University of Manitoba, Winnipeg, MB, Canada.
Foot Ankle Int. 2013 May;34(5):673-83. doi: 10.1177/1071100712471662. Epub 2013 Jan 25.
Lateral column lengthening (LCL) has been shown to radiographically restore the medial longitudinal arch. However, the impact of LCL on foot function during gait has not been reported using validated clinical outcomes and gait analysis.
Thirteen patients with a stage II flatfoot who had undergone unilateral LCL surgery and 13 matched control subjects completed self-reported pain and functional scales as well as a clinical examination. A custom force transducer was used to establish the maximum passive range of motion of first metatarsal dorsiflexion at 40 N of force. Foot kinematic data were collected during gait using 3-dimensional motion analysis techniques.
Radiographic correction of the flatfoot was achieved in all cases. Despite this, most patients continued to report pain and dysfunction postoperatively. Participants post LCL demonstrated similar passive and active movement of the medial column when we compared the operated and the nonoperated sides. However, participants post LCL demonstrated significantly greater first metatarsal passive range of motion and first metatarsal dorsiflexion during gait than did controls (P < .01 for all pairwise comparisons).
Patients undergoing LCL for correction of stage II adult-acquired flatfoot deformity experience mixed outcomes and similar foot kinematics as the uninvolved limb despite radiographic correction of deformity. These patients maintain a low arch posture similar to their uninvolved limb. The consequence is that first metatarsal movement operates at the end range of dorsiflexion and patients do not obtain full hindfoot inversion at push-off. Longitudinal data are necessary to make a more valid comparison of the effects of surgical correction measured using radiographs and dynamic foot posture during gait.
Level III, comparative series.
外侧柱延长术（LCL）已被证明可在影像学上恢复内侧纵弓。然而，LCL 对步态中足部功能的影响尚未通过已验证的临床结果和步态分析来报道。
13 例患有 II 期扁平足的患者接受了单侧 LCL 手术，13 例匹配的对照组完成了自我报告的疼痛和功能量表以及临床检查。使用定制的力传感器在 40N 的力下确定第一跖骨背屈的最大被动活动范围。使用三维运动分析技术在步态期间收集足部运动学数据。
所有病例均实现了扁平足的影像学矫正。尽管如此，大多数患者术后仍继续报告疼痛和功能障碍。与对照组相比，LCL 术后患者的内侧柱被动和主动运动相似，当我们比较手术侧和非手术侧时。然而，LCL 术后患者在步态中第一跖骨的被动活动范围和第一跖骨背屈明显大于对照组（所有两两比较的 P 值均<.01）。
接受 LCL 手术以矫正 II 期成人获得性扁平足畸形的患者尽管影像学上矫正了畸形，但仍会出现混合结果和与未受累侧相似的足部运动学。这些患者保持与未受累侧相似的低弓姿势。结果是第一跖骨的运动处于背屈的终末范围，并且患者在蹬离时不能获得完全的后足内翻。需要纵向数据来更有效地比较使用 X 线片测量的手术矫正效果和步态中动态足部姿势。
III 级，比较系列。
