Stevens P M, Otis S
University of Utah School of Medicine, Salt Lake City, USA.
J Pediatr Orthop. 1999 Jul-Aug;19(4):515-7. doi: 10.1097/00004694-199907000-00018.
Congenital equinovarus is a complex deformity that involves the ankle as well as the foot. Although equinus is the obvious and presenting ankle deformity that is typically addressed with serial manipulation, casts, and surgery, ankle valgus is a more insidious and often overlooked problem that evolves with growth. With a high prevalence (67% in this series), it may, in some cases, ameliorate the effects of residual hindfoot varus. More commonly, it may result in prominence of the medial malleolus, lateral shift of the ground reactive forces, compression of the lateral portion of the distal tibial epiphysis, fibular impingement, and excessive shoe wear. If mistaken for hindfoot valgus ("overcorrected clubfoot"), inappropriate hindfoot surgery may result. Although one may temporize with orthoses, definitive treatment options include medial malleolar epiphysiodesis or, in mature patients, supramalleolar osteotomy. We recommend a weight-bearing anteroposterior radiograph of the ankles in any patient presenting with valgus and suspected of having overcorrected congenital equinovarus, particularly if surgical intervention is being contemplated. If valgus deformity is noted in the ankle, hindfoot surgery may be contraindicated.
先天性马蹄内翻足是一种涉及踝关节和足部的复杂畸形。虽然马蹄足是明显的且表现出来的踝关节畸形，通常通过系列手法治疗、石膏固定和手术来处理，但踝关节外翻是一个更隐匿且常常被忽视的问题，它会随着生长而发展。其发生率较高（本系列中为67%），在某些情况下，它可能会改善残留后足内翻的影响。更常见的是，它可能导致内踝突出、地面反作用力向外侧偏移、胫骨远端骨骺外侧部分受压、腓骨撞击以及鞋子过度磨损。如果被误认为是后足外翻（“过度矫正的马蹄足”），可能会导致不恰当的后足手术。虽然可以使用矫形器暂时缓解，但确定性的治疗选择包括内踝骨骺阻滞术，对于成年患者，则包括踝关节上截骨术。我们建议，对于任何出现外翻且怀疑患有过度矫正的先天性马蹄内翻足的患者，尤其是考虑进行手术干预时，拍摄踝关节负重前后位X线片。如果在踝关节发现外翻畸形，后足手术可能是禁忌的。
