197. LONG TERM RESULTS OF ILIZAROV TREATMENT IN RELAPSED CLUB FEET- A COMPARISON OF SCORING SYSTEMS WITH A PATIENT’S PERSPECTIVE OF OUTCOME

Abstract

Purpose: The Ponseti method of clubfoot treatment has revolutionised the management of this condition. Prior to the introduction of the Ponseti regime to the UK in the late 1990’s children were frequently treated by open surgical releases. The aim of our study is to compare the patient’s perspective of outcome following Ilizarov treatment against the long-term outcome generated by the formal scoring systems.

Method: We identified nine patients and 14 feet from the theatre logbooks, treated by the senior author (CB), with recurrent deformity of idiopathic clubfeet, using an ilizarov external fixator between 1994 and 1996. A variety of objective and subjective scoring systems were used to compare the results following Ilizarov treatment.

Results: International Clubfoot Study Group (ICFSG) scores on six patients gave two excellent feet, one good foot, four fair feet and one poor foot. Giving an excellent/ good rate of only 37.5% with a mean follow up of 13.5 years. The Reinker & Carpenter scoring system resulted in five feet graded as excellent, one as good and two were rated poor. Giving an excellent/good rate of 75%. Functional questioning was also undertaken, six of seven (85%) patients deemed their treatment a success and were glad to have undergone treatment with an ilizarov frame. All but one patient is in higher education pursuing a vocational career or are in full time employment.

Conclusion: Our results show that 85% of our patients who were treated with an Ilizarov frame for correction of a relapsed clubfoot were happy with their long term outcome. Thus the patient’s perspective of the long term results of Ilizarov treatment for relapsed club foot are very encouraging. These results do not appear to correlate well with the International Clubfoot Study Group scores.