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Abstract Complex foot deformity can be described as a foot with multiplanar abnormalities with or without shortening of the foot. Conventional surgical treatment may not be able to correct these deformities. There are many drawbacks to using conventional approaches for the treatment of complex foot deformities like the increased risk of the neurovascular injury, soft tissue injury and shortening of the foot. An alternative approach that that can eliminate these problems is Ilizarov method(58). The Ilizarov method permits accurate force application to individual parts of the foot using combination of compression and distraction forces to gradually correct the deformity. Distraction directly stimulates new bone formation while musculo – tendinous units stretch to accommodate the correction (58). Osteotomies can also be used for distraction osteogenesis. Younger children rarely require foot osteotomies since physeal distraction is still possible. Older children and adults frequently require an osteotomy for correction with Ilizarov device. Concurrent planter fasciotomy may also be necessary. Oftentimes, the wire placement distributes the forces across multiple joints, gaining gradual correction at many locations(59). The modalities of treatment used in deformity correction are physiotherapy, splintage, corrective devices, capsulotomy, corrective plaster cast and traction. Ilizarov ring fixator which allows flexibility and adjustment at one or more levels for correction of multi – directional, multi – Summary - 65 - planar and multi – level axial deformities is superior to other conventional method(60). The principle of compression – distraction histogenesis of bone and soft tissue is the basis of treatment of the Ilizarov ring fixator. Distraction histogenesis generates new bone and soft tissue under gradual distraction. Although distraction is important for maturation, which includes neocorticalisation and remodeling, the apparatus is removed once the newly formed bone achieves adequate strength to resist physiologic loading (61). The Ilizarov apparatus is rigid and the minimal nature of the surgical intervention create the optimal biologic and mechanical environment for soft tissue correction and early functional rehabilitation. By the use of the Ilizarov apparatus it is possible to treat severely deformed foot non invasively, without bone resection and without shortening of the foot. The Ilizarov method allows simultaneous correction of all components of any deformity and it is not necessary to wait for completion of skeletal growth. The Ilizarov method avoids disturbing a child life during a very active and important period of development(62). The disadvantages of the Ilizarov technique are obviously those of the external fixation device and in particular those of pin site problems. In addition, the Ilizarov method requires a lengthy treatment time with prolonged joint immobilization and is frequently associated with mild to moderate pain during the distraction period(63). Although, Ilizarov technique is requiring long treatment time, long follow up duration and the apparatus is Summary - 66 - expensive but it has earned a distinct place in the orthopedic surgery by providing better alternative solutions(63). |