CLINICAL AND PATIENT REPORTED OUTCOMES FOLLOWING ILIZAROV TREATMENT OF SEVERE NEGLECTED CLUBFOOT: CASE SERIES

Abstract

Severe residual and neglected rigid clubfoot deformities present significant reconstructive challenges in pediatric and adolescent orthopedics. We report two adolescent patients with severe rigid clubfoot deformity treated with gradual correction using an Ilizarov circular external fixator. This retrospective two-case series included two adolescent patients treated in 2022: a 13-year-old female with congenital bilateral clubfoot and a 17-year-old male with a residual clubfoot deformity associated with spastic cerebral palsy. Both underwent percutaneous Achilles tendon release and staged Ilizarov frame application followed by gradual closed manipulation. Clinical and radiographic correction, treatment duration, functional status, and recurrence during follow-up were assessed. Functional status was categorized using the ASAMI functional criteria, adapted from their original use in Ilizarov treatment of tibial nonunion. Plantigrade clinical and radiographic correction was achieved after 60 days of active manipulation in Case 1 and 50 days in Case 2. The frames were maintained in static fixation for 75 and 90 days, respectively, before removal. Case 1 received a Good and Case 2 an Excellent ASAMI functional grade at the one-year and three-year assessments. At the available one- and three-year postoperative examinations, both patients maintained plantigrade weight-bearing without documented recurrent equinus or varus deformity. In these two cases, gradual closed correction with an Ilizarov circular external fixator provided plantigrade alignment and preserved weight-bearing function without extensive bone resection. The findings are descriptive and cannot establish comparative efficacy or generalizability. Larger prospective studies using validated foot-specific and patient-reported outcome measures are needed.

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