Westhoff B, Weimann-Stahlschmidt K, Krauspe R
Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
Orthopade. 2011 Jul;40(7):637-47. doi: 10.1007/s00132-011-1782-x.
Pes equinus is the most common deformity in cerebral palsy. A primarily dynamic pes equinus without shortening of the calf muscle in many cases turns into a structural pes equinus. This is due to insufficient linear growth of the calf muscle compared to bone growth. Structural pes equinus has to be distinguished from marked, compensatory and forefoot pes equinus. Conservative as well as operative treatment options are often applied in combination or sequentially. In dynamic pes equinus botulinum toxin A is the therapy of choice. Only slight structural pes equinus may improve under botulinum toxin A injection with and without additional casting. Usually, structural pes equinus requires operative treatment or lengthening of the gastrocnemius and/or soleus muscle (operation according to Baumann). Because of its side effect of inducing loss of power of the calf muscle, lengthening of the Achilles tendon should only be performed with caution. Especially in bilateral spastic cerebral palsy, the increased risk of causing talipes calcaneovalgus and crouch gait has to be considered.
马蹄足是脑瘫中最常见的畸形。在许多情况下，主要为动态性马蹄足且小腿肌肉无缩短，会转变为结构性马蹄足。这是由于小腿肌肉的线性生长与骨骼生长相比不足所致。结构性马蹄足必须与明显的、代偿性的和前足马蹄足相区分。保守治疗和手术治疗方案通常联合应用或序贯使用。对于动态性马蹄足，A型肉毒毒素是首选治疗方法。仅轻度结构性马蹄足在注射A型肉毒毒素并加或不加额外石膏固定的情况下可能有所改善。通常，结构性马蹄足需要手术治疗或对腓肠肌和/或比目鱼肌进行延长（根据鲍曼手术）。由于跟腱延长会导致小腿肌肉力量丧失的副作用，应谨慎进行。特别是在双侧痉挛性脑瘫中，必须考虑导致仰趾外翻足和蹲伏步态的风险增加。
