McCluskey W P, Lovell W W, Cummings R J
Division of Orthopaedics, Nemours Children's Clinic, Jacksonville, FL 32247.
Clin Orthop Relat Res. 1989 Oct(247):27-37.
The cavovarus foot is a complex deformity of the forefoot and hindfoot, frequently of neuropathologic etiology. A progressive spinal or peripheral neuromuscular disorder must be excluded by a thorough clinical evaluation. With the failure of nonoperative modalities, surgical options depend on patient age, etiology of the deformity, and the constellation and flexibility of the defects observed. If the hindfoot varus is flexible, correction of the cavus and forefoot pronation through extensive plantar release and metatarsal osteotomies is reliable. The underlying muscle imbalance must be addressed through tendon transfers to prevent further progression. In the young child, a rigid hindfoot varus will often be corrected by a radical plantar-medial release, but the more mature foot may require midtarsal osteotomy and calcaneal osteotomy or triple arthrodesis. The surgery is usually staged to provide correction of deformity and stabilization of the hindfoot prior to tendo Achilles lengthening or tendon transfer. Arthrodesis of a previously well-corrected foot is common due to progression of the neurologic deficit or failure to achieve muscular balance. The claw toe deformity also must be corrected by tendon transfer, osteotomy, and arthrodesis for reasons of both comfort and function.
高弓内翻足是一种涉及前足和后足的复杂畸形，病因常为神经病理性。必须通过全面的临床评估排除进行性脊柱或周围神经肌肉疾病。若非手术治疗方法无效，手术选择取决于患者年龄、畸形病因以及所观察到的缺陷组合和灵活性。如果后足内翻是可屈性的，通过广泛的足底松解和跖骨截骨术矫正高弓和前足内旋是可靠的。必须通过肌腱转位解决潜在的肌肉失衡问题，以防止进一步发展。对于幼儿，严重的足底内侧松解通常可矫正僵硬的后足内翻，但年龄稍大的足部可能需要中跗骨截骨术、跟骨截骨术或三关节融合术。手术通常分阶段进行，以便在跟腱延长或肌腱转位之前矫正畸形并稳定后足。由于神经功能缺损进展或未能实现肌肉平衡，先前矫正良好的足部进行关节融合术很常见。出于舒适度和功能的原因，爪形趾畸形也必须通过肌腱转位、截骨术和关节融合术进行矫正。
