Research progress on correction of severe ankle deformities with digital hexapod external fixators_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DU Hui ¹ , WANG Zhiyu ¹ , QIN Sihe ²

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：

Digital hexapod external fixator; foot and ankle deformity; Taylor spatial external fixator; precise correction; complications

DOI：

10.7507/1002-1892.202505066

Video：

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Objective To review the research progress on correction of severe ankle deformities with digital hexapod external fixators. Methods The relevant research literature on digital hexapod external fixators at home and abroad in recent years was reviewed and analyzed. Taking Taylor spatial frame (TSF) as a representative, this article elaborates on the research progress of this technology in the treatment of severe foot and ankle deformities from aspects such as device principle, technical characteristics, clinical application, complication management, and controversial perspectives, aiming to provide theoretical references for clinical application. Results The treatment of severe foot and ankle deformities is a complex challenge in orthopedics, often involving multiple plane alignment abnormalities, muscle weakness, soft tissue contractures, and joint dysfunction. The digital hexapod external fixators (such as TSF), based on the principle of six degrees of freedom motion and combined with computer-assisted technology, enables precise correction of multi-dimensional deformities. Conclusion The digital hexapod external fixators provide a minimally invasive and efficient option for the treatment of severe foot and ankle deformities, and shows significant advantages in the treatment of complex post-traumatic deformities, neuromuscular deformities, diabetes foot Charcot arthropathy, and other diseases.

