Orthopedic Foot and Ankle Center, Westerville, OH 43082, USA.
Foot Ankle Int. 2011 May;32(5):S533-9. doi: 10.3113/FAI.2011.0533.
The rigid equinovarus foot deformity is a challenging condition treated by the orthopaedic foot and ankle surgeon. Rapid surgical correction of the deformity may lead to skin and neurologic complications. Gradual correction of the deformity with a multiplanar external fixator may decrease these complications. The purpose of this study was to present the results of a group of patients with rigid equinovarus deformities corrected using a multiplanar external fixator.
We retrospectively reviewed the results of correction of a rigid equinovarus deformity using multiplanar external fixation in a small group of patients. All patients underwent open Achilles lengthening, posterior capsule release, tibialis posterior tendon lengthening, flexor digitorum longus and flexor hallux longus lengthening, followed by application of a multiplanar external fixator with gradual correction of the deformity over a period of several weeks. Preoperative and postoperative deformity and AOFAS ankle-hindfoot scores were assessed.
A total of eight rigid equinovarus deformities in six patients were treated with a multiplanar external fixator. The average patient age at the time of surgery was 37.2 (range, 17 to 59 ± 15.0) years. Causes of the deformity included trauma in three patients, traumatic brain injury in two patients, and long-standing rheumatoid arthritis in one patient. The average preoperative AOFAS ankle-hindfoot score was 28.3 (range, 12 to 38 ± 7.7). The average postoperative AOFAS ankle-hindfoot score was 68.1 (range 38 to 86 ± 15.5) at an average followup of 71.9 (30 to 120 ± 36.2) weeks. All deformities were gradually corrected to a plantigrade foot using a multiplanar external fixator over an average time of 5 (range, 4 to 6 ± 0.8) weeks. After correction of the deformity, the external fixator was left in place for a time period equal to or twice the length of time it took to achieve correction. The average duration of external fixation was 10.8 (range, 8 to 16 ± 2.8) weeks. Seven of eight deformities maintained correction at final followup. There was one case of recurrence.
Correction of a rigid equinovarus deformity using a multiplanar external fixator was a viable treatment option. It allowed for correction of the deformity in a controlled manner, helping to reduce the risk of neurovascular complications that may result from single stage surgical correction. The risk of wound complications still exists with the correction of such a complex deformity.
僵硬的马蹄内翻足畸形是矫形足踝外科医生面临的一项具有挑战性的病症。快速矫正畸形可能会导致皮肤和神经并发症。使用多平面外固定器逐渐矫正畸形可能会降低这些并发症的发生。本研究旨在介绍一组使用多平面外固定器矫正僵硬马蹄内翻足畸形的患者的结果。
我们回顾性分析了一小部分患者使用多平面外固定器矫正僵硬马蹄内翻畸形的结果。所有患者均接受了开放性跟腱延长术、后囊松解术、胫后肌腱延长术、趾长屈肌和踇长屈肌延长术，然后应用多平面外固定器，在数周内逐渐矫正畸形。评估术前和术后的畸形和 AOFAS 踝关节-后足评分。
共有 6 名患者的 8 个僵硬马蹄内翻足畸形采用多平面外固定器治疗。手术时患者的平均年龄为 37.2 岁（范围，17 至 59 ± 15.0 岁）。畸形的病因包括 3 例创伤、2 例创伤性脑损伤和 1 例长期类风湿关节炎。术前 AOFAS 踝关节-后足评分平均为 28.3（范围，12 至 38 ± 7.7）。平均随访 71.9（30 至 120 ± 36.2）周时，术后 AOFAS 踝关节-后足评分平均为 68.1（范围 38 至 86 ± 15.5）。所有畸形均通过多平面外固定器逐渐矫正为足底负重位，平均矫正时间为 5（范围，4 至 6 ± 0.8）周。畸形矫正后，外固定器的放置时间等于或超过矫正所需时间的两倍。平均外固定时间为 10.8（范围，8 至 16 ± 2.8）周。8 个畸形中有 7 个在最终随访时保持矫正。有 1 例复发。
使用多平面外固定器矫正僵硬马蹄内翻足畸形是一种可行的治疗选择。它可以通过控制方式矫正畸形，有助于降低单阶段手术矫正可能导致的神经血管并发症的风险。对于如此复杂的畸形，仍存在伤口并发症的风险。
