Principles of Foot Deformity Correction: Ilizarov Technique

The Ilizarov technique lends itself well to correction of foot deformities because of the three-dimensional nature of the foot and of the apparatus. The two approaches to the correction of foot deformities are (1) soft tissue distraction of the deformity and (2) distraction of an osteotomy. In the former, the deformity is corrected by eliminating pre-existing contractures and by distracting across joints in an attempt to bring them into a new congruous relationship to a plantigrade position. 3,5.8.18 In the second, the distraction occurs through osteotomies, regenerating new bone and eliminating deformities by opening wedge-type corrections." 8.15.18 The joints remain undisturbed with osteotomy distraction techniques. The decision as to which approach to use depends on several factors: (1) age, (2) the presence or absence of fixed bony deformities, and (3) the stiffness of the deformity. The decision for nonosteotomy treatment depends primarily on the age of the patient. Essentially, any deformity can be treated without osteotomy in patients younger than 8 years of age. In patients older than 8, the presence of fixed bony deformities is generally a contraindication to nonosteotomy treatment. An exception to this rule is when the joints to be distracted are so stiff that tlrere is significant risk of physeal disruption rather than joint distraction. In these cases, osteotomy treatment may be preferable. The indications for nonosteotomy treatment are similar to those for soft tissue release by conventional means. 17 Soft tissue release relies on biologic plasticity and remodeling of cartilaginous bones. Dis-