1.	Lamm BM, Standard SC, Galley IJ, et al. External fixation for the foot and ankle in children. Clin Podiatr Med Surg, 2006, 23(1): 137-166.
2.	Keshet D, Eidelman M. Clinical utility of the Taylor spatial frame for limb deformities. Orthop Res Rev, 2017, 9: 51-61.
3.	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.
4.	Taylor JC. Perioperative planning for two- and three-plane deformities. Foot Ankle Clin, 2008, 13(1): 69-121.
5.	Sluga M, Pfeiffer M, Kotz R, et al. Lower limb deformities in children: two-stage correction using the Taylor spatial frame. J Pediatr Orthop B, 2003, 12(2): 123-128.
6.	Dabash S, Potter E, Catlett G, et al. Taylor spatial frame in treatment of equinus deformity. Strategies Trauma Limb Reconstr, 2020, 15(1): 28-33.
7.	Fadel M, Hosny G. The Taylor spatial frame for deformity correction in the lower limbs. Int Orthop, 2005, 29(2): 125-129.
8.	Eidelman M, Bialik V, Katzman A. Correction of deformities in children using the Taylor spatial frame. J Pediatr Orthop B, 2006, 15(6): 387-395.
9.	Eidelman M, Katzman A. Treatment of arthrogrypotic foot deformities with the Taylor Spatial Frame. J Pediatr Orthop, 2011, 31(4): 429-434.
10.	Manggala Y, Angthong C, Primadhi A, et al. The deformity correction and fixator-assisted treatment using Ilizarov versus Taylor spatial frame in the foot and ankle. Orthop Rev (Pavia), 2018, 9(4): 7337. doi: 10.4081/or.2017.7337.
11.	Matsubara H, Tsuchiya H, Takato K, Tomita K. Correction of ankle ankylosis with deformity using the taylor spatial frame: a report of three cases. Foot Ankle Int, 2007, 28(12): 1290-1294.
12.	Takata M, Vilensky VA, Tsuchiya H, et al. Foot deformity correction with hexapod external fixator, the Ortho-SUV Frame™. J Foot Ankle Surg, 2013, 52(3): 324-330.
13.	Cherkashin AM, Samchukov ML, Birkholts F. Treatment strategies and frame configurations in the management of foot and ankle deformities. Clin Podiatr Med Surg, 2018, 35(4): 423-442.
14.	杜辉, 李兴, 李恒, 等. Miter 构型泰勒空间外固定架治疗重度马蹄高弓足. 广西医科大学学报, 2024, 41(7): 1013-1019.
15.	Floerkemeier T, Stukenborg-Colsman C, Windhagen H, et al. Correction of severe foot deformities using the Taylor spatial frame. Foot Ankle Int, 2011, 32(2): 176-182.
16.	Waizy H, Windhagen H, Stukenborg-Colsman C, et al. Taylor spatial frame in severe foot deformities using double osteotomy: technical approach and primary results. Int Orthop, 2011, 35(10): 1489-1495.
17.	Eidelman M, Keren Y, Katzman A. Correction of residual clubfoot deformities in older children using the Taylor spatial butt frame and midfoot Gigli saw osteotomy. J Pediatr Orthop, 2012, 32(5): 527-533.
18.	Lahoti O, Abhishetty N, Shetty S. Correction of foot deformities from charcot arthropathy with the Taylor spatial frame: A 7-14-year follow-up. Strategies Trauma Limb Reconstr, 2021, 16(2): 96-101.
19.	Eidelman M, Kotlarsky P, Herzenberg JE. Treatment of relapsed, residual and neglected clubfoot: adjunctive surgery. J Child Orthop, 2019, 13(3): 293-303.
20.	Hassan A, Letts M. The management of the neglected congenital foot deformity in the older child with the Taylor spatial frame. J Pediatr Orthop, 2012, 32(1): 85-92.
21.	吴刚, 陈建文, 郭悦, 等. 后足截骨结合泰勒空间外固定支架矫正严重马蹄足畸形临床研究. 足踝外科电子杂志, 2020, 7(1): 1-5,38.
22.	Eidelman M, Katzman A, Zaidman M, et al. Deformity correction using supramalleolar gigli saw osteotomy and Taylor spatial frame: how to perform this osteotomy safely? J Pediatr Orthop B, 2011, 20(5): 318-322.
23.	Yang X, Du H, Yin X, et al. Optimizing outcomes in distal tibial deformity correction: The role of supramalleolar osteotomy with computer-assisted Hexapod external fixator. Orthop Surg, 2024, 16(9): 2173-2180.
