To investigate the clinical outcomes of combined Ilizarov technique with tendon transfer for the treatment of rigid equinovarus foot deformity.

A retrospective analysis was performed on the clinical data of 11 patients (14 feet) with rigid equinovarus foot deformity who were treated by Ilizarov technique combined with tendon transfer without additional bony procedures from August 2015 to February 2018. The average age was 21.6 years old (range, 12-36 years old) and 6 patients were males and 5 patients were females. According to Dimeglio classification, 8 feet were grade II and 6 feet were grade III. Seven patients (10 feet) were treated with external fixator and tendon transfer simultaneously. Four patients (4 feet) underwent staging surgery, in which Achilles tendon lengthening, plantar fascia lysis and slow correction of deformity with external fixator were performed as the first stage operation, followed by the second stage tendon transfer. The average interval between the two operations was 26.5 days (range, 20-32 days). The lateral tibiotalar angle on load-bearing ankle radiographs and tibiocalcaneal angle on Saltzman view radiographs were measured after operation, and compared with that before operation. Functional evaluation was performed by The American Orthopaedic Foot and Ankle Society (AOFAS) and Ankle Hind foot Scale. Quality of life assessment was assessed by the MOS 36-Item Short Form Health Survey (SF-36) Scale. The excellent and good rate of operation was evaluated by the International Clubfoot Study Group (ICFSG) scoring system.

All patients were followed up for 6 months to 36 months with an average of 20 months. All cases achieved effective correction. There were no neurovascular complications in this group of patients. The preoperative ankle range of motion in dorsiflexion was -19.9°±14.8°, and plantar flexion 38.5°±12.8°. At the latest follow-up, the mean dorsiflexion increased to 2.7°±1.6° and the plantar flexion decreased to 21.0°±9.2°. Preoperative Dimeglio classification included 8 feet in grade II, 6 feet in grade III. At the latest follow-up, there were 13 feet in grade I and 1 foot in grade II. The tibiotalar angle was 122.2°±16.6° before surgery and 100.8°±4.8° at the latest follow-up. The tibiocalcaneal angle of the Saltzman view was-25.2°±9.2° before surgery and-3.7°±2.8° at the latest follow-up. The mean preoperative AOFAS score increased from 63.9±12.7 to 85.2±9.7, with statistically significant difference (t=14.87, P< 0.05). The average SF-36 score increased from 50.1±8.4 to 63.7±8.1, with statistically significant difference (t=4.10, P< 0.05). At the latest follow-up, the average ICFSG score was 6.6 (range, 3-16). According to the classification of ICFSG score, there were 7 feet excellent, 6 feet good, and 1 foot fair, with an excellent and good rate of 92.9% (13/14).

Ilizarov technique combined with tendon transfer could achieve successful correction of rigid equinovarus foot deformity with satisfactory short-term results.

Clubfoot; Ilizarov technique; External fixators