Departament of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo, R Dr Cesário Motta Jr, 112, São Paulo, SP 01221-020, Brazil.
Clin Orthop Relat Res. 2012 May;470(5):1334-43. doi: 10.1007/s11999-011-2185-3.
Treatment of spastic planovalgus feet is challenging, especially in patients with severe and rigid deformities. The available techniques do provide some correction but not at the site of the deformity and sometimes the correction is lost over time. We describe a new surgical approach at the site of the deformity.
Indications for the surgery included adolescents or young adults with severe and rigid planovalgus deformities of the feet resulting from cerebral palsy. Through a medial approach, arthrodesis of the talonavicular, navicular-medial cuneiform, and medial cuneiform first metatarsal joints was internally fixed using a single-molded plate over the plantar surface of the foot, recreating the longitudinal arch.
We retrospectively reviewed 21 patients (35 feet) with spastic cerebral palsy in whom the new technique was indicated for severe and rigid deformity, gait dysfunction, and pain (mean age, 190 months; range, 96-345 months). The mean age of the patients was 16 years (range, 8-29 years). We analyzed the patients clinically and radiographically. The minimum followup was 2.5 years (mean, 58 months; range, 2.5-7.5 years).
At last followup, 34 of the 35 feet (97%) had radiographic improvement of the deformity with no difficulties wearing shoes; one patient had persistent pain despite bone union. Union was achieved initially in eight patients (17 feet) and in another eight (10 feet) after revision surgery, of 27 of the 35 feet. The radiographic calcaneal inclination angle improved an average of 13°. The lateral talocalcaneal angle decreased from a mean of 43° to 26° after surgery. Four patients (five feet) had revision surgery for pseudoarthrosis, and another four patients (five feet) had revision surgery for other problems.
Based on our preliminary observations, we believe stabilization of the medial column is a reasonable option for treating selected patients with severe and rigid planovalgus feet by providing a stable and pain-free foot, recreating the anatomy, and allowing the use of braces or regular shoes. Further studies with longer followup periods will be required to confirm these initial results and to verify if these findings persist over time.
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
痉挛性-planovalgus 足的治疗具有挑战性，尤其是在患有严重和僵硬畸形的患者中。现有的技术确实可以提供一些矫正，但不是在畸形部位，而且有时随着时间的推移矫正会丢失。我们描述了一种在畸形部位的新手术方法。
手术适应证包括青少年或年轻成人，患有脑瘫导致的严重和僵硬-planovalgus 足畸形。通过内侧入路，跗舟状骨、舟骨-内侧楔骨和内侧楔骨-第一跖骨关节的融合采用足底表面的单一模塑板进行内部固定，重建纵弓。
我们回顾性分析了 21 例（35 足）痉挛性脑瘫患者，这些患者由于严重和僵硬的畸形、步态功能障碍和疼痛而需要采用新的技术（平均年龄 190 个月；范围 96-345 个月）。患者的平均年龄为 16 岁（范围 8-29 岁）。我们对患者进行了临床和影像学分析。随访时间至少为 2.5 年（平均 58 个月；范围 2.5-7.5 年）。
末次随访时，35 足中的 34 足（97%）的畸形有影像学改善，无穿鞋困难；1 例患者尽管骨愈合仍有持续性疼痛。27 足中的 8 足（17 足）在初始时和另外 8 足（10 足）在翻修手术后获得了融合。跟骨倾斜角平均改善了 13°。术后外侧距跟角从平均 43°降至 26°。4 例（5 足）患者因假关节行翻修手术，另外 4 例（5 足）患者因其他问题行翻修手术。
基于我们的初步观察，我们认为内侧柱的稳定是治疗严重和僵硬-planovalgus 足的一种合理选择，它可以提供稳定无痛的足部，重建解剖结构，并允许使用支具或常规鞋子。需要进一步进行随访时间更长的研究来证实这些初步结果，并验证这些发现是否随着时间的推移而持续存在。
IV 级，病例系列研究。欲了解完整的证据等级描述，请参见作者指南。
