Research and clinical application progress of foot lengthening surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhiyu ¹ , ZHANG Baozhou ¹ , WANG Xuewen ¹ , LU Ban ¹ , ZHANG Zeyu ¹ , ZHANG Yingdong ¹ , QIN Sihe ² , WU Yong ¹ ,  DU Hui ¹

1. Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 102200, P. R. China;
2. Department of Orthopedic Surgery, Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China;

Corresponding author：

DU Hui, Email: huidu@jst-hosp.com.cn

Keywords：

Foot lengthening surgery; Ilizarov technique; distraction osteogenesis; calcaneal lengthening; metatarsal lengthening; complication

DOI：

10.7507/1002-1892.202505070

Video：

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Objective To summarize the research and clinical application progress of foot lengthening surgery. Methods Relevant research literature on foot lengthening surgery in recent years at home and abroad was reviewed, and a summary was made from aspects such as the types of lengthening surgery, the types of foot diseases treated by clinical application, effectiveness, and complications. Results Bone defects and shortening deformities of the foot are relatively common clinically. As an innovative treatment method, foot lengthening surgery has gradually attracted attention, mainly including the Ilizarov technique and one-stage bone grafting lengthening surgery. The former promotes bone regeneration based on the tension-stress principle and is widely used in the treatment of calcaneal defects and congenital metatarsal brachymetatarsia, achieving good curative effects. However, there are also complications such as pin-tract infection, joint stiffness and contracture, non-union and delayed union of bone, re-fracture, and alignment deviation. The latter has a short treatment cycle, but the lengthening length is limited. Bone graft resorption and soft - tissue complications are its main complications. Conclusion Foot lengthening surgery will develop towards the direction of personalization, intelligence, and precision. With the help of multi-center research, biological materials, and intelligent technologies, the effectiveness and safety will be further improved to better restore the function and appearance of the foot.

