What device is used to straighten a leg?

Devices for Leg Straightening

The most effective device for straightening a leg is a knee-high non-removable offloading device, such as a total contact cast (TCC) or a non-removable walker, which provides immobilization and proper alignment. 1

Types of Leg Straightening Devices

Non-Removable Devices (First Choice)

• Total Contact Cast (TCC) - a custom-made, well-molded, minimally padded, knee-high non-removable fiberglass or plaster cast that maintains total contact with the entire plantar surface and lower leg 1
• Non-removable walker - a prefabricated removable knee-high walker rendered non-removable by circumferentially wrapping with fiberglass cast material or using tie wraps 1
• These devices provide superior immobilization and prevent patient non-adherence to treatment 1

Removable Devices (Second Choice)

• Removable knee-high walker - can be considered when non-removable devices are contraindicated or not tolerated 1
• Allows for removal during bathing or skin examination but carries risk of non-adherence 1
• Less effective than non-removable options due to potential for inconsistent use 1

External Fixation Devices

• External fixators - versatile stabilization options that can be used as temporary traction devices 2
• Can help condition soft tissues and stay in place for definitive treatment 2
• Useful for intraoperative distraction and as a reduction tool 2
• However, they carry risks of pin-track infection, soft tissue tethering, pain, joint stiffness, and late fracture 3, 4

Internal Fixation Devices

• Intramedullary nails/rods - can be used in combination with external fixators to reduce fixator time and prevent deformity 5, 6
• Intramedullary lengthening nails - newer devices that allow for controlled lengthening without external frames 5
• Patient satisfaction is typically higher with internal devices compared to external fixators 4

Specialized Devices for Specific Conditions

For Congenital Pseudarthrosis of the Tibia (CPT)

• Combination of external fixation with intramedullary fixation is recommended (84% expert consensus) 1
• Intramedullary rods (IMR) alone are not recommended (74% experts disagree with using them alone) 1
• Cross-union technique with appropriate fixation may be considered for specific cases 1

For Diabetic Foot Conditions

• Knee-high offloading devices should be used as soon as possible once active Charcot neuro-osteoarthropathy is diagnosed 1
• Below-ankle devices (surgical shoes, postoperative sandals) are not recommended for conditions requiring immobilization 1

Implementation Considerations

• Treatment should begin immediately once the diagnosis requiring leg straightening is made 1
• Assistive devices (crutches, wheelchairs) should be used in conjunction with leg straightening devices to reduce weight-bearing on the affected limb 1
• For lengthening procedures, the "lengthening and then nailing" (LATN) technique shows advantages including shorter time in external fixation and quicker bone healing 6

Common Pitfalls and Caveats

• Non-adherence to removable devices can lead to development or progression of deformity 1
• External fixators can cause complications including pin-site infection, soft tissue problems, and patient intolerance 5, 4
• Below-ankle devices provide inadequate immobilization for conditions requiring complete leg straightening 1
• Previous open fractures increase infection risk when using internal fixation devices 3