Correction of Severe Foot and Ankle Contracture Due to CRPS Using External Fixation and Pain Management: Report of a Pediatric Case

Complex regional pain syndrome–induced dystonia is a severe deformity that can affect the lower extremities and hinder ambulation. Although a number of conservative treatments have been described for this condition, we are not aware of any publications describing the use of surgical intervention for the treatment of this condition. In this report, we describe the case of a pediatric patient with a severe lower extremity deformity in conjunction with chronic pain syndrome. A concerted, interdisciplinary treatment approach was undertaken for the management of this patient, and this included contributions from a foot and ankle surgeon, a pain specialist, an internist, a physical therapist, and a psychiatrist. The primary goal of the treatment strategy was to recreate a plantigrade, weight-bearing lower extremity, while controlling pain. To this end, gradual correction of deformity was achieved using an external fixator and, by 6 months after the surgery, the patient was for the first time in years ambulating on the realigned lower extremity. After 3 years of follow-up, she maintained an activity level that was equal to that which she enjoyed before the injury. Level of Clinical Evidence: 4