Niedzielski Kryspin, Lipczyk Zbigniew, Klawe Filip, Flont Paweł
Klinika Ortopedii i Traumatologii z Pododdziałem Chirurgii Reki dla Dzieci, Instytut Centrum Zdrowia Matki Polki w Łodzi.
Chir Narzadow Ruchu Ortop Pol. 2010 Sep-Oct;75(5):312-7.
Metatarsus adductus is usually a morphologic feature of the clubfoot or occurs as an isolated defect. Such deformation causes shortening of the medial foot column and lengthening of the lateral. The purpose of the study is a retrospective evaluation of long-term therapeutic effects in a group of patients, who underwent closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy. Surgery was performed in 19 persons, procedure was applied to 26 feet, of which 3 presented congenital metatarsus adductus and 23 presented recurrent clubfoot. During ostoetomy we performed additional corrective procedures on soft tissues. Foot and gait deformation, pain associated with activities, presence of calluses on the lateral plantar surface of the foot, difficulty in footwear were evaluated before and after surgery on clinical examination. The pre- and post operative X-rays were used to determine: in AP view the Kite's angle and the angle between the calcaneal bone and the 5th metatarsalbone (forefoot adduction evaluation), in lateral view the Kite's angle, the angle between the calcaneal bone and the 1st metatarsal bone (forefoot supination evaluation) and the angle between the talus and the 1st metatarsal bone (cavus evaluation). An early recurrence of the deformation after the removal of wire fixation occurred in 2 patients. Late complications taking the form of adduction and supination of the forefoot occurred in 5 cases. In general recurrences of adduction of the metatarsus occurred in 27 % operated feet. Radiographic evaluation proved a significant statistical effect of the "plus-minus" osteotomy limited to the reduction of the adduction angle of the forefoot and not affect improvement of the supination of the forefoot and the foot excavation.
内收型足通常是马蹄内翻足的一种形态学特征，或作为一种孤立性缺陷出现。这种畸形会导致足内侧柱缩短和外侧柱延长。本研究的目的是对一组接受闭合楔形骰骨截骨术和开放楔形内侧楔骨截骨术的患者的长期治疗效果进行回顾性评估。对19人实施了手术，手术应用于26只足，其中3只足表现为先天性内收型足，23只足表现为复发性马蹄内翻足。在截骨术中，我们对软组织进行了额外的矫正手术。在临床检查中，对手术前后的足部和步态畸形、与活动相关的疼痛、足底外侧表面胼胝的存在情况以及穿鞋困难程度进行了评估。术前和术后的X线片用于确定：在前后位视图中，测量Kite角以及跟骨与第5跖骨之间的角度（前足内收评估）；在侧位视图中，测量Kite角、跟骨与第1跖骨之间的角度（前足旋后评估）以及距骨与第1跖骨之间的角度（高弓足评估）。2例患者在拆除钢丝固定后出现畸形早期复发。5例出现了以前足内收和旋后为形式的晚期并发症。总体而言，27%的手术足出现了跖骨内收复发。影像学评估证明，“±”截骨术具有显著的统计学效果，仅限于减少前足内收角，而不影响前足旋后和足弓凹陷的改善。
