Kristen K-H
Fusszentrum Wien, Alserstrasse 43/8D, A-1080 Wien.
Radiologe. 2007 Mar;47(3):202, 204-9. doi: 10.1007/s00117-007-1484-x.
The human foot is a complex biomechanical structure. The arch of the foot is formed by the bony and articular structure of the midfoot and supported by strong ligaments and tendons. The normal arch develops in childhood. Tendon and ligament rupture and degeneration often lead to flattening of the arch. Frequent painful conditions include hallux valgus deformity and rupture of the posterior tibial tendon both leading to flat feet. Radiological examination is necessary in a standardized, full weight bearing standing position. The standing dorsoplantar view shows hallux valgus angle and intermetatarsal 1/2 angle. The side view shows Lisfranc joint instability and decrease of the talometatarsal angle. Talonavicular instability is a frequent secondary sign of spring ligament and posterior tibial tendon lesion. After failure of conservative therapy, corrective surgery with osteotomy and realignment procedure of the malpositioned bones in combination with tendon and ligament reconstruction is the state of the art procedure. In postoperative follow-up a standing X-ray of the foot is again the standard tool. Additional MRI and CT examinations help to detect bone and cartilage lesions and tendon/ligament ruptures.
人脚是一个复杂的生物力学结构。足弓由中足的骨骼和关节结构形成，并由强壮的韧带和肌腱支撑。正常足弓在儿童期发育形成。肌腱和韧带的断裂与退变常导致足弓扁平。常见的疼痛性病症包括拇外翻畸形和胫后肌腱断裂，两者均可导致扁平足。需要在标准化的全负重站立位进行放射学检查。站立位背跖位片可显示拇外翻角和第1、2跖骨间角。侧位片可显示Lisfranc关节不稳和距跖角减小。距舟关节不稳是弹簧韧带和胫后肌腱损伤常见的继发征象。保守治疗失败后，采用截骨术及对错位骨骼进行重新排列的矫正手术，同时结合肌腱和韧带重建，是目前的先进治疗方法。术后随访时，足部站立位X线片仍是标准检查手段。额外的MRI和CT检查有助于检测骨和软骨病变以及肌腱/韧带断裂。
