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[Long-term outcome after Ilizarov corrective fixation for severe foot deformity].

PURPOSE OF THE STUDY
Much work has focused on the short-term outcome after external fixation with the Ilizarov apparatus for treatment of severe recurrent or neglected foot deformity. No series has provided sufficient follow-up to allow an analysis of long-term stabilization.


MATERIAL AND METHODS
We reviewed a series of 17 patients (21 feet) treated with the Ilizarov apparatus between 1988 and 1998 and reexamined after a mean 6-year follow-up. We assessed the risk of degradation of the initial result and quantified the need for secondary arthrodesis surgery. This series included 18 congenital clubfeet and 3 cases of acquired talipes equinus. Mean patient age was 15 years.


RESULTS
Pain, morphology, weight bearing attitude and quality of shoe fit were assessed. Results at treatment end were very good in 16 cases, good in 4 and poor in 1. Two early recurrences required arthrodesis. At last follow-up, results were very good in 17 cases, good in 3, and poor in 1 (late recurrence with arthrogryposis).


DISCUSSION
With 3 recurrences among 21 cases, results were maintained well over time in this series. Most of the recurrences were observed during the first year and never completely reproduced the initial deformation. In 2 out of 3 cases, the recurrence occurred on a secondary talipes equinovarus. Age was not a risk factor (only 2 feet have not reached maturity to date). The lack of over-correction at treatment end is a factor predictive of poor outcome.


CONCLUSION
Long-term outcome demonstrated the stability of the results and the absence of severe complications and foot shortening, emphasizing the important contribution of Ilizarov fixation for severe foot deformity.