Benedetti Maria Grazia, Berti Lisa, Straudi Sofia, Ceccarelli Francesco, Giannini Sandro
Istituto Ortopedico Rizzoli, University of Bologna, Italy.
J Am Podiatr Med Assoc. 2010 Nov-Dec;100(6):463-71. doi: 10.7547/1000463.
Radiographic assessment is still used to evaluate flexible flatfoot in children.
To find a set of radiologic parameters for assessing this disease, we studied 53 children aged 10 to 14 years. The degree of plantar collapse was measured by Viladot's classification (grades 0-4). The degree of valgus deformity measured in the heel in a standing position, the presence of painful points, and functional limitation during daily-living activities were also reported. The children underwent standard radiography of the foot under load. On the dorsoplantar view, the talocalcaneal, hallux metatarsophalangeal, and first intermetatarsal angles were measured. On the lateral view, the talocalcaneal, Costa Bertani, talometatarsal, talonavicular, and tibiotalar angles were measured. The radiographic measurements were compared with the data reported in the literature and were correlated with the clinical parameters studied (degree of flatfoot, valgus deviation of the heel, pain, and functional limitation).
The radiographic measures that resulted increased with respect to the reference values reported in the literature for the Costa Bertani (93.1% of feet), talometatarsal (93.5%), talonavicular (89.1%), and tibiotalar (69.7%) angles, all in the lateral view. Of the angles assessed in the dorsoplantar view, the hallux metatarsophalangeal (11.1%) and first intermetatarsal (24.2%) angles were increased. The degree of flatfoot was correlated with the Costa Bertani angle (P < .0005). In the group with pain, the lateral talocalcaneal (P = .016) and first intermetatarsal (P = .02) angles were increased compared within the group without pain.
Despite technical limitations, we still consider standard radiography of the foot, combined with clinical examination, to be a valid tool for assessing flexible flatfoot in children, especially when surgical treatment is expected and when a basic measure of the structural setup of the foot is necessary.
X线片评估仍用于儿童柔韧性扁平足的评估。
为找到一组评估该疾病的放射学参数，我们研究了53名10至14岁的儿童。采用维拉多特分类法（0 - 4级）测量足底塌陷程度。还报告了站立位时足跟外翻畸形程度、压痛点的存在情况以及日常生活活动中的功能受限情况。这些儿童接受了负重下足部的标准X线检查。在正位片上，测量距跟角、拇趾跖趾关节角和第一跖骨间角。在侧位片上，测量距跟角、科斯塔·贝尔塔尼角、距跖角、距舟角和胫距角。将放射学测量结果与文献报道的数据进行比较，并与所研究的临床参数（扁平足程度、足跟外翻偏差、疼痛和功能受限）进行相关性分析。
在侧位片上，与文献报道的参考值相比，科斯塔·贝尔塔尼角（93.1%的足部）、距跖角（93.5%）、距舟角（89.1%）和胫距角（69.7%）的放射学测量值增加。在正位片上评估的角度中，拇趾跖趾关节角（11.1%）和第一跖骨间角（24.2%）增加。扁平足程度与科斯塔·贝尔塔尼角相关（P <.0005）。在有疼痛的组中，与无疼痛组相比，外侧距跟角（P =.016）和第一跖骨间角（P =.02）增加。
尽管存在技术局限性，但我们仍认为足部标准X线检查结合临床检查是评估儿童柔韧性扁平足的有效工具，尤其是在预期进行手术治疗以及需要对足部结构设置进行基本测量时。
