Siberian 'magic' that can mend a club foot

Surgeons are pioneering a 50-year-old technique, Paul Field reports

Surgeons in Britain have been pioneering a radical technique to correct club foot in babies and make dwarfs walk taller, some 50 years after the procedure was developed in Stalinist Russia.

The treatment involves breaking legs, embedding steel pins deep into the flesh and bone and fixing a circular frame onto the patient which looks as if it comes from a Meccano set.

Invented by a Siberian doctor called Gavril Ilizarov to repair the broken limbs of soldiers wounded at the end of the Second World War, the procedure was hidden from the West until the fall of the Iron Curtain.

The technique has been developed in Britain by Rowan Pool and Robert Simonis, consultant orthopaedic surgeons at St Peter's hospital in Chertsey. They have treated around 500 people at their Ilizarov clinic - 25 of them for club foot - since they first tried it in 1988.

One of the most recent success stories in Britain, which is the focus of the BBC1 science series QED on Thursday, is William Knight, who became the youngest person to have the operation at six months old after being born with club foot.

''He looked perfect until a nurse told us she suspected club foot,'' said his mother Madeleine. Within three days, she and her husband Alan had an appointment at the Ilizarov clinic and were surprised by the possibilities offered by the individually fitted frame, which costs around pounds 1,000 a time. After discussions, the Knights went ahead with the treatment, but not without reservations.

''It was either the frame or an operation snipping the tendons and stetching the foot into position with a failure rate and scar tissue problems. When we were showed the frame and told about drilling pins into his leg we did feel rather wobbly,'' Mrs Knight explained.

The metal rods drilled into William's lower left leg and ankle, combined with the frame bolted to them, made it almost impossible for the Knights to share a cuddle with their young son. Of more concern though, were the screams William would give if he caught the frame on furniture and the open wounds that often became infected and painful.

But after 11 weeks - to great relief - the frame was removed and his leg put into plaster. ''The leg was sensitive for a couple of weeks, but soon improved and on his first birthday William took his first steps. I burst into tears. After that there was no stopping him,'' said Mrs Knight.

Apart from correcting club foot, particularly in children, the treatment is used to repair fractures which fail to knit together normally and would otherwise lead to a life long disability, make short people taller and treat bone infections - such as osteomyelitis. ''I cannot get over the fact that I set out to treat a bent leg and the patient comes back after six weeks with it straightened,'' said Mr Pool.

The technique was developed when, trying to find a way to mend broken bones, Ilizarov, a doctor in a Siberian hospital on his first posting at the end of the war, came up with the idea of putting a frame onto the damaged leg. Using a bicycle wheel and spokes he found it held the broken bone together.

It was only when a patient, intending to tighten the rods, turned the spanner the wrong way, that Ilizarov discovered that once the bones were pulled apart, new tissue grew in the gap. He then adapted the procedure and used it to lengthen legs and correct club foot.

Ilizarov moonlighted as a conjuror and his nickname, the Magician of Kurgan, where his clinic was based, became known throughout the Soviet Union. It is said the Olympic team manager of the day instructed his high jumper, who broke a leg, to see Ilizarov and his box of stainless steel tricks.

Before Glasnost, any exchange of ideas with the West was forbidden. It took Communism's collapse to allow medical advances like this to be disseminated. William, meanwhile - now 15 months - may need further surgery later in life. But , thanks to a Siberian magician, he should always lead a normal life.