Correction of Resistant/Relapsed/Neglected Clubfeet by Differential Distraction with a Simple Unconstrained Ilizarov Construct

Abstract

ABSTRACT Introduction External fixators were used to correct difficult clubfeet by the principle of differential distraction. Following the distraction phase, the fixator was conventionally maintained for a prolonged period to prevent recurrence. The purpose of the study was to analyze whether early removal of the fixator followed by Ponseti's technique of manipulation is compatible with good result and maintenance of correction at long-term follow-up. Materials and methods A total of 21 children with resistant/ relapsed/neglected clubfeet in the age group of 2 to 13 years were treated by an unconstrained Ilizarov frame and differential distraction. Once the deformity was clinically corrected, the distraction was stopped and the fixator was removed after 3 weeks. During removal of the fixator, the feet were manipulated according to Ponseti's principles and if necessary a posterior TendoAchilles lengthening/tenotomy was done to obtain more dorsiflexion. Above-knee plaster casts were applied for a period of 3 weeks. Following removal of casts, measurements were taken for foot abduction orthosis and a below-knee cast was applied till the foot abduction orthosis was ready. The foot abduction orthosis was used at nighttime. Parents were taught to manipulate the feet after each meal. Results Good clinical correction was obtained in all feet. At 2 years follow-up, correction was well maintained, implying that there is no risk of recurrence if the fixator is removed early during the static phase. The use of Ponseti's technique at fixator removal may also help in reducing the risk of recurrence. Conclusion Clubfeet can be easily corrected by differential distraction using external fixators. Early removal of fixator followed by the application of Ponseti's technique of manipulation gives good correction of deformity and does not increase the rates of recurrence. How to cite this article Harshavardhan G, Ganesan GR. Correction of Resistant/Relapsed/Neglected Clubfeet by Differential Distraction with a Simple Unconstrained Ilizarov Construct. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):1-5.