Younger Alastair S E, Hansen Sigvard T
Foot and Ankle Program, Providence Health Care, University of British Columbia, Vancouver, Canada.
J Am Acad Orthop Surg. 2005 Sep;13(5):302-15. doi: 10.5435/00124635-200509000-00004.
Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.
高弓内翻足畸形通常由肌肉力量失衡引起，常见病因是遗传性运动感觉神经病。其他病因包括脑瘫、脑损伤（中风）、前角细胞疾病（脊髓神经根损伤）、距骨颈损伤和残留马蹄内翻足。在高弓内翻足畸形中，相对较强的腓骨长肌和胫骨后肌导致后足内翻和前足外翻（旋前）位。后足内翻导致足外侧缘负荷过重，进而引起踝关节不稳、腓骨肌腱炎和应力性骨折。过度负荷的关节可出现退行性关节炎改变。步态检查有助于合理规划肌腱转移术，以纠正站立期和摆动期的缺陷。检查前足和后足位置可确定是否需要进行软组织松解和截骨术。科尔曼垫块试验对于评估后足内翻的病因非常重要。长期使用矫形器或支撑性鞋类可导致肌肉失衡，引起畸形加重以及肌腱和关节的不可逆损伤。早期优先进行肌腱再平衡，以防止足部出现无法挽救的恶化。肌肉失衡可通过肌腱转移、矫正性截骨术和融合术来纠正。固定性骨畸形可通过融合术和截骨术来解决。
