Centro di Chirurgia del Piede "Prof. G. Pisani", Clinica "Fornaca di Sessant", Corso Vittorio Emanuele II, 91, 10128 Torino, Italy.
Foot Ankle Surg. 2010 Dec;16(4):183-8. doi: 10.1016/j.fas.2009.10.011. Epub 2009 Dec 2.
In cases of adult acquired flatfoot associated with peritalar destabilisation, special reference is made to the plantar calcaneo-navicular (spring) ligament's degenerative disease (degenerative glenopathy) and to the presence of the accessory navicular bone as a possible pathogenic cause. Peritalar destabilization syndrome is proposed for the articular (subtalar and talo-navicular joints) or tendinosis (tibialis posterior tendon) separately or in association with degenerative glenopathy of the coxa pedis. In degenerative glenopathy surgical reconstruction of the glenoid also makes use of a posterior tibial split to create a new tibial-navicular ligament. The concept of pronatory syndrome deemed as the root the pathological subtalar pronation, which is an entirely secondary factor in peritalar destabilisation, must be questioned. We must keep in mind that subtalar pronation and supination are respectively subsequent to opening and closing of the coxa pedis (talo-calcaneo-navicular joint) kinetic chain.
成人获得性扁平足伴跗骨间不稳定时，特别提到足底跟舟（弹簧）韧带的退行性疾病（退行性距下关节炎）和副舟骨的存在可能是致病原因。跗骨间不稳定综合征分别或与跗骨（距下和跟舟关节）或跟腱病（胫后肌腱）的关节病或腱病同时发生，也与足部距骨的退行性距下关节炎有关。在退行性距下关节炎中，关节重建也利用胫骨后部分裂来创建新的跟舟韧带。作为病理性距下内翻的根源的旋前综合征的概念被认为是跗骨间不稳定的完全次要因素，必须受到质疑。我们必须记住，距下内翻和外翻分别是跗骨（距下跟骨-舟骨关节）运动链的打开和关闭的后续动作。
