Treatment of arthrogrypotic foot deformities with the Taylor Spatial Frame

Abstract

Background: Treatment of foot deformities in arthrogryposis is a challenging problem. Most deformities are very rigid clubfeet, such as deformities with severe equinus, supination, cavus, hindfoot varus, and forefoot adduction. Vertical talus with severe rocker bottom is also common. Traditional approaches included casting and soft tissue release, which are usually only partially successful. We describe our experience with the treatment of arthrogrypotic foot deformities with the Taylor Spatial Frame.

Methods: Over a period of 5 years, we treated 7 patients (10 feet) with various arthrogrypotic foot deformities. There were 4 girls and 3 boys with a mean age 10.6 years (range: 4 to 16 y). Six patients had clubfoot deformities and 1 had vertical talus. All patients had previous surgeries, including soft tissue release in 8 feet and Ilizarov correction in 3 feet. Three patients underwent bilateral correction, 3 patients underwent midfoot osteotomies, and 2 patients had supramalleolar osteotomies and lengthening to compensate for growth arrest of the distal tibia. The remaining feet had correction of their deformities by soft tissue distraction. Six patients underwent correction using a Butt frame and 5 by standard frame configuration.

Results: All patients achieved the preoperative correction goal and their frames were removed at an average of 16.1 weeks (range: 14 to 18 wk). Complications included pin tract infections in 4 patients. One patient had iatrogenic regenerate translation that was reduced by a residual program, 1 patient had recurrence of equines, and another had partial recurrence of forefoot supination. Two hindfoot varus deformities were successfully treated by calcaneal osteotomy at the time of Butt frame removal.

Conclusions: On the basis of our preliminary experience, we believe that the Taylor Spatial Frame is a reliable and accurate method of correction of complex foot deformities in children with arthrogryposis.