Hôpital Necker-Enfants malades, Paris Descartes University, 149, rue de Sèvres, 75015 Paris, France.
Orthop Traumatol Surg Res. 2013 Oct;99(6 Suppl):S345-55. doi: 10.1016/j.otsr.2013.07.003. Epub 2013 Aug 23.
The talonavicular (TN) joint and the three subtalar (ST) joints are linked anatomically and functionally. Together they form the subtalar joint complex, where movement occurs between the calcaneopedal unit (CPU) (entire foot except the talus) and the talotibiofibular unit (talus held tightly by the ankle mortise). Many are unaware of the TN joint's dual membership: it is a component of the subtalar joint complex (talocalcaneonavicular joint) and also the transverse tarsal joint (with the calcaneal-cuboid joint). The anatomy of the articulating surfaces, movement of the CPU when unloaded, shifts and changes in CPU shape with weight bearing, application to clinical tests and X-ray interpretation, and the pathophysiology applications to pes cavovarus, pes planovalgus and congenital talipes equinovarus (club foot) will be reviewed here. The CPU concept corresponds to a horizontal segmentation of the foot. This is a useful supplement to the two other segmentation methods: frontal (hindfoot, midfoot and forefoot) and sagittal (medial and lateral columns). This horizontal segmentation solves the issues with the ST joint complex, which straddles the hindfoot and midfoot, and also the issues with the dual membership of the TN joint. This concept makes it easier to understand foot deformities, better interpret the clinical and radiological signs and deduce logical treatments.
距跟（TN）关节和三个跗骨间（ST）关节在解剖学和功能上是相连的。它们共同构成了跗骨间关节复合体，在这个关节中，跟距骨单位（CPU）（除距骨外的整个足部）和距下腓骨单位（由踝关节窝紧紧固定的距骨）之间发生运动。许多人没有意识到 TN 关节的双重成员身份：它是跗骨间关节复合体（距跟舟关节）的一个组成部分，也是横跗关节（跟骰关节）的一个组成部分。本文将回顾关节表面的解剖结构、未负重时 CPU 的运动、承重时 CPU 形状的移位和变化、应用于临床测试和 X 射线解释的情况，以及病理生理学在马蹄内翻足、平足和先天性马蹄内翻足（足内翻）中的应用。CPU 概念对应于足部的水平分段。这是对另外两种分段方法（额状面（后足、中足和前足）和矢状面（内侧和外侧柱））的有用补充。这种水平分段解决了 ST 关节复合体跨越后足和中足的问题，以及 TN 关节的双重成员身份问题。这个概念使得理解足畸形变得更容易，更好地解释临床和影像学征象，并推导出合理的治疗方法。
