The Gradual Correction of Rigid Pes Cavus Using Midfoot Osteotomy Combined with Ilizarov Methods

Abstract

Objective: Midfoot osteotomy combined with Ilizarov methods of correction is a rarely reported treatment that is particularly well-suited for severe rigid pes cavus. The study aimed to assess the radiological and clinical results of patients who had been treated for rigid pes cavus using this method.

Methods: The study retrospectively analyzed the clinical and radiological data of 15 pes cavus in 12 patients who were corrected by midfoot osteotomy with Ilizarov external frame in our department from March 2020 to September 2022. Radiologic outcomes were measured using the Meary angle (MA), talus-first metatarsal angle (TM1A), calcaneal varus angle (CVA) and foot length with weight-bearing radiographs. Functional assessments were evaluated in terms of pain, function, and quality of life by using the visual analogue scale (VAS), the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), and 36-item Short Form Health Survey (SF-36). Additionally, the postoperative satisfaction of patients was investigated by a questionnaire. The clinical and radiological results were evaluated by a paired t-test.

Results: All patients received plantigrade feet and pain relief. The mean follow-up was 33.1 ± 5.0 months (range from 25 to 41 months). The etiology included poliomyelitis (4), idiopathic (3), trauma (2), spina bifida (2) and tethered cord syndrome (1). The duration of gradual correction was 30.4 ± 10.6 days, and the external fixation time was 116.3 ± 33.3 days. The bony union rate was 100%. The VAS, AOFAS, and SF-36 scores significantly improved (p < 0.05). The MA, TM1A, and CVA were close to or reached the normal range postoperative (p < 0.01). The length of each foot was well preserved, which was increased more than 0.8 cm than preoperative. No major complications were reported except two cases of mildly hindfoot varus deformity. The results of the questionnaire showed that patients' satisfaction was 92% (11/12).

Conclusion: Midfoot osteotomy combined with Ilizarov external frame proved to be a reasonable procedure with satisfying mid-term results for the gradual correction of rigid pes cavus.

Keywords: Ilizarov external frame; midfoot osteotomy; pes cavus; tendon transfer.

FIGURE 1

The schematic diagram of midfoot osteotomy combined with Ilizarov technique for rigid pes casvus. (A) A linear osteotomy was performed for a rigid pes cavus when the apex is located in the midfoot. Black dashed line, midfoot osteotomy. White lines, the force line of foot. (B) Excellent correction was achieved without foot shorteningvia gradual distraction by Ilizarov technique. Bidirectional red arrow, Ilizarov distraction.Red area, distraction area.White line, the force line of foot.

FIGURE 2

The midfoot osteotomy combined with Ilizarov technique for rigid pes casvus. (A) The anteroposterior (AP) and lateral view of the foot for intraoperatively determining the level of the osteotomy. (B) The transverse midfoot osteotomy was performed after exposing the talar‐navicular joint, cuneiforms and cuboid. (C) The Ilizarov technique was performed to gradually correct the pes cavus.

FIGURE 3

A 16‐year‐old male patient with a congenital pes cavus was successfully treated by midfoot osteotomy combined with Ilizarov technique. (A) The preoperative outlook and (B) X‐ray show a rigid pes cavus. (C) The schematic diagram of preoperatively surgical planning and (D) X‐ray at 7 days after surgery show the midfoot osteotomy combined Ilizarov technique for this patient. White lines, the force line of foot. Red dashed line, midfoot osteotomy. Red area, distraction area. (E) The outlook and (F) X‐ray at 1 year after surgery show an excellent correction was achieved in this patient.

FIGURE 4

A 46‐year‐old female patient who suffered a rigid pes cavus and a limb deformity from poliomyelitis was successfully treated by midfoot osteotomy combined with Ilizarov technique. (A) The preoperative outlook and (B) X‐ray show a rigid pes cavus and a leg length discrepancy and valgus deformity of the ipsilateral lower extremity. Red lines, the force lines of low limbs. (C) The outlook and (D) X‐ray at 3 months after surgery show midfoot osteotomy combined with Ilizarov technique for this patient. (E) The outlook and (F) X‐ray at 2 years after surgery show excellent correction was achieved in this patient. Red lines, the force lines of low limbs.