Objective To explore the biomechanical characteristics and clinical application effect of three-dimensional (3D) printed osteotomy guide plate combined with Ilizarov technique in the treatment of rigid clubfoot. Methods  The clinical data of 11 patients with rigid clubfoot who met the selection criteria between January 2019 and December 2024 were retrospectively analyzed. There were 6 males and 5 females with an average age of 43.2 years ranging from 21 to 60 years. There were 5 cases of congenital rigid clubfoot without treatment, 4 cases of recurrent rigid clubfoot after treatment, and 2 cases of rigid clubfoot caused by traumatic sequelae. After 11 patients were slowly stretched by Ilizarov technique combined with circular external fixator until the alignment of foot and ankle joint was basically normal, one 24-year-old male patient was selected to obtain the imaging data of ankle joint and foot by CT scan, and a 3D finite element model was established. Biomechanical changes of tibiotalar joint under the same load were simulated after triple arthrodesis. The optimal angle of the force line of the hindfoot was determined to make the 3D printed osteotomy guide plate, which was used in the triple arthrodesis of 11 patients. The American Orthopaedic Foot and Ankle Society (AOFAS) score, International Congenital Clubfoot (ICFSG) score, and short-form 36 health survey scale (SF-36) score were compared before and after operation to evaluate the functional recovery. Results  Finite element analysis showed that there was no significant difference in the overall peak von Mises stress of the articular cartilage in varus 3°, neutral 0°, valgus 3° and 9° positions compared with that before triple arthrodesis (P>0.05), and the overall peak von Mises stress of the articular cartilage in valgus 6° position was significantly lower than that before triple arthrodesis (P<0.05). The peak von Mises stress of the tibiotalar joint was the highest at 3° of varus and the lowest at 6° of valgus, and the average peak von Mises stress of the three navicular-cuneiform joints was the highest before operation and the lowest at 6° of valgus. The average peak von Mises stress of the 5 tarsometatarsal joints in each condition was the highest at 0° of hindfoot neutral position and the lowest at 6° of valgus position. The results of clinical application showed that the deformity characteristics of talipes equinovarus were consistent with the 3D reconstruction model before operation. All the 11 patients were followed up 8-24 months, with an average of 13.1 months. Postoperative incision exudation occurred in 1 patient and healed by dressing change; the incisions of the other patients healed well. The osteotomy segments healed well in all patients, and the healing time was . The scores of AOFAS, SF-36, and ICFSG significantly improved at last follow-up compared to preoperative ones (P<0.05). Conclusion  3D printed osteotomy guide plate combined with Ilizarov technique has good biomechanical advantages in the treatment of rigid clubfoot, and the clinical efficacy is remarkable, which can effectively improve the foot function of patients, and achieve precise and personalized treatment.

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