Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique

Abstract

Complex foot deformity is a multiplanar deformity with or without foot shortening. It also includes deformed feet with poor soft-tissue coverage, relapsed or neglected cases, and those with acompanying problems such as leg-length discrepancy, lower leg deformity, osteomyelitis and nonunions. Traditionally, correction of these deformities can be achieved by extensive soft tissue releases, osteotomies or arthrodesis with or without internal fixation. This usually involves excision of large appropriate bony wedges and has many disadvantages, including neurovascular injury, soft tissue problems and a shortened foot. We present our experience with a group of severe deformities of the foot that we managed using the V-osteotomy combined with the Ilizarov technique. We present our algorithm of management of complex foot and ankle deformities, together with our prerequisites for patient selection. A detailed description of the operative technique, postoperative care and possible complications is also presented. The combination of the Ilizarov technique and the V-osteotomy offers versatility in foot deformity correction, enabling correction of individual components of the deformity at rates that may be tailored to achieve accurate three-dimensional control.

Application of the Ilizarov Technique to the Correction of Neurologic Equinocavovarus Foot Deformity

“…Instead, we perform a first cuneiform plantar opening wedge osteotomy along with plantar fasciotomy and abductor hallucis fasciotomy. For forefeet with a severe pronation deformity, a transcuneiform plantar opening wedge osteotomy is beneficial for complete correction of forefoot pronation, as reported by others [23]. Thereafter, if the cavus deformity remains, a first metatarsal base dorsal closing wedge osteotomy may be combined.…”

Talar and Calcaneal Y-Osteotomy with Distraction Osteogenesis for the Correction of Rigid Equinus

“…15 Different osteotomies with and without an external fixator have been described in literature for correction of complex foot deformities. 9,11,14,16,17,20 Correcting deformities such as clubfoot become a challenge especially after failed surgeries due to stiffness of the soft tissues and residual deformities such as equinus. 16,17 There are several osteotomies and a few of the commonly discussed ones are the U (Scythe-shaped), V, and less commonly discussed Yosteotomy.…”

“…9,11,14,16,17,20 Correcting deformities such as clubfoot become a challenge especially after failed surgeries due to stiffness of the soft tissues and residual deformities such as equinus. 16,17 There are several osteotomies and a few of the commonly discussed ones are the U (Scythe-shaped), V, and less commonly discussed Yosteotomy. 16,17 The scythe-shaped (U) osteotomy is a curved osteotomy that divides the foot into two sections.…”

“…16,17 There are several osteotomies and a few of the commonly discussed ones are the U (Scythe-shaped), V, and less commonly discussed Yosteotomy. 16,17 The scythe-shaped (U) osteotomy is a curved osteotomy that divides the foot into two sections. It starts posterior to the lateral malleolus and runs from 1-1.5 cm below the posterior subtalar joint, then penetrates the floor of the sinus tarsi and emerges at the talar neck.…”

“…9 The Ilizarov method with external fixation was chosen for the correction after performing the osteotomy because it enables correction in all three orthogonal planes. 4,9,11,14,17 Using an external fixator is not only minimally invasive, but it also allows the surgeon to stage the treatment appropriately to manipulate the rate and direction of the correction. It can be used as either a constrained or unconstrained hinge system.…”