24.	Horn DM, Fragomen AT, Rozbruch SR. Supramalleolar osteotomy using circular external fixation with six-axis deformity correction of the distal tibia. Foot Ankle Int, 2011, 32(10): 986-993.
25.	Schoenleber SJ, Hutson JJ Jr. Treatment of hypertrophic distal tibia nonunion and early malunion with callus distraction. Foot Ankle Int, 2015, 36(4): 400-407.
26.	Cuttica DJ, Decarbo WT, Philbin TM. Correction of rigid equinovarus deformity using a multiplanar external fixator. Foot Ankle Int, 2011, 32(5): S533-S539.
27.	Gourdine-Shaw MC, Lamm BM, Paley D, et al. Distraction osteogenesis for complex foot deformities: U-osteotomy with external fixation. J Bone Joint Surg (Am), 2012, 94(15): 1420-1427.
28.	Du H, He XT, Yin XH, et al. The gradual correction of adult severe rigid equinus deformity using minimal invasive U-osteotomy with Taylor spatial frame. Foot Ankle Int, 2023, 44(1): 62-70.
29.	Kucukkaya M, Karakoyun O, Armagan R, et al. Correction of complex lower extremity deformities with the use of the Ilizarov-Taylor spatial frame. Acta Orthop Traumatol Turc, 2009, 43(1): 1-6.
30.	Du H, Li H, He X, et al. Gradual transverse transport of naturally tibialized fibula using hexapod frames to treat neglected type Ⅴ tibial segmental defects. Orthop Surg, 2024, 16(9): 2123-2131.
31.	Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
32.	Zhang Q, Rehemutula A, Maitudi M, et al. Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique. Injury, 2025, 56(4): 112224. doi: 10.1016/j.injury.2025.112224.
33.	Cui Y, Xu Q, Zang J, et al. Preliminary outcomes of calcaneal body lengthening for the calcaneus shortening. Orthop Surg, 2024, 16(9): 2283-2288.
34.	Zhang R, Wang X, Liu S, et al. Modified calcanization of tibia for hindfoot defect reconstruction: method and preliminary results. Orthop Surg, 2024, 16(9): 2202-2210.
35.	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.
36.	Thiryayi WA, Naqui Z, Khan SA. Use of the Taylor spatial frame in compression arthrodesis of the ankle: a study of 10 cases. J Foot Ankle Surg, 2010, 49(2): 182-187.
37.	Fuentes P, Cuchacovich N, Gutierrez P, et al. Treatment of severe rigid posttraumatic equinus deformity with gradual deformity correction and arthroscopic ankle arthrodesis. Foot Ankle Int, 2021, 42(12): 1525-1535.
38.	Lamm BM, Gottlieb HD, Paley D. A two-stage percutaneous approach to charcot diabetic foot reconstruction. J Foot Ankle Surg, 2010, 49(6): 517-522.
39.	Gutteck N, Delank KS, Schilde S. Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy. Eur J Orthop Surg Traumatol, 2023, 33(8): 3577-3584.
40.	关升升, 杜辉, 秦泗河. 计算机辅助环形外固定器在足踝外科中的临床进展. 中华骨与关节外科杂志, 2021, 14(6): 572-576.
41.	Liu Y, Yushan M, Liu Z, et al. Application of elliptic registration and three-dimensional reconstruction in the postoperative measurement of Taylor spatial frame parameters. Injury, 2020, 51(12): 2975-2980.
42.	Bai LB, Wang ZJ, Wang ZT. Telescopic rod technique to reverse anterior subluxation of the talus during the correction of equinocavovarus deformity with the Ilizarov fixator. J Orthop Translat, 2020, 25: 43-46.
43.	Sibbel J, Abdulkarim A, Fisher R, et al. Eccentric Taylor spatial frame placement for the correction of femoral fracture deformity: a novel technique. Eur J Orthop Surg Traumatol, 2020, 30(5): 869-875.
44.	Manner HM, Huebl M, Radler C, et al. Accuracy of complex lower-limb deformity correction with external fixation: a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop, 2007, 1(1): 55-61.
45.	Eidelman M, Katzman A. Treatment of complex foot deformities in children with the taylor spatial frame. Orthopedics, 2008, 31(10): 1-5.