1.	林项叶, 王昌兴, 董黎强. 肢体延长国内外研究进展. 医学综述, 2009, 15(17): 2639-2642.
2.	García-Cimbrelo E, Curto de la Mano A, García-Rey E, et al. The intramedullary elongation nail for femoral lengthening. J Bone Joint Surg (Br), 2002, 84(7): 971-977.
3.	Gubin AV, Borzunov DY, Marchenkova LO, et al. Contribution of G. A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strategies Trauma Limb Reconstr, 2016, 11(3): 145-152.
4.	Malkova TA, Borzunov DY. International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100th birthday of G. A. Ilizarov). World J Orthop, 2021, 12(8): 515-533.
5.	陈甫寰, Peter H. Thaller, 秦泗河. 体外控制全植入性髓内延长钉及其临床治疗理念研究进展. 中国修复重建外科杂志, 2021, 35(12): 1623-1629.
6.	朱跃良, 郑学建, 张庆彬, 等. 中国学者对Ilizarov技术发展的贡献. 中华创伤杂志, 2023, 39(1): 62-69.
7.	康庆林, 陆联松, 喻鑫罡, 等. 跖侧入路截骨延长治疗先天性第四跖骨短小症. 中国矫形外科杂志, 2012, 20(21): 5.
8.	Baek GH, Chung MS. The treatment of congenital brachymetatarsia by one-stage lengthening. J Bone Joint Surg (Br), 1998, 80(6): 1040-1044.
9.	Keshet D, Salminen S, Eidelman M. Acute correction of congenital brachymetatarsia in adolescents and young adults. Traumatology and Orthopedics of Russia, 2019, 25(3): 84-89.
10.	Smolle E, Scheipl S, Leithner A, et al. Management of congenital fourth brachymetatarsia by additive autologous lengthening osteotomy (AALO): a case series. Foot Ankle Int, 2015, 36(3): 325-329.
11.	Zhu D, Lefèvre M, Fernandez A, et al. Brachymetatarsia: Surgical management, case report, and literature review. Case Rep Orthop, 2022, 2022: 8253096. doi: 10.1155/2022/8253096.
12.	Jones MD, Pinegar DM, Rincker SA. Callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia: A systematic review. J Foot Ankle Surg, 2015, 54(5): 927-931.
13.	陈挺, 曹文亮. 一期延长髂骨植骨治疗第一跖骨短小症. 中国美容整形外科杂志, 2019, 30(5): 299-301.
14.	Lee WC, Yoo JH, Moon JS. Lengthening of fourth brachymetatarsia by three different surgical techniques. J Bone Joint Surg (Br), 2009, 91(11): 1472-1477.
15.	邓伟, 刘熹, 陈宇, 等. 微创截骨结合Ilizarov技术治疗先天性第4跖骨短小症. 中华骨与关节外科杂志, 2021, 14(6): 533-537.
16.	Li X, Gu J, Wu Y, et al. Treatment of fourth metatarsal brachymetatarsia using distraction osteogenesis with external fixator: surgical techniques, outcomes and complications. Orthop Surg, 2024, 16(9): 2148-2156.
17.	Waizy H, Polzer H, Schikora N, et al. One-stage metatarsal interposition lengthening with an autologous fibula graft for treatment of brachymetatarsia. Foot Ankle Spec, 2019, 12(4): 330-335.
18.	Hung WC, Chen CH, Lin CH, et al. Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review. Foot Ankle Surg, 2023, 29(1): 86-89.
19.	Giannini S, Faldini C, Pagkrati S, et al. One-stage metatarsal lengthening by allograft interposition: a novel approach for congenital brachymetatarsia. Clin Orthop Relat Res, 2010, 468(7): 1933-1942.
20.	Kim HS, Lee YS, Jung JH, et al. Complications of distraction osteogenesis in brachymetatarsia: Comparison between the first and fourth brachymetatarsia. Foot Ankle Surg, 2019, 25(2): 113-118.
21.	Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
22.	Zhang R, Yao X, Wang X, et al. Calcaneal lengthening after tarsal bone fusion for massive calcaneus defect reconstruction. Orthop Surg, 2024, 16(9): 2211-2220.
23.	Wardak M, Wardak E, Goel A. Calcanisation of tibia using Ilizarov fixator in crush injuries of hindfoot: a new method. Int Orthop, 2008, 32(6): 779-784.
24.	郑韶博, 刘伟, 赵立强, 等. 应用足延长器治疗足缺损9例观察报告. 中国矫形外科杂志, 2004, 12(21-22): 1660-1663.
25.	Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strategies Trauma Limb Reconstr, 2016, 11(2): 75-85.
26.	Hosny GA, Ahmed AS. Distraction osteogenesis of fourth brachymetatarsia. Foot Ankle Surg, 2016, 22(1): 12-16.
27.	Lamm BM. Percutaneous distraction osteogenesis for treatment of brachymetatarsia. J Foot Ankle Surg, 2010, 49(2): 197-204.
28.	Jones MD, Pinegar DM, Rincker SA. Callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia: A systematic review. J Foot Ankle Surg, 2015, 54(5): 927-931.
29.	臧建成, 秦泗河. 下肢延长术并发症的分类与治疗策略. 中华骨科杂志, 2021, 41(11): 728-736.
30.	沈洁, 叶晓健. “手风琴”技术在牵张成骨区新生骨矿化中的作用. 中国修复重建外科杂志, 2018, 32(5): 558-567.
31.	Maria J T, Carl B, Cory M R, et al. Distraction Osteogenesis [J]. null, 2022.

