Treatment of relapsed or neglected clubfeet between the age of 8-15 years is at present unsatisfactory. Correction by triple arthrodesis with wedge osteotomies is not possible before the end of skeletal maturation. This caused us to use Ilizarov's external fixator, which made it possible to correct all components of clubfoot simultaneously by continuous guided distraction. Thirteen feet in 12 children were treated. A plantigrade foot was achieved in all cases. All patients were able to wear ready-made shoes. Complications were some slight and two severe pin track infections, temporary edema, and two relapses successfully treated by means of second procedures.

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We have used Ilazorov's method of distraction epiphyseolysis for leg lengthening since 1977 and his new method of corticotomy or compactotomy since 1983. The first method was carried out in 22 lower limbs with an average lengthening of 8.25 cm (range 4 to 18 cm); included in this group are 2 patients with achondroplasia in whom both legs were lengthened 12 cm. In the second method, a corticotomy is carried out at the metaphyseal-diaphyseal junction followed by distraction in Ilazorov's apparatus (4 x 0.25 mm a day). We lengthened 30 legs; included are 5 patients who had both legs lengthened from between 8 and 12 cm. In the remainder an average of 7.9 cm of lengthening was achieved (range from 4 to 15 cm). The index for the treatment time per cm achieved (time from operation until full weight-bearing per cm of lengthening) was shorter after distraction epiphyseolysis than after corticotomy. Complications were also a little less after the latter procedure. Distraction epiphyseolysis has to be limited to children from aged 12 years until growth ceases. The advantage with corticotomy is that it can be done at any age from 5 to 30 years. Care is needed in both cases to avoid complications.

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