(mentions CMT) V osteotomy and Ilizarov technique for residual idiopathic or ne

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J Orthop Surg (Hong Kong). 2008 Aug;16(2):215-9.

V osteotomy and Ilizarov technique for residual idiopathic or

neurogenic clubfeet.

Segev E, Ezra E, Yaniv M, Wientroub S, Hemo Y.

Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel-

Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine,

Tel-Aviv University, Tel-Aviv, Israel.

PURPOSE. To report the treatment outcomes of V osteotomy and Ilizarov

technique for residual idiopathic or neurogenic clubfeet.

METHODS. 13 patients (14 feet) aged 8 to 18 years underwent V

osteotomy via the calcaneus and talus, followed by gradual

distraction of soft tissue and bone for foot reconstruction. Eight of

the clubfeet were idiopathic and had undergone previous surgeries.

The remaining 6 were neurogenic and their pathologies were: Charcot-

Marie-Tooth disease (n=2), myelomeningocele (n=2), neurofibromatosis

(n=1), and distal arthrogryposis (n=1). Three of them had undergone

previous surgeries.

The Ilizarov frames were retained for 3 to 6 months and the patients

were followed up for 1.8 to 8.9 years. Range of movement of the ankle

and foot, appearance and position, gait, pain, function, and patient

satisfaction were assessed according to the modified clubfoot grading

system. The talo-1st metatarsal angle was measured on anteroposterior

radiographs.

RESULTS. Scores associated with the appearance and position of the

foot, and thus patient satisfaction were significantly improved, but

not for range of movement, pain, and function. The mean preoperative

and final talo-1st metatarsal angles were 39.7 and 8.7 degrees,

respectively (p<0.01). Ten feet achieved the plantigrade position,

one had residual equinus, and 3 had residual adduction and

supination.

CONCLUSION. Patient satisfaction improved significantly despite no

major improvement in pain, function, and range of movement of the

ankle and foot. This reflects the importance of the appearance and

position of the foot, and justifies the decision to undergo this long

and demanding procedure.