Clinical Research on Foot & Ankle
Open Access

Ankle Foot; Osteotomy; Muscle strength balance

Introduction

Central or peripheral nerve injuries or illnesses are responsible for a large number of ankle-foot abnormalities. Foot feeling and neurotrophic deficits are present in some people. Infections, hard-to-heal ulcers, scar contractures, stiffness in the joints, persistent deformities, muscle atrophy, uneven muscle strength, and other problems are particularly common in limbs with neurotrophic insufficiency, which makes treatment more challenging [1]. Amputations are thus carried out in some circumstances. The task of treating limbs with neurotrophic insufficiency is difficult. Restoration surgery for neurotrophic foot and ankle deformities recently produced promising outcomes. Here, we present a summary and analysis of 10 patients who underwent Ilizarov technique treatment for denervated ankle-foot abnormalities.

Patients [2-5]

This study examined 10 patients who received treatment from January 2014 to May 2019 for complicated ankle-foot abnormalities with nerve damage. The age of the patients ranged from 13 to 57 years, with an average of 27.9 years. There were six male and four female patients. 10 to 30 years, or an average of 26 years, pass between the commencement of the condition and the surgery. The following factors contributed to the complicated ankle-foot deformities: Spina bifida consequences include dysaesthesia in the ankles and foot in 5 individuals, total loss of feeling in 1 patient's sole and back of foot, post-traumatic injury to the common peroneal nerve and tibial nerve in 4, and subacute spinal cord degeneration in 1. Two patients had local skin necrosis (non-pin tract), which was caused by compression and healed after protection; none of the patients had postoperative wound infection or a loose or broken steel pin, necessitating reoperation. One patient had ankle subluxation, which was quickly corrected after discovery. At the site of the osteotomy, no patient had bone nonunion. A pin tract infection affected ten patients, but it cleared up after saline cleaning. No patient had recurrence after removing the external fixator. An assessment was made of the ankle's muscle power. During the procedure, it was intended to balance the muscular strength. Prior to surgery, a deformity study was prepared using Paley Orthopedics principles, the deformity's centre of angular rotation was identified, and an individual annular external fixation arrangement was devised [6- 8]. External ring fixation, tendon translocation, and lengthening were all performed intraoperatively using minimally invasive techniques.Within a week of surgery, all patients put on orthopaedic shoes and progressed from partial to full weight bearing. 3-6 days following surgery, all patients were released. The external fixator frame was modified, the deformity was gradually fixed, and rehabilitation advice was given under the supervision of the doctor during follow-up in the outpatient clinic [9,10].

