Malicky Eric S, Crary Jay L, Houghton Michael J, Agel Julie, Hansen Sigvard T, Sangeorzan Bruce J
Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA.
J Bone Joint Surg Am. 2002 Nov;84(11):2005-9. doi: 10.2106/00004623-200211000-00015.
Patients with symptomatic flatfoot deformity often present with pain in the lateral part of the hindfoot. The cause of this pain has not been clearly established. Impingement between the talus and the calcaneus or between the calcaneus and the fibula has been suggested as a cause but has not been documented.
We examined the computed tomographic scans, performed with simulated weight-bearing, of nineteen adult patients with symptomatic flatfoot to determine the potential causes of pain in the lateral aspect of the foot. The scans were performed with use of a custom loading frame designed to simulate weight-bearing with the foot in a neutral position while a 75-N axial compressive load was applied. Four examiners independently examined the coronal images as well as sagittal plane reconstructions for direct (bone-on-bone contact) and indirect (subchondral sclerosis or cysts) evidence of (1) extra-articular contact between the talus and the calcaneus in the sinus tarsi and (2) contact between the calcaneus and the fibula. The data were compared with those from five scans of normal feet in neutral alignment.
Overall, the prevalence of sinus tarsi impingement was 92% and the prevalence of calcaneofibular impingement was 66% in the flatfoot group versus 0% and 5%, respectively, in the control group. The study patients who had calcaneofibular impingement also had sinus tarsi impingement. There was substantial agreement among the examiners as to whether impingement was present.
There appear to be two frequently occurring extra-articular sources of bone impingement in the lateral aspect of the hindfoot in adults with symptomatic severe flatfoot deformity. The impingement in the lateral aspect of the hindfoot may first occur within the sinus tarsi and then involve the calcaneofibular region. Cyst formation and/or sclerosis in this region that is visible on plain radiographs or on computed tomographic scans performed without weight-bearing should create suspicion of impingement.
有症状的扁平足畸形患者常表现为后足外侧疼痛。这种疼痛的原因尚未明确。距骨与跟骨之间或跟骨与腓骨之间的撞击被认为是一个原因，但尚未得到证实。
我们对19例有症状的扁平足成年患者进行了模拟负重的计算机断层扫描，以确定足部外侧疼痛的潜在原因。扫描时使用定制的加载框架，设计用于在足部处于中立位时模拟负重，同时施加75 N的轴向压缩负荷。四名检查人员独立检查冠状位图像以及矢状面重建图像，以寻找（1）跗骨窦内距骨与跟骨之间的关节外接触以及（2）跟骨与腓骨之间接触的直接（骨对骨接触）和间接（软骨下硬化或囊肿）证据。将这些数据与五例中立位正常足部扫描的数据进行比较。
总体而言，扁平足组跗骨窦撞击的发生率为92%，跟腓撞击的发生率为66%，而对照组分别为0%和5%。有跟腓撞击的研究患者也有跗骨窦撞击。检查人员在是否存在撞击方面有很大的一致性。
对于有症状的严重扁平足畸形的成年人，后足外侧似乎有两个常见的关节外骨撞击源。后足外侧的撞击可能首先发生在跗骨窦内，然后累及跟腓区域。在平片或非负重计算机断层扫描上可见的该区域囊肿形成和/或硬化应引起对撞击的怀疑。
