Napolitano C, Walsh S, Mahoney L, McCrea J
Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Clin Podiatr Med Surg. 2000 Jul;17(3):397-417.
Flatfoot is one of the most common conditions seen in pediatric podiatry practice. There is no universally accepted definition for flatfoot. Flatfoot is a term used to describe a recognizable clinical deformity created by malalignment at several adjacent joints. Clinically, a flatfoot is one that has a low or absent longitudinal arch. Determining flexibility (physiologic) or rigidity (pathologic) is the first step in management. A flexible flat foot will have an arch that is present in open kinetic chain (off weight-bearing) and lost in closed kinetic chain (weight-bearing). A rigid flatfoot has loss of the longitudinal arch height in open and closed kinetic chain. According to Mosca, "The anatomic characteristics of a flatfoot are excessive eversion of the subtalar complex during weight-bearing with plantarflexion of the talus, plantarflexion of the calcaneus in relation to the tibia, a dorsiflexed and abducted navicular and a supinated forefoot." Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life. When evaluating an infant for a pronated condition, the examiner must also consider other risk factors that may affect the foot in its overall development. These contributing factors will play a role in the development of a treatment plan. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions. The authors realize other less significant factors exist but are not as detrimental to the foot as the primary ones discussed in depth. The primary risk factors that affect the pronated foot have been outlined. The clinician should always examine for these conditions when presented with a child exhibiting pronatory changes. A thorough explanation to the parents as to the consequential effects of these risk factors and their effects on the pediatric pronated foot is paramount to providing an acceptable comprehensive treatment program. Children often are noncompliant with such treatments as stretching and orthotic maintenance. The support of the parents is crucial to maintaining an effective treatment program continued at home.
扁平足是小儿足病诊疗中最常见的病症之一。目前对于扁平足尚无普遍认可的定义。扁平足是一个用于描述由多个相邻关节排列不齐所导致的可识别临床畸形的术语。临床上，扁平足是指足弓低或无足弓。确定柔韧性（生理性）或僵硬性（病理性）是治疗的第一步。柔韧性扁平足在开链运动（非负重）时足弓存在，而在闭链运动（负重）时足弓消失。僵硬性扁平足在开链和闭链运动中均失去纵弓高度。根据莫斯卡的说法，“扁平足的解剖学特征是负重时距下关节复合体过度外翻，同时距骨跖屈、跟骨相对于胫骨跖屈、舟骨背屈并外展以及前足旋后。”正常发育的婴儿有柔韧性扁平足，并在生命的第一个十年中逐渐形成正常足弓。在评估婴儿是否有旋前状况时，检查者还必须考虑其他可能影响足部整体发育的风险因素。这些促成因素将在治疗方案的制定中发挥作用。风险因素包括韧带松弛、肥胖、旋转畸形、胫骨影响、病理性胫骨内翻、马蹄足、外侧胫骨籽骨存在以及跗骨联合。作者认识到还存在其他不太重要的因素，但不如深入讨论的主要因素对足部有害。已概述了影响旋前足的主要风险因素。当遇到表现出旋前变化的儿童时，临床医生应始终检查这些情况。向家长全面解释这些风险因素的相应影响及其对小儿旋前足的影响，对于提供可接受的综合治疗方案至关重要。儿童通常不配合诸如伸展和矫形器维护等治疗。家长的支持对于在家中持续维持有效的治疗方案至关重要。
