DeLauro T M, Positano R G
New York College of Podiatric Medicine, New York.
Clin Podiatr Med Surg. 1989 Jan;6(1):83-92.
As demonstrated in a recent survey, hallux limitus and rigidus are often the presenting complaints of our young population. Normal first metatarsophalangeal joint function depends not only on an intact articulation but also sesamoidal mobility and the capacity for the first metatarsal to plantarflex. Whereas acute or chronic microtrauma can impair articular surfaces, first metatarsal plantarflexion can be limited in cases of hypermobility, excessive metatarsal length, immobility of the first metatarsocuneiform joint, or metatarsus primus elevatus. Conservative therapy can be more effective in relieving the symptoms of hallux limitus or rigidus in young patients; however, surgical intervention is often necessary or desirable. The choice of surgical procedure should be based on the etiology of the deformity, as well as the degree of articular degeneration. It is the senior author's opinion that young patients with hallux limitus or rigidus are best served by the performance of cheilectomy with osteotomies designed to create an internal rocker bar mechanism. Procedures designed to shorten or plantarflex the first metatarsal should be reserved for obvious cases of excessive metatarsal length or elevation.
正如最近一项调查所示，拇趾僵硬和拇趾强直常常是年轻人群的就诊主诉。正常的第一跖趾关节功能不仅取决于完整的关节连接，还取决于籽骨的活动度以及第一跖骨跖屈的能力。急性或慢性微创伤会损害关节面，而在关节活动过度、跖骨过长、第一跖楔关节活动受限或第一跖骨抬高的情况下，第一跖骨的跖屈可能会受到限制。保守治疗在缓解年轻患者拇趾僵硬或拇趾强直症状方面可能更有效；然而，手术干预往往是必要的或可取的。手术方式的选择应基于畸形的病因以及关节退变的程度。资深作者认为，对于患有拇趾僵硬或拇趾强直的年轻患者，最好的治疗方法是进行切骨术并设计截骨术以形成内部摇椅杆机制。旨在缩短或跖屈第一跖骨的手术应保留用于明显的跖骨过长或抬高病例。
