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.

In the most severe clubfeet, especially in relapse, traditional operations are not helpful any longer. In these cases the Ilizarov method (IM) can correct even the worst deformities by gradual correction. Up to the age of about eight years, traditional operations can be performed in most cases of relapsed clubfoot. A disadvantage of the traditional operation is the shortening of the foot if a wedge is resected. With the IM the patient need not be immobilised postoperatively for a long period, which is important especially for those children with neurological diseases. We report on our 18 years experience with the IM.

We have operated 99 clubfeet with the IM. The first 91 consecutive cases in 79 patients are included in this retrospective study. The mean age of our patients was 14.2 years. The mean follow-up was two years, five months. The etiology was 28 congenital, 51 neurological, five rheumatological and seven with posttraumatic clubfeet. The mean number of operations per patient before presenting to us was 1.6 (range 0 to 8). The mean healing time – the number of days from application of the external fixator until its removal – was 115 days. Using the classification of Dimeglio we found 12 type 3 feet and 79 type 4 feet (stiff-stiff).

In 37 feet we observed a superficial infection, in seven a deep infection, and an ostitis in one. At the end of a seven-year follow-up period, clinical, radiological and laboratory tests of the patient with ostitis showed no signs of infection. In the beginning we had some torn wires, but this was a problem that could be solved with increasing experience.

We classify the patients into three groups. Feet that have a normal or almost normal shape and permit weight bearing and walking without pain are rated as good. Radiologically the foot is well corrected. A residual deformity without skin damage or complaints is rated as fair. A relapse, overcorrection or severely restricted walking capacity is rated as bad.

In our study we found 52 good, 33 fair and 6 bad results. All feet with a preoperative infection due to long lasting skin breakdown and ostitis healed well during treatment with an external fixator.

The IM is a safe procedure even in the most severe cases and allows correction if traditional methods can no longer be used. The results show that many good and at least fair results can be achieved. Normal function cannot be expected in these severely deformed feet, but the aim is to allow weight bearing and walking even in severe cases. The IM is especially helpful in neurologically relapsed clubfeet. The IM is an efficient tool in the hands of an experienced orthopaedic paediatric surgeon.