Treatment of Equinocavovarus Deformity in Adults with the Use of a Hinged Distraction Apparatus*

We evaluated the results following the use of the Volkov-Oganesyan-Povarov hinged distraction apparatus to correct equinocavovarus deformity of the foot in sixty-five adults (eighty-three feet). The deformity was secondary to ischemic and neuropathic changes after trauma to the foot and ankle, poliomyelitis, Charcot-Marie-Tooth disease, or untreated clubfoot. The deformity often was associated with severe neurotrophic changes, extensive scarring of the skin, callosities, or osteomyelitis of the foot, all of which usually preclude operative reconstruction. The average age of the patients was twenty-six years (range, sixteen to fifty-six years). The average duration of follow-up was ten years (range, three to nineteen years). The duration of distraction was three to thirteen weeks, and the apparatus usually was kept in place for an additional two months after the desired position of correction had been achieved. The patient then wore a plaster cast for an average of eight weeks and custom-molded shoe-inserts for at least one year. A plantigrade foot was obtained with this external transosseous distraction device. Eight patients had inflammation of pin tracks, which was treated with local injection of antibiotics into the soft tissues and application of bandages soaked in antibiotics to the area around the pin sites. The pins were removed from five of the eight patients, and the apparatus was removed from three additional patients because of osteomyelitis. The results were classified as good in fifty-nine feet, satisfactory in twenty, and unsatisfactory in four. In the four feet (three patients) with an unsatisfactory result, a good result was obtained after an arthrodesis was done.