CAN CHRONIC SEVERE OSTEOMYELITIS OF THE FOOT BE TREATED SUCCESSFULLY WITH THE ILIZAROV METHOD?

Abstract

Introduction: Even most severe foot deformities can be treated with the Ilizarov method (IM). In the last 17 years the IM was used in more than 200 feet. 11 of these feet had a severe chronic Osteomyelitis of the foot. In one case the osteomyelitis lasted more than 21 years. With traditional methods these feet cannot be healed, but often must be amputated.

Material and method: AH 11 feet had a type 4 classification according to Dimeglio. All feet have been treated unsuccessfully up to ten times and more before. In one foot necrotic bone was sequestrated regularly. Our operation consisted in all cases in one step only: the Ilizarov ring fixator was put to the foot and the lower leg according to the deformity. No necrectomy was done. An open wedge osteotomy was done if necessary. Postoperatively the feet were gradually distracted and kept in orthograde position. Antibiotics were given as a single shot intraoperatively only.

Results: During the time of correction in all cases secernation stopped without any further treatment. In all cases the osteomyelitis became clinically inapparent. Even serology became normal. The feet could be kept in normal position. The patients were able to walk even longer distances. All became pain free. Mean follow-up is 3 years and 7 months (6 months-15 years).

Complications: In 4 feet a 2nd procedure with resection of subcutaneous bone spurs was necessary. Not a single case became worse or developed a sepsis.

Discussion: We could show that even long lasting cases of severe osteomyelitis of the foot can be treated successfully with the IM. It is most important to correct the deformity. No skin flap or muscle transfer is necessary to improve the condition. The IM should be the treatment of choice in severely involved cases with osteomyelitis and chronic ulceration, especially in patients with neuropathic osteomyelitis, e.g. spina bifida.