Van Boerum Drew H, Sangeorzan Bruce J
Department of Orthopaedics and Sports Medicine, Harborview Medical Center, P.O. Box 359798, Seattle, WA 98104, USA.
Foot Ankle Clin. 2003 Sep;8(3):419-30. doi: 10.1016/s1083-7515(03)00084-6.
When the foot works properly it is an amazing, adaptive, powerful aid during walking, running, jumping, and in locomotion up or down hill and over uneven ground. Dysfunction of the foot can often arise from the foot losing its normal structural support, thus altering is shape. An imbalance in the forces that tend to flatten the arch and those that support the arch can lead to loss of the medial longitudinal arch. An increase in the arch-flattening effects of the triceps surae or an increase in the weight of the body will tend to flatten the arch. Weakness of the muscular, ligamentous, or bony arch supporting structures will lead to collapse of the arch. The main factors that contribute to an acquired flat foot deformity are excessive tension in the triceps surae, obesity, PTT dysfunction, or ligamentous laxity in the spring ligament, plantar fascia, or other supporting plantar ligaments. Too little support for the arch or too much arch flattening effect will lead to collapse of the arch. Acquired flat foot most often arises from a combination of too much force flattening the arch in the face of too little support for the arch. Treatment of the adult acquired flat foot is often difficult. The clinician should remember the biomechanics of the normal arch and respond with a treatment that strengthens the supporting structures of the arch or weakens the arch-flattening effects on the arch. After osteotomies or certain hindfoot fusions, the role of the supporting muscles of the arch, in particular the PTT, play less of a role in supporting the arch. Rebalancing the forces that act on the arch can improve function and lessen the chance for further or subsequent development of deformity.
当足部正常工作时，它在行走、跑步、跳跃以及上下坡和在不平地面上移动时，是一种惊人的、适应性强且有力的辅助工具。足部功能障碍通常源于足部失去正常的结构支撑，从而改变其形状。趋于使足弓变平的力量与支撑足弓的力量失衡，会导致内侧纵弓消失。小腿三头肌使足弓变平的作用增强或身体重量增加，往往会使足弓变平。肌肉、韧带或骨性足弓支撑结构的薄弱会导致足弓塌陷。导致后天性平足畸形的主要因素包括小腿三头肌过度紧张、肥胖、胫后肌腱功能障碍，或弹簧韧带、足底筋膜或其他足底支撑韧带的韧带松弛。对足弓的支撑过少或足弓变平的作用过大，都会导致足弓塌陷。后天性平足最常见的原因是在对足弓支撑过少的情况下，使足弓变平的力量过大。成人后天性平足的治疗通常很困难。临床医生应牢记正常足弓的生物力学原理，并采取加强足弓支撑结构或减弱对足弓变平作用的治疗方法。在进行截骨术或某些后足融合术后，足弓支撑肌肉，尤其是胫后肌腱，在支撑足弓方面的作用会减弱。重新平衡作用于足弓的力量，可以改善功能并减少畸形进一步发展或后续发生的可能性。
