Foot and Ankle Function at Maturity After Ilizarov Treatment for Atrophic-Type Congenital Pseudarthrosis of the Tibia: A Comprehensive Outcome Comparison with Normal Controls

J Bone Joint Surg Am. 2016 Mar 16;98(6):490-8. doi: 10.2106/JBJS.15.00964.

Abstract

Background: The purpose of this study was to evaluate clinical outcomes and the biomechanical function of the foot and ankle at skeletal maturity of patients treated for atrophic-type congenital pseudarthrosis of the tibia (CPT) compared with healthy young adult controls.

Methods: Twenty-four patients (mean age of 19.1 years) who had undergone Ilizarov treatment for unilateral atrophic-type CPT were compared with twenty-four controls (mean age of 19.6 years). All participants were evaluated using validated outcome questionnaires, radiographs, physical examination, instrumented motion analysis including a multisegmental foot model, and pedobarographic measurement.

Results: Within the CPT group, the mean score of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale was 89.9 (range, 76 to 100), and the mean score of the Oxford Ankle Foot Questionnaire (OAFQ) was 42.8 (range, 15 to 60). Motion analysis and pedobarographic measurement showed differences in biomechanical function of the foot and ankle on the side affected by CPT: a slower walking speed due to the short stride length; decreased dorsiflexion in hallux motion; increased hindfoot pronation in the presence of forefoot supination; diminished ankle push-off power; delayed time to heel-rise; and decreased forefoot pressure relative to hindfoot pressure. However, sagittal motion of the hindfoot and forefoot on the affected side was relatively well preserved. Subgroup analysis demonstrated no significant differences in terms of clinical outcome scores and most biomechanical parameters between the tibiofibular synostosis group and the intact-fibula group.

Conclusions: Children with atrophic-type CPT can obtain satisfactory foot and ankle function at maturity after successful Ilizarov treatment. Early stabilization of the ankle mortise by fibular stabilization and preservation of ankle mobility during and after treatment is thought to be crucial to maintaining function of the ankle in patients with CPT.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Ankle Joint / physiopathology
  • Case-Control Studies
  • Female
  • Foot / physiopathology
  • Humans
  • Ilizarov Technique*
  • Male
  • Pseudarthrosis / congenital*
  • Pseudarthrosis / physiopathology
  • Pseudarthrosis / surgery
  • Surveys and Questionnaires
  • Tibia / physiopathology
  • Tibia / surgery
  • Treatment Outcome

Supplementary concepts

  • Congenital pseudoarthrosis