we observed complications in 31.6% of patients, 94.7% of cases went on to receive definitive orthopaedic correction with successful primary closure.

Digital Planning for Foot and Ankle Deformity Correction: Evans Osteotomy

Preoperative planning is commonly performed for many foot and ankle procedures. The purpose of the present study was to prospectively determine the preoperative digital planning accuracy of predicting the calcaneal graft size used during the “Evans” calcaneal osteotomy. Preoperative digital deformity correction planning, using a standard planning method (TraumaCad® software), was performed on 10 feet scheduled to undergo an Evans procedure. Of the 10 patients, 6 were female and 4 were male, with an average age of 43 ± 22 years. Digital planning was used to predict the Evans graft size. The surgeon was unaware of the predicted graft size, which was then compared with the actual graft size inserted during the procedure. In addition, the pre- and postoperative radiographic angles were recorded and compared (anteroposterior view, talo–first metatarsal angle, calcaneocuboid abduction; lateral view, calcaneal inclination angle; and axial view, tibial–calcaneal angle). The average preoperative talo–first metatarsal angle, calcaneocuboid angle, calcaneal inclination angle, and tibial–calcaneal angle measured 21° ± 9.6°, 28.3° ± 9.0°, 13.8° ± 5.7°, and 15.3° ± 8.2°, respectively. The preoperative tibial–calcaneal position was 2.8 ± 1.2 mm. The radiographic weightbearing angles measured at an average follow-up of 7.4 (range 6 to 12) months improved to 6.3° ± 7.4° (p = .0015), 12.3° ± 6.1° (p < .001), 21.3° ± 7.7° (p = .0122), and 2.2° ± 3.6° (p = .0019) for the talo–first metatarsal, calcaneocuboid abduction, calcaneal inclination, and tibial–calcaneal angles, respectively. The final tibial–calcaneal position measured 1.4 ± 0.7 mm (p < .001). The preoperative Evans graft measurement (11.8 ± 2.6 mm) compared with the actual graft (12.2 ± 1.3 mm) placed was within 0.4 ± 1.8 mm (p = .51). Preoperative digital planning for Evans calcaneal osteotomy has been shown to be a valuable tool for predicting the surgical graft size for accurate pedal realignment.

Radiographic Analysis of an Opening Wedge Osteotomy of the Medial Cuneiform

Forefoot varus deformity and medial column instability can develop or be present in association with ankle and hindfoot pathology. This study aimed to confirm the utility of medial cuneiform opening wedge osteotomy as part of hindfoot and ankle deformity correction. Patients requiring operative management of flatfoot deformity between January 2002 and December 2007 were prospectively entered in a database. We selected all patients who underwent medial cuneiform opening wedge osteotomy. One hundred and one feet in 86 patients of mean age 36 (range, 9 to 80) years were evaluated. Eighty-one feet had adequate radiographic imaging for assessment. Concomitant procedures were performed. We measured standardized, validated radiographic parameters on pre- and postoperative weightbearing foot radiographs. Variables including concomitant surgical procedures, osteotomy union, malunion, and midfoot arthritis were noted. The mean lateral talus-first metatarsal angle improved from 23 degrees to 1 degrees (p < 0.001); mean medial cuneiform to floor distance improved from 20 mm to 34 mm (p < 0.001); mean talar declination angle improved from 39 degrees to 27 degrees (p < 0.001); mean calcaneal-talar angle improved from 64 degrees to 55 degrees (p < 0.001); calcaneal pitch angle improved from 14 degrees to 23 degrees (p < 0.001); mean first metatarsal declination angle improved from 17 degrees to 26 degrees (p < 0.001); mean talonavicular coverage angle improved from 45 degrees to 18 degrees (p < 0.001); and mean anteroposterior talus-first metatarsal angle improved from 19 degrees to 0 degrees (p < 0.001). Radiographical analysis showed that medial cuneiform opening wedge osteotomy combined with other corrective procedures corrected forefoot varus, elevated first metatarsal and medial column instability radiographic parameters that are most commonly associated with flatfoot deformity.

Outcome After Foot and Ankle Deformity Correction Using Circular External Fixation

External fixation is the method of choice for correction of chronic severe foot and ankle deformities. We report our experience and outcomes of circular external fixation. Fifty-five patients (60 feet) were treated with circular external fixation. The mean age at surgery was 36 (range 16 to 65) years. The mean followup was 4.4 (range 1 to 10) years. The mean time spent in external fixation was 2.1 (range 1 to 12) months. There were six excellent, 35 good, eight fair, and six poor results, five of which had below knee amputations. All the patients who had an amputation were treated for infected nonunion of the ankle. Circular external fixation was found to be an effective method for treating a variety of complex foot and ankle problems. The complications were more common in patients with infected nonunions.