ILIZAROV in clubfoot

Club foot as the name implies is a congenital foot deformity that looks like the end of a golf club. The foot is twisted inward and downward and cannot be turned back to the normal position. If both feet are involved, the sole faces each other. It is otherwise known as talipes. Sometimes, depending on the abnormality of the assumed position, it may be called talipes equinovarus. This is found in normal children or among those with concomitant disorders like spina bifida, hand deformities or congenital hip dislocation. This is usually diagnosed in the nursery, it being an apparent gross deformity. The cause for this disorder has been a subject of debate for centuries. Nevertheless, a number of theories have been proposed as follows:The chromosomal theory believes that the defect is in the unfertilized egg. The embryonic theory rather believes that it occurs between conception to about 12 weeks of conception. The osteogenic theory proposed that there is an arrest in bone development between 7 to8 weeks.Other theories are the fetal , neurogenic and Amyogenic theory. The latter blames the defect primarily to a muscular problem.

At risk to have this deformity are those with a family history of talipes. Those with one parent or sibling with the deformity has a 50% chance to develop it. On the general population it occurs 1 in 1000 live births and is twice more common among males.

Treatment can be non operative which consist of serial manipulation and casting or bracing. There are different methods of non operative treatment. But the two most common, with the highest claim of success are those by Kite/Lowell and the Ponsetti technique. In Ponsetti the manipulation is done soonest after birth. It involves stretching and change of cast weekly for several weeks until the normal or near normal position is attained. A brace is then worn at night for 2 years to maintain the desired foot position. When a non operative treatment is of no avail to the prevailing deformity, resort to surgery is done. The treatment goal is to approximate the normal foot anatomy and function. So that by the time the child is ready to walk his foot is already stable and functional. Generally, the surgical technique may involve only the bone, the soft tissues or both. The timing of surgery is controversial. Some proponents are for early surgery at 3 to 6 months old, believing that correction is easier and better results will be achieved. The latter claim however is short of evidence. Some believe that surgery is best done at 9 to 12 months. At this time, the child is older and will be safer subjected to anaesthesia. The extent of the surgery depends on the complexity presented by the deformity.

Ilizarov is another surgical option used in cases of recalcitrant clubfoot or clubfoot with relapse following the conventional surgical treatment. With Ilizarov, correction of the deformity is achieved with gradual traction. The average hospital stay is about 1 week. The patients' care takers are then instructed how to adjust the frames and which rods to manipulate. Weekly follow-up and every other week radiograph is done. The Ilizarov frame is worn approximately for 6 weeks with the patient mobility restricted until the sole of the foot becomes flat close to a normal anatomic position of the foot. From then on weight bearing is allowed.