1. 林项叶, 王昌兴, 董黎强. 肢体延长国内外研究进展. 医学综述, 2009, 15(17): 2639-2642.
2. García-Cimbrelo E, Curto de la Mano A, García-Rey E, et al. The intramedullary elongation nail for femoral lengthening. J Bone Joint Surg (Br), 2002, 84(7): 971-977.
3. Gubin AV, Borzunov DY, Marchenkova LO, et al. Contribution of G. A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strategies Trauma Limb Reconstr, 2016, 11(3): 145-152.
4. Malkova TA, Borzunov DY. International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100th birthday of G. A. Ilizarov). World J Orthop, 2021, 12(8): 515-533.
5. 陈甫寰, Peter H. Thaller, 秦泗河. 体外控制全植入性髓内延长钉及其临床治疗理念研究进展. 中国修复重建外科杂志, 2021, 35(12): 1623-1629.
6. 朱跃良, 郑学建, 张庆彬, 等. 中国学者对Ilizarov技术发展的贡献. 中华创伤杂志, 2023, 39(1): 62-69.
7. 康庆林, 陆联松, 喻鑫罡, 等. 跖侧入路截骨延长治疗先天性第四跖骨短小症. 中国矫形外科杂志, 2012, 20(21): 5.
8. Baek GH, Chung MS. The treatment of congenital brachymetatarsia by one-stage lengthening. J Bone Joint Surg (Br), 1998, 80(6): 1040-1044.
9. Keshet D, Salminen S, Eidelman M. Acute correction of congenital brachymetatarsia in adolescents and young adults. Traumatology and Orthopedics of Russia, 2019, 25(3): 84-89.
10. Smolle E, Scheipl S, Leithner A, et al. Management of congenital fourth brachymetatarsia by additive autologous lengthening osteotomy (AALO): a case series. Foot Ankle Int, 2015, 36(3): 325-329.
11. Zhu D, Lefèvre M, Fernandez A, et al. Brachymetatarsia: Surgical management, case report, and literature review. Case Rep Orthop, 2022, 2022: 8253096. doi: 10.1155/2022/8253096.
12. Jones MD, Pinegar DM, Rincker SA. Callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia: A systematic review. J Foot Ankle Surg, 2015, 54(5): 927-931.
13. 陈挺, 曹文亮. 一期延长髂骨植骨治疗第一跖骨短小症. 中国美容整形外科杂志, 2019, 30(5): 299-301.
14. Lee WC, Yoo JH, Moon JS. Lengthening of fourth brachymetatarsia by three different surgical techniques. J Bone Joint Surg (Br), 2009, 91(11): 1472-1477.
15. 邓伟, 刘熹, 陈宇, 等. 微创截骨结合Ilizarov技术治疗先天性第4跖骨短小症. 中华骨与关节外科杂志, 2021, 14(6): 533-537.
16. Li X, Gu J, Wu Y, et al. Treatment of fourth metatarsal brachymetatarsia using distraction osteogenesis with external fixator: surgical techniques, outcomes and complications. Orthop Surg, 2024, 16(9): 2148-2156.
17. Waizy H, Polzer H, Schikora N, et al. One-stage metatarsal interposition lengthening with an autologous fibula graft for treatment of brachymetatarsia. Foot Ankle Spec, 2019, 12(4): 330-335.
18. Hung WC, Chen CH, Lin CH, et al. Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review. Foot Ankle Surg, 2023, 29(1): 86-89.
19. Giannini S, Faldini C, Pagkrati S, et al. One-stage metatarsal lengthening by allograft interposition: a novel approach for congenital brachymetatarsia. Clin Orthop Relat Res, 2010, 468(7): 1933-1942.
20. Kim HS, Lee YS, Jung JH, et al. Complications of distraction osteogenesis in brachymetatarsia: Comparison between the first and fourth brachymetatarsia. Foot Ankle Surg, 2019, 25(2): 113-118.
21. Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
22. Zhang R, Yao X, Wang X, et al. Calcaneal lengthening after tarsal bone fusion for massive calcaneus defect reconstruction. Orthop Surg, 2024, 16(9): 2211-2220.
23. Wardak M, Wardak E, Goel A. Calcanisation of tibia using Ilizarov fixator in crush injuries of hindfoot: a new method. Int Orthop, 2008, 32(6): 779-784.
24. 郑韶博, 刘伟, 赵立强, 等. 应用足延长器治疗足缺损9例观察报告. 中国矫形外科杂志, 2004, 12(21-22): 1660-1663.
25. Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strategies Trauma Limb Reconstr, 2016, 11(2): 75-85.
26. Hosny GA, Ahmed AS. Distraction osteogenesis of fourth brachymetatarsia. Foot Ankle Surg, 2016, 22(1): 12-16.
27. Lamm BM. Percutaneous distraction osteogenesis for treatment of brachymetatarsia. J Foot Ankle Surg, 2010, 49(2): 197-204.
28. Jones MD, Pinegar DM, Rincker SA. Callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia: A systematic review. J Foot Ankle Surg, 2015, 54(5): 927-931.
29. 臧建成, 秦泗河. 下肢延长术并发症的分类与治疗策略. 中华骨科杂志, 2021, 41(11): 728-736.
30. 沈洁, 叶晓健. “手风琴”技术在牵张成骨区新生骨矿化中的作用. 中国修复重建外科杂志, 2018, 32(5): 558-567.
31. Maria J T, Carl B, Cory M R, et al. Distraction Osteogenesis [J]. null, 2022.

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