Henn R Frank, Crawford Dennis C, Eberson Craig P, Ehrlich Michael G
Providence, RI, USA.
Foot Ankle Int. 2008 Apr;29(4):390-5. doi: 10.3113/FAI.2008.0390.
Optimal management of congenital talipes equinovarus continues to be controversial. There is a dramatically renewed emphasis on non-operative management partly because there has been a high recurrence rate among operated feet. Our hypothesis is that early, extensive subtalar ligament release as the cornerstone of aggressive hindfoot realignment prevents recurrence and retains mobility.
Twenty-two congenital clubfeet (14 patients) corrected by one surgeon were evaluated using two validated patient-based outcome instruments, dynamic pedobarographic analysis, hindfoot mobility, and weightbearing radiographs. Pedobarographic analysis consisted of quantifying peak plantar forces and pressures during the gait cycle in 22 corrected feet and 24 control feet using the FSCAN in-shoe device.
The mean age at surgery was 8 months and mean followup was 10 years. No patients experienced recurrence of deformity. Reported foot function and satisfaction were very high for all patients and were comparable to reported normal population values. AP and lateral talocalcaneal angles for each foot were within normal limits for age. Hindfoot range of motion, including dorsiflexion, was preserved in all feet. Peak regional forces throughout the gait cycle and plantar pressures at foot flat were mildly, but statistically significantly, higher in the midfoot of corrected feet suggesting slight flattening of the arch. One patient had tendon transfers for bilateral calcaneal deformity and one patient had surgical correction of a bilateral valgus deformity.
Aggressive hindfoot realignment provides definitive treatment of an equinovarus deformity, but care must be taken to avoid overcorrection.
先天性马蹄内翻足的最佳治疗方案仍存在争议。非手术治疗重新受到显著重视，部分原因是手术治疗后的足部复发率较高。我们的假设是，早期广泛的距下韧带松解作为积极的后足重新排列的基石，可防止复发并保留活动度。
对由一位外科医生矫正的22例先天性马蹄内翻足（14例患者），使用两种经过验证的基于患者的结局评估工具、动态足底压力分析、后足活动度和负重X线片进行评估。足底压力分析包括使用FSCAN鞋内装置，对22只矫正足和24只对照足在步态周期中的足底峰值力和压力进行量化。
手术时的平均年龄为8个月，平均随访时间为10年。没有患者出现畸形复发。所有患者报告的足部功能和满意度都很高，与报告的正常人群值相当。每只脚的前后位和侧位距跟角均在该年龄的正常范围内。所有足部均保留了包括背屈在内的后足活动范围。在步态周期中，矫正足中足的峰值区域力和足放平位时的足底压力略高，但具有统计学意义，提示足弓略有扁平。1例患者因双侧跟骨畸形进行了肌腱转移，1例患者接受了双侧外翻畸形的手术矫正。
积极的后足重新排列为马蹄内翻足畸形提供了确定性治疗，但必须注意避免过度矫正。
