Efficacy of the Ilizarov technique combined with the enhanced recovery after surgery to treat clubfoot associated with tethered cord syndrome

WANG Jingshuang; XU Zhenzhen; LIU Linlin

doi:10.3969/j.issn.1002-7386.2025.06.020

Abstract：Objective To observe the efficacy of the Ilizarov technique combined with the enhanced recovery after surgery(ERAS)to treat clubfoot associated with tethered cord syndrome(TCS),and to explore the new ideas and techniques for correction and functional reconstruction.Methods A total of 19 cases(24 feet)of clubfoot associated with TCS from March 2015 to October 2020 were recruited,including 13 males and 6 females with a mean age of 13.3(7-19)years.The left feet were involved 7 cases,the right feet in 7 cases,and both feet in 5 cases.According to the Harrold and Walker mild clubfoot deformity,3 feet were rated as degree Ⅰ,15 feet as degree Ⅱ,6 feet as degree Ⅲ.A total of 24 feet were fixed by Ilizarov external fixation instruments.The deformity was gradually corrected on the 4th day post operatively with a distraction of 0.5-1 mm/d based on the individualized conditions of pain and swelling.The correction was stopped when the ankle was corrected at a hyperextension of 5°-10° and light valgus.Combined with the theory of ERAS,preoperative health education,psychological intervention and encouragement were given to enhance their confidence in the treatment.In the absence of pain,early rehabilitation was applied by physiotherapists.For patients with both-feet clubfoot,a staged operation should be performed with an interval of 3.3(3-4)months.Results The mean fixation time using the Ilizarov external fixation instruments was 12(8-18)weeks in 24 feet.All 19 patients were followed up for an average of 24(5-60)months.During the process of correction,slight pin track infections occurred in 3 cases(3 feet),and they were recovered from infection after symptomatic treatment.One patient had a partial recurrence of the deformity at 1 year postoperatively,which was corrected by Ilizarov external fixation again,with a satisfactory correction after weight-bearing walking for 14 weeks.The remaining clubfeet were all satisfactorily corrected and could bear full plantar weight during the follow-up period.According to the International Clubfoot Study Group(ICFSG)score,excellent in 19 feet,good in 4 feet,and fair in 1 foot,with an excellent and good rate of 95.9％at last follow-up were achieved.Conclusion The Ilizarov technique combined with ERAS to correct clubfoot associated TCS conforms to the principle of minimally invasive surgery and natural reconstruction,which is safe and effective to be applied.