Delpont M, Lafosse T, Bachy M, Mary P, Alves A, Vialle R
Service de chirurgie orthopédique pédiatrique, université Pierre-et-Marie-Curie Paris 6, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France.
Arch Pediatr. 2015 Mar;22(3):331-6. doi: 10.1016/j.arcped.2014.11.009. Epub 2014 Dec 15.
The foot may be the site of birth defects. These abnormalities are sometimes suspected prenatally. Final diagnosis depends on clinical examination at birth. These deformations can be simple malpositions: metatarsus adductus, talipes calcaneovalgus and pes supinatus. The prognosis is excellent spontaneously or with a simple orthopedic treatment. Surgery remains outstanding. The use of a pediatric orthopedist will be considered if malposition does not relax after several weeks. Malformations (clubfoot, vertical talus and skew foot) require specialized care early. Clubfoot is characterized by an equine and varus hindfoot, an adducted and supine forefoot, not reducible. Vertical talus combines equine hindfoot and dorsiflexion of the forefoot, which is performed in the midfoot instead of the ankle. Skew foot is suspected when a metatarsus adductus is resistant to conservative treatment. Early treatment is primarily orthopedic at birth. Surgical treatment begins to be considered after walking age. Keep in mind that an abnormality of the foot may be associated with other conditions: malposition with congenital hip, malformations with syndromes, neurological and genetic abnormalities.
足部可能是出生缺陷的部位。这些异常情况有时在产前就会被怀疑。最终诊断取决于出生时的临床检查。这些畸形可能是简单的位置异常，如内收跖骨、仰趾外翻足和旋后足。预后无论是自发的还是通过简单的矫形治疗都非常好。手术治疗仍不常见。如果几周后位置异常仍未缓解，会考虑请小儿骨科医生会诊。畸形（马蹄内翻足、垂直距骨和斜形足）需要早期的专业护理。马蹄内翻足的特征是后足马蹄样畸形和内翻，前足内收和旋后，且不可复位。垂直距骨表现为后足马蹄样畸形和前足背屈，且背屈发生在中足而非踝关节处。当内收跖骨对保守治疗有抵抗时，应怀疑斜形足。出生时的早期治疗主要是矫形治疗。行走年龄后开始考虑手术治疗。要记住，足部异常可能与其他情况相关：位置异常可能与先天性髋关节异常有关，畸形可能与综合征有关，还可能伴有神经和遗传异常。
