Recalcitrant Clubfeet in a 4 Year Old with Arthrogryposis Treated with External Fixation

Clubfoot deformity in arthrogrypotic patients is difficult to correct, and its recurrence rate is high. Although children with neglected and recurrent clubfoot do learn to walk, they can develop pain and difficulty with locomotion over long distances. As well, they can develop pain and soft tissue ulceration on the weight-bearing dorsal surface of the foot. Traditional treatment options for a relapsed clubfoot include repeat soft tissue procedures, various osteotomies, and triple arthrodesis. An alternative consideration is gradual correction with external fixation. The Ilizarov technique is less invasive than open procedures and allows for multiplanar deformity correction without shortening of the foot. This chapter describes the treatment of a 4 year old child with arthrogryposis and stiff, recurrent, severely deformed clubfeet. Circular external fixation (pediatric Ilizarov and Taylor Spatial Frame) was used to gradually “unwind” and correct the foot and ankle deformities.