The Combined Lambrinudi and Ankle Arthrodesis with Ring External Fixation in the Long-term Severe Neuromuscular Equinocavovarus Deformity with Ankle and Hindfoot Osteoarthritis: The Cases Presentation and Modified Guideline of Treatment

Prasit Rajbhandari1, 2, Chayanin Angthong1, *, Jiancheng Zang3, Sihe Qin3, Andrea Veljkovic4
1 Department of Orthopaedics, Faculty of Medicine, Thammasat University Pathum Thani, 12120 Thailand
2 Orthopaedics Department, Manmohan Memorial Teaching Hospital, Kathmandu, Nepal
3 Qinsihe Orthopedic Institute Orthopaedics department of Chinese National Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids (NRRA, Beijing, China)
4 Department of Orthopaedic Surgery, University of British Columbia, Vancouver, Canada

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© 2019 Rajbhandari et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Foot and Ankle Surgery Unit, Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand, Tel: 662-926-9775; Fax: 662-926-9793; E-mail:



Severe equinocavovarus deformity develops from various causes and generally results in major disability that affects patient’s mobility and quality of life. It can be divided into neuromuscular and non-neuromuscular deformities, including two major subtypes: i.e., paralytic and spastic. In addition, ankle osteoarthritis could be caused by prolonged or progressive foot deformity.


The present report proposes a modification of the accepted treatment algorithm and Lambrinudi’s surgical technique with ankle and hindfoot arthrodesis to correct theses challenging deformities with the long-term condition.


Two equinocavovarus cases were included, one in a 54-year old male and the second in a 63-year old female with paralaytic and spastic etiologies respectively. Patient’s deformity correction was acceptable. Each patient demonstrated improved outcomes due to a postoperative plantigrade foot and ankle position. No significant complications were encountered during the course of care and last follow-up. The mean follow-up time was 26 months.


Severe long term neuromuscular equinocavovarus deformities are a challenging disability in the foot and ankle surgery. The present article proposes a modified guideline of treatment illustrated in two representative case studies of long-term paralytic and spastic equinocavovarus deformities. These conditions can be treated surgically using the stepwise approach as demonstrated in this article with acceptable outcomes.