Department of pediatric radiology, Paris Descartes University, Cochin - Saint-Vincent-de-Paul Hospital, AP-HP, 27, rue du Faubourg-Saint-Jacques, Paris, France.
Orthop Traumatol Surg Res. 2013 Feb;99(1):80-7. doi: 10.1016/j.otsr.2012.10.008. Epub 2012 Dec 20.
Pes planovalgus (PPV) is a complex three-dimensional deformity of which routine radiographs provide only a two-dimensional analysis.
Angles and other radiographic parameters of the foot in children and adolescents, when studied on both the dorsoplantar and the lateral view, can be used to establish a radiographic classification system for PPV that provides useful therapeutic guidance in clinical practice.
A retrospective single-centre study was conducted on 65 feet in 35 patients aged 7 to 18 years and having adequate ossification. All patients had a clinical diagnosis of idiopathic or neurologic PPV and available weight-bearing dorsoplantar and strict lateral radiographs. We excluded pes planus due to tarsal coalition, congenital bone deformities, or overcorrection of talipes equinovarus (n=25). All possible axes were drawn and angles measured after an evaluation of interindividual agreement.
We identified four patterns of PPV: subtalar pes planus (n=16) with marked subtalar valgus and longitudinal sag predominating at the talonavicular joint, midtarsal pes planus (n=12) without subtalar valgus but with marked midtarsal abduction and sag predominating at the cuneonavicular joint, mixed pes planus (n=28) with subtalar valgus, midtarsal abduction, and sag at both the talonavicular and cuneonavicular joints, and pes planocavus (n=9) with sag of the medial arch and cavus deformity of the lateral arch.
This original classification system provides therapeutic guidance by helping to match the surgical procedure to the nature and location of the deformities.
Level IV.
足旋前（PPV）是一种复杂的三维畸形，常规 X 线片仅提供二维分析。
在儿童和青少年中，对足的前后位和侧位片同时进行研究时，其角度和其他影像学参数可用于建立一种用于 PPV 的影像学分类系统，该系统可为临床实践提供有用的治疗指导。
对 35 例 7 至 18 岁且具有足够骨化的患者的 65 足进行回顾性单中心研究。所有患者均有特发性或神经源性 PPV 的临床诊断，且均有负重前后位和严格的侧位 X 线片。我们排除了由于跗骨联合、先天性骨畸形或马蹄内翻足过度矫正导致的平足（n=25）。在评估个体间一致性后，我们绘制了所有可能的轴线并测量了角度。
我们确定了 4 种 PPV 类型：距下型足旋前（n=16），距下关节明显外旋，跟舟关节以纵向跖屈为主；中跗型足旋前（n=12），无距下关节外旋，但中跗关节明显外展和跖屈为主；混合型足旋前（n=28），距下关节、中跗关节外展和跖屈均存在，距舟关节和跟骰关节均存在；平足型足旋前（n=9），内侧弓跖屈，外侧弓高弓畸形。
该原始分类系统通过帮助将手术程序与畸形的性质和位置相匹配，提供了治疗指导。
IV 级。
