Department of Foot & Ankle Surgery, Nuffield Orthopaedic Centre NHS Trust, Windmill Road, Headington, Oxford OX3 7LD, UK.
Foot Ankle Surg. 2008;14(2):89-95. doi: 10.1016/j.fas.2007.11.005. Epub 2008 Jan 31.
We present nine cases of acquired flat foot deformity (AFFD) in adults caused by isolated spring ligament insufficiency.
We present the clinical sign that allows differentiation of this diagnosis from posterior tibialis tendon (PTT) dysfunction namely the ability to single leg tiptoe, but with persistent forefoot abduction and heel valgus. In addition we illustrate the unique radiological features which allow confirmation of the diagnosis. Only a solitary previous case report has documented this alternative aetiology of AFFD; in that case, diagnosis was made intra-operatively.
Six patients have been managed with orthoses. Three patients underwent surgery; one patient who presented early had isolated repair of the spring ligament complex. The remaining two required a calcaneal osteotomy and flexor digitorum longus transfer as for a PTT reconstruction.
We propose that early diagnosis (with ultrasound confirmation) and management of this condition would offer a better prognosis and allow less interventional surgery.
我们报告了 9 例由孤立性弹簧韧带不足引起的成人获得性扁平足畸形（AFFD）。
我们提出了一种可以将这种诊断与胫骨后肌腱（PTT）功能障碍区分开来的临床体征，即单腿踮脚尖的能力，但前足仍有外展和跟骨外翻。此外，我们还说明了可以确认诊断的独特影像学特征。只有一个先前的病例报告记录了 AFFD 的这种替代病因；在那种情况下，是在手术中做出诊断的。
6 名患者接受了矫形器治疗。3 名患者接受了手术；1 名早期就诊的患者仅接受了弹簧韧带复合体的修复。其余 2 名患者需要跟骨截骨术和趾长屈肌转移术，类似于 PTT 重建。
我们提出，早期诊断（通过超声确认）和这种情况的治疗将提供更好的预后，并允许更少的介入性手术。
