Heck K, Heck A, Placzek R
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
Oper Orthop Traumatol. 2016 Dec;28(6):449-471. doi: 10.1007/s00064-016-0460-x. Epub 2016 Aug 3.
Pain-free, plantigrade, functional foot through gentle manipulation without extended surgery and with decreased probability of relapse.
Idiopathic clubfoot; neurogenic and secondary clubfeet.
None.
Simultaneous correction of all components of the clubfoot. Mainly conservative, with serial casts. Slight supination to address the cavus and increasing abduction to align the midfoot bones while putting counter-pressure on the head of the talus. Surgery primarily only to correct the equinus, which can often not be accomplished through casting, and consists of a simple subcutaneous section. Due to tendency to relapse, further surgery might be necessary, followed by serial casting. Remaining deformity can be treated by percutaneous lengthening of the Achilles tendon, percutaneous release of the plantar fascia or a transfer of the tibialis anterior tendon to the third cuneiform.
Abduction orthosis for stabilization of the clinical result 24 h/day for 3 months, then only at night- and naptime through end of the third year of life. Follow-up every 3-4 months.
通过轻柔手法实现无痛、足跟着地、功能正常的足部，无需进行广泛手术且复发概率降低。
特发性马蹄内翻足；神经性和继发性马蹄内翻足。
无。
同时矫正马蹄内翻足的所有组成部分。主要采用保守治疗，使用系列石膏。轻微内旋以解决高弓足问题，增加外展以使中足骨对齐，同时对距骨头施加反压力。手术主要仅用于矫正马蹄足畸形，这通常无法通过石膏固定完成，手术包括简单的皮下切断。由于有复发倾向，可能需要进一步手术，随后进行系列石膏固定。残留畸形可通过经皮跟腱延长、经皮跖腱膜松解或胫骨前肌腱转移至第三楔骨来治疗。
使用外展矫形器以稳定临床效果，术后3个月内每天24小时佩戴，然后仅在夜间和午睡时佩戴，直至3岁末。每3 - 4个月随访一次。