Discussion

After conducting a number of fundamental experiments and doing clinical research, Professor Ilizarov, an orthopaedic surgeon from the former Soviet Union, developed his central hypothesis, the "law of tension-stress (LTS)" in the 1950s. According to this notion, gradual and constant distraction has an impact on biological tissues and creates a tension that may promote tissue regeneration and active growth. All biological tissues go through cell mitosis in the same way, hence their growth patterns are identical to those of foetal tissues. To achieve the synchronous regeneration of bone and soft tissue, the Ilizarov technique uses the tension-stress stimulus produced by the external fixator to slowly and steadily pull the living tissues, activate the ability of bone and muscle cells to regenerate, promote the differentiation and proliferation of tissue cells, and stimulate continuous distraction. The Ilizarov technique is a minimally invasive procedure that can be used to cure short limbs and rectify limb abnormalities. Due to the sophistication of this theory and technology, numerous challenging orthopaedic problems can now be resolved. As a four-dimensional external fixation (three-dimensional space plus time phase), the Ilizarov external ring frame fixation can be thought of. The external fixator can be adjusted in all directions during the procedure to allow for effective draught control. In accordance with the patient's tolerance, the pace and frequency of distraction should be changed, and the possibility of tissue necrosis should be diminished. In order to lower the danger of osteoporosis and mental health problems brought on by prolonged bed rest, the patient can walk with crutches early in the course of the treatment. The Ilizarov approach, in contrast to conventional surgery for one-stage treatment of abnormalities, uses regular, continuous, and slow stretch or compression force to regenerate the soft tissues and bones that produce tension. As a result, many severe side effects associated with conventional orthopaedic surgery are reduced. Through constant and slow distraction, the Ilizarov approach can be used to restore the look and function of the limbs with the least amount of medical damage feasible, resulting in natural rehabilitation, optimum reconstruction, and patient-centered medical thinking. In this investigation, every patient had denervated ankle-foot abnormalities. Correcting abnormalities, regulating muscular strength, stabilising joints, and maintaining foot suppleness are the four cornerstones of the total orthopaedic approach. Patients with ankle sensory loss are more likely to get reoccurring chronic ulcers that are difficult to cure because of aberrant paresthesia and neurotrophic abnormalities in the weightbearing area. It can penetrate deeply into the bone tissue in extreme cases, resulting in osteomyelitis and a subsequent spontaneous toe amputation. The local ulcer was treated with surgical dressing changes during the earlier orthopaedic treatment. Following the healing of the ulcer, the orthopaedic procedure was carried out. The ulcer was difficult to treat and required a long time to cure. As a result, complications with wound healing, infection exacerbation, and necrosis of the skin and limbs are frequently encountered during traditional correction and treatment.

Conclusion

The bones and joints of the foot and ankle develop abnormalities and positioning issues in patients with severe denervation-dominated ankle-foot malformations. At one point, traditional surgery was done, increasing the risks of blood vessel and nerve issues due to the vessels' and nerves' greater vulnerability to traction. The therapeutic outcome cannot be ensured. The deformity can be simultaneously corrected by simple osteotomy and bone arthrodesis, however this procedure has the potential to drastically shorten the length of the foot and cause joint stiffness. By gently applying strain, the Ilizarov external fixator achieves slow traction and progressively corrects the deformity. It prevents limb necrosis brought on by vascular injury while repairing the deformity and guaranteeing the length of the affected limb.

1. Mutluoglu M, Uzun G, Sildiroglu O, Turhan V, Mutlu H, et al. (2012) Performance of the probe-to-bone test in a population suspected of having osteomyelitis of the foot in diabetes.J Am Podiatr Med Assoc102(5): 369-373.

Indexed at, Google Scholar, Crossref

2. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, et al. (2022) IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 183: 109-119.

Indexed at, Google Scholar, Crossref

3. Hudish LI, Reusch JE, Sussel L (2019) Β cell dysfunction during progression of metabolic syndrome to type 2 diabetes. J Clin Investig 129: 4001-4008.

Indexed at, Google Scholar, Crossref

4. Jung CH, Son JW, Kang S, Kim WJ, Kim H, et al. (2021) Diabetes fact sheets in korea, 2020: An appraisal of current status. Diabetes Metab J 45: 1-10.

Indexed at, Google Scholar, Crossref

5. https://pubmed.ncbi.nlm.nih.gov/35321676/
6. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, et al. (2022) IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 183: 109-119.

Indexed at, Google Scholar, Crossref

7. Tietjen AK, Ghandour R, Mikki N, Jerdén L, Eriksson JW, et al. (2021) Complications of type 2 diabetes mellitus in Ramallah and al-Bireh: The Palestinian diabetes complications and control study (PDCCS). Qual Life Res 30: 547-557.

Indexed at, Google Scholar, Crossref

8. Wang Q, Xu G (2022) Chronic kidney disease in patients with diabetes: Diabetic vs. Non-diabetic kidney etiologies. J Diabet Res Rev Rep 4: 1-3.

Google Scholar

9. https://www.sciencedirect.com/science/article/abs/pii/S1751991818301955
10. https://pubmed.ncbi.nlm.nih.gov/35321676/