Frances Jenny M, Feldman David S
Assistant Professor of Orthopedic Surgery, Division of Pediatric Orthopedics, New York University Hospital for Joint Diseases, New York, New York.
Instr Course Lect. 2015;64:429-40.
Flatfoot in a child may be normal before development of the arch, but the prevalence decreases with age. Treatment is indicated only in the presence of pain and should begin with nonsurgical management options such as stretching of the Achilles tendon and the use of soft shoe orthotics. If pain persists, a modified Evans procedure, together with additional procedures to address forefoot supination, can be successful in correcting deformity and addressing pain. A thorough understanding of the pathology and correction desired will help minimize complications and recurrence. If neuromuscular pathology is present, treatment principles are altered and greatly depend on the severity of the deformity, the association of tibialis posterior spasticity, and ambulatory status. In mild to moderate pathology in walking patients with cerebral palsy, osteotomies can be successful. Various forms of arthrodesis can decrease recurrence when the deformity is severe in a nonambulatory patient with cerebral palsy and a symptomatic valgus foot deformity. In cases of collagen disorders, where soft-tissue laxity complicates management, deformity correction may be of higher importance. Overall alignment always should be evaluated and corrected when necessary to optimize the outcome in patients with valgus foot deformities. The successful treatment of flexible or rigid flatfoot deformity must take into account underlying pathology to optimize outcomes.
儿童扁平足在足弓发育之前可能是正常的，但患病率会随着年龄增长而降低。仅在出现疼痛时才需要治疗，治疗应首先采用非手术管理方法，如拉伸跟腱和使用软质鞋垫。如果疼痛持续，改良的埃文斯手术以及其他解决前足内旋的手术，可能成功矫正畸形并缓解疼痛。全面了解病理情况和预期矫正效果有助于将并发症和复发风险降至最低。如果存在神经肌肉病变，治疗原则会有所改变，并且很大程度上取决于畸形的严重程度、胫后肌痉挛的关联情况以及行走状态。对于患有脑瘫的行走患者，轻度至中度病变时截骨术可能成功。对于患有脑瘫且有症状性外翻足畸形的非行走患者，当畸形严重时，各种形式的关节固定术可减少复发。在胶原紊乱的病例中，软组织松弛会使治疗复杂化，此时矫正畸形可能更为重要。对于外翻足畸形患者，始终应评估并在必要时矫正整体对线情况，以优化治疗效果。成功治疗柔韧性或僵硬性扁平足畸形必须考虑潜在的病理情况，以实现最佳治疗效果。
