The Ilizarov Technique -- Another Option (1991)

Bob Burke in Kansas wrote telling us about a doctor who used a surgical technique, often used to lengthen bones, on Bob's misshapen foot and ankle. You may have seen a program on this technique on television concerning young people who were too short to reach the gas pedals of a car. This technique gave them a few more inches. In Bob's case, it helped correct a foot deformity. Because it was interesting and innovative we thought you might like to know more.
First from Bob:
Dear Linda:
I wanted to give you some information about my recent surgery. I was referred from the MDA Clinic at the University of Kansas Medical Center in Kansas City, Kansas, to see Dr. Brad Olney, also at the Medical Center, about my right ankle deformity. It gradually became worse from corrective surgery in 1982. I have had numerous surgeries for toe fusions, triple arthrodesis, tendon transplants, and osteotomies.

The ankle and right lower leg gradually became a very abnormal joint. The right lower leg was sliding to the inside of the foot allowing the foot to roll out. I then was walking on the outer edge of my foot. This not only created calluses and great pain but made walking difficult for several years. It gradually started bothering my knees and hips because of the stress on these joints from compensating for my foot and ankle.

Dr. Olney was trained in Siberia to do the Ilizarov procedure because Russia wouldn't allow their doctors out of the country to teach this procedure. This is normally done to "lengthen bones." However, we thought this might work in my case. Dr. Olney did "learn" some things about my case as healing took place. The normal procedure involves using two rings to lengthen a bone. My procedure used five rings. Also used were 13 pins going through the leg and foot at specifically planed angles. My lower leg was broken in surgery just above the ankle, which was about one inch off to the side from the deformity. In other words, if you cut your foot off at the ankle and moved it sideways one inch, that's what it looked like. Four times a day, I adjusted different bolts on the frame, slowly sliding the leg and ankle into a more correct position. With the blood vessels in place, because the leg was broken and not cut, healing began immediately even though I was moving the bone during adjustments. Surgery started December 14, 1989 and he removed the frame April 9, 1990. I was on crutches with no weight bearing while the frame did its work.

When the frame came off, I had a "straight" leg and ankle, however, my walking was worse. The front part of the foot from all the previous surgeries was now angled and turned in. Dr. Olney, in May 1990, then did an osteotomy, removing a wedge of bone from the side of the foot, allowing the foot to turn to the right, and rotating the front part of the foot from 12 to 2 o'clock; this returned my foot to a fairly normal position. I was in a non-weight-bearing cast until August 1990. This did wonders as I can now walk with little or no pain and no callus buildup. However, I still wear my braces but I am starting to try to walk without the right leg brace.

I think this procedure is really fairly helpful in situations like mine. However, there are several stressful situations that you need to think about. Some are time off from work, clothing to wear (because of frame size), daily cleaning of pins, depending on other people more, is there room to get in your car, and who will drive for you, just to name a few.

From Dr. Brad Olney, Bob's doctor at the University of Kansas Medical Center:
This letter is in response to your inquiries about my patient Bob Burke. Mr. Burke indeed had a very interesting and difficult problem when I first saw him. I did improve the position of his foot, both with the Ilizarov apparatus and also with conventional surgical procedures.

The Ilizarov apparatus and technique was developed in Russia. It has been used in this country for the last five 10 years. The technique involves putting an external frame on a limb which is held to the different bone segments with wires that are hooked to the circular ring frame. This allows correction, both through the existing joints and soft tissues, as well as correction through a cut that is made in the bone. All the corrections are done gradually and the correction in the bone is done slowly while the bone is healing. This technique has allowed correction of some very difficult deformities, as well as allowing us to lengthen bone segments. This is a very demanding technique and it must be stressed that it is not for every patient and must be individualized in each case. I suspect that the majority of foot problems involving Charcot-Marie-Tooth could be handled with easier methods, but the Ilizarov technique gives us another option in the more difficult cases.

In Mr. Burke's case, when he presented to my clinic, he had a very difficult deformity of his foot secondary to Charcot-Marie-Tooth disease and also previous surgeries. He had a marked bony deformity above the ankle from previous osteotomies, as well as a deformity of the foot itself rom the muscle imbalance secondary to Charcot-Marie-Tooth disease. I chose to use the Ilizarov technique because I could correct both the bony deformity above the ankle without extensive open surgery as well as try to correct some of the deformity in the foot without having to do further osteotomies or fusions. The frame was applied to Mr. Burke's foot and the bone was cut just above the ankle. Once the cut in the bone started to heal, the ankle deformity was corrected slowly with the external frame applying hinges and fulcrums in the appropriate places. At the same time, once the ankle joint was corrected, the foot deformity was also corrected, utilizing the various rings and wires. The foot deformity was corrected without making any cuts in the bone in the attempt at trying to maintain as much mobility as we could.

The technique worked well for correcting the ankle deformity but was less successful in correcting the foot deformity. I believe this is because he already had marked stiffness in the foot and the frame corrected the foot deformity but we had a certain amount of rebound after the frame was removed. Part of the foot deformity recurred but this was taken care of with a conventional osteotomy through the mid foot, which corrected the last bit of deformity. I still believe that correcting most of the deformity initially with the Ilizarov technique made final correction of the foot easier to do.

At this point, Mr. Burke is out of his frame and the foot is in a much-improved position. The foot is not normal by any means but now is flat to the ground and he can walk without pain on the bottom surface of the foot. The Ilizarov technique is appealing in advanced cases of Charcot-Marie-Toooth disease because you can do correction of foot deformities without cutting the bone or doing minimal cuts in the bone. As I stated previously, it is a very demanding technique but one that may be useful in selected patients with this disease.