1. Lamm BM, Standard SC, Galley IJ, et al. External fixation for the foot and ankle in children. Clin Podiatr Med Surg, 2006, 23(1): 137-166.
2. Keshet D, Eidelman M. Clinical utility of the Taylor spatial frame for limb deformities. Orthop Res Rev, 2017, 9: 51-61.
3. 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.
4. Taylor JC. Perioperative planning for two- and three-plane deformities. Foot Ankle Clin, 2008, 13(1): 69-121.
5. Sluga M, Pfeiffer M, Kotz R, et al. Lower limb deformities in children: two-stage correction using the Taylor spatial frame. J Pediatr Orthop B, 2003, 12(2): 123-128.
6. Dabash S, Potter E, Catlett G, et al. Taylor spatial frame in treatment of equinus deformity. Strategies Trauma Limb Reconstr, 2020, 15(1): 28-33.
7. Fadel M, Hosny G. The Taylor spatial frame for deformity correction in the lower limbs. Int Orthop, 2005, 29(2): 125-129.
8. Eidelman M, Bialik V, Katzman A. Correction of deformities in children using the Taylor spatial frame. J Pediatr Orthop B, 2006, 15(6): 387-395.
9. Eidelman M, Katzman A. Treatment of arthrogrypotic foot deformities with the Taylor Spatial Frame. J Pediatr Orthop, 2011, 31(4): 429-434.
10. Manggala Y, Angthong C, Primadhi A, et al. The deformity correction and fixator-assisted treatment using Ilizarov versus Taylor spatial frame in the foot and ankle. Orthop Rev (Pavia), 2018, 9(4): 7337. doi: 10.4081/or.2017.7337.
11. Matsubara H, Tsuchiya H, Takato K, Tomita K. Correction of ankle ankylosis with deformity using the taylor spatial frame: a report of three cases. Foot Ankle Int, 2007, 28(12): 1290-1294.
12. Takata M, Vilensky VA, Tsuchiya H, et al. Foot deformity correction with hexapod external fixator, the Ortho-SUV Frame™. J Foot Ankle Surg, 2013, 52(3): 324-330.
13. Cherkashin AM, Samchukov ML, Birkholts F. Treatment strategies and frame configurations in the management of foot and ankle deformities. Clin Podiatr Med Surg, 2018, 35(4): 423-442.
14. 杜辉, 李兴, 李恒, 等. Miter 构型泰勒空间外固定架治疗重度马蹄高弓足. 广西医科大学学报, 2024, 41(7): 1013-1019.
15. Floerkemeier T, Stukenborg-Colsman C, Windhagen H, et al. Correction of severe foot deformities using the Taylor spatial frame. Foot Ankle Int, 2011, 32(2): 176-182.
16. Waizy H, Windhagen H, Stukenborg-Colsman C, et al. Taylor spatial frame in severe foot deformities using double osteotomy: technical approach and primary results. Int Orthop, 2011, 35(10): 1489-1495.
17. Eidelman M, Keren Y, Katzman A. Correction of residual clubfoot deformities in older children using the Taylor spatial butt frame and midfoot Gigli saw osteotomy. J Pediatr Orthop, 2012, 32(5): 527-533.
18. Lahoti O, Abhishetty N, Shetty S. Correction of foot deformities from charcot arthropathy with the Taylor spatial frame: A 7-14-year follow-up. Strategies Trauma Limb Reconstr, 2021, 16(2): 96-101.
19. Eidelman M, Kotlarsky P, Herzenberg JE. Treatment of relapsed, residual and neglected clubfoot: adjunctive surgery. J Child Orthop, 2019, 13(3): 293-303.
20. Hassan A, Letts M. The management of the neglected congenital foot deformity in the older child with the Taylor spatial frame. J Pediatr Orthop, 2012, 32(1): 85-92.
21. 吴刚, 陈建文, 郭悦, 等. 后足截骨结合泰勒空间外固定支架矫正严重马蹄足畸形临床研究. 足踝外科电子杂志, 2020, 7(1): 1-5,38.
22. Eidelman M, Katzman A, Zaidman M, et al. Deformity correction using supramalleolar gigli saw osteotomy and Taylor spatial frame: how to perform this osteotomy safely? J Pediatr Orthop B, 2011, 20(5): 318-322.
23. Yang X, Du H, Yin X, et al. Optimizing outcomes in distal tibial deformity correction: The role of supramalleolar osteotomy with computer-assisted Hexapod external fixator. Orthop Surg, 2024, 16(9): 2173-2180.
24. Horn DM, Fragomen AT, Rozbruch SR. Supramalleolar osteotomy using circular external fixation with six-axis deformity correction of the distal tibia. Foot Ankle Int, 2011, 32(10): 986-993.
25. Schoenleber SJ, Hutson JJ Jr. Treatment of hypertrophic distal tibia nonunion and early malunion with callus distraction. Foot Ankle Int, 2015, 36(4): 400-407.
26. Cuttica DJ, Decarbo WT, Philbin TM. Correction of rigid equinovarus deformity using a multiplanar external fixator. Foot Ankle Int, 2011, 32(5): S533-S539.
27. Gourdine-Shaw MC, Lamm BM, Paley D, et al. Distraction osteogenesis for complex foot deformities: U-osteotomy with external fixation. J Bone Joint Surg (Am), 2012, 94(15): 1420-1427.
28. Du H, He XT, Yin XH, et al. The gradual correction of adult severe rigid equinus deformity using minimal invasive U-osteotomy with Taylor spatial frame. Foot Ankle Int, 2023, 44(1): 62-70.
29. Kucukkaya M, Karakoyun O, Armagan R, et al. Correction of complex lower extremity deformities with the use of the Ilizarov-Taylor spatial frame. Acta Orthop Traumatol Turc, 2009, 43(1): 1-6.
30. Du H, Li H, He X, et al. Gradual transverse transport of naturally tibialized fibula using hexapod frames to treat neglected type Ⅴ tibial segmental defects. Orthop Surg, 2024, 16(9): 2123-2131.
31. Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
32. Zhang Q, Rehemutula A, Maitudi M, et al. Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique. Injury, 2025, 56(4): 112224. doi: 10.1016/j.injury.2025.112224.
33. Cui Y, Xu Q, Zang J, et al. Preliminary outcomes of calcaneal body lengthening for the calcaneus shortening. Orthop Surg, 2024, 16(9): 2283-2288.
34. Zhang R, Wang X, Liu S, et al. Modified calcanization of tibia for hindfoot defect reconstruction: method and preliminary results. Orthop Surg, 2024, 16(9): 2202-2210.
35. 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.
36. Thiryayi WA, Naqui Z, Khan SA. Use of the Taylor spatial frame in compression arthrodesis of the ankle: a study of 10 cases. J Foot Ankle Surg, 2010, 49(2): 182-187.
37. Fuentes P, Cuchacovich N, Gutierrez P, et al. Treatment of severe rigid posttraumatic equinus deformity with gradual deformity correction and arthroscopic ankle arthrodesis. Foot Ankle Int, 2021, 42(12): 1525-1535.
38. Lamm BM, Gottlieb HD, Paley D. A two-stage percutaneous approach to charcot diabetic foot reconstruction. J Foot Ankle Surg, 2010, 49(6): 517-522.
39. Gutteck N, Delank KS, Schilde S. Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy. Eur J Orthop Surg Traumatol, 2023, 33(8): 3577-3584.
40. 关升升, 杜辉, 秦泗河. 计算机辅助环形外固定器在足踝外科中的临床进展. 中华骨与关节外科杂志, 2021, 14(6): 572-576.
41. Liu Y, Yushan M, Liu Z, et al. Application of elliptic registration and three-dimensional reconstruction in the postoperative measurement of Taylor spatial frame parameters. Injury, 2020, 51(12): 2975-2980.
42. Bai LB, Wang ZJ, Wang ZT. Telescopic rod technique to reverse anterior subluxation of the talus during the correction of equinocavovarus deformity with the Ilizarov fixator. J Orthop Translat, 2020, 25: 43-46.
43. Sibbel J, Abdulkarim A, Fisher R, et al. Eccentric Taylor spatial frame placement for the correction of femoral fracture deformity: a novel technique. Eur J Orthop Surg Traumatol, 2020, 30(5): 869-875.
44. Manner HM, Huebl M, Radler C, et al. Accuracy of complex lower-limb deformity correction with external fixation: a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop, 2007, 1(1): 55-61.
45. Eidelman M, Katzman A. Treatment of complex foot deformities in children with the taylor spatial frame. Orthopedics, 2008, 31(10): 1-5.

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Latest ArticlesResearch progress on correction of severe ankle deformities with digital hexapod external fixators

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