Exner G Ulrich, Jacob Hilaire A C, Maquieira Gerardo J
Orthopaedic Surgeon, Assistant Professor of Orthopaedics University of Zurich, Orthopaedie Zentrum, Zurich, Switzerland.
Consultant in Orthopaedic Biomechanics, Private Practice, Winterthur, Switzerland.
J Foot Ankle Surg. 2017 Nov-Dec;56(6):1323-1327. doi: 10.1053/j.jfas.2017.05.047.
Subfibular impingement has been described in patients with flatfoot. It possibly occurs with valgus deformity associated with talocalcaneal coalition. We observed symptomatic unilateral fibular impingement initially on the left foot of an 11-year-old female with an otherwise asymptomatic bilateral talocalcaneal coalition. From the age of 8 years, she had complained of pain around the left fibular tip. Magnetic resonance imaging showed a partial talocalcaneal coalition. At 10 years of age, it was questioned whether the pain was related to the coalition. However, imaging of the asymptomatic right foot also showed a talocalcaneal coalition, with the coalition in both feet appearing equal. Additionally, the peroneal trochlea appeared particularly prominent, more so on the left than on the right foot. Therefore, the symptoms were suspected to have been caused only by fibulocalcaneal impingement owing to a relatively long fibula. Subperiosteal shortening of the fibula was performed at when she was 11 years old. A bed for the peroneal tendons was created around the remaining epiphysis of the fibula, and the fibular ligaments were reattached with Arthrex anchors (Arthrex, Naples, FL). At 14 months postoperatively, the patient was free of pain with unrestricted movement, although the follow-up imaging studies showed complete bony fusion on the medial aspect of the coalition between the talus and calcaneus. Approximately 1.5 years after surgery, our female patient at 12.5 years old complained of the same problems on her right foot, definitely occurring only around the fibula. The same procedure was performed as she had undergone on the left foot. At the last follow-up examination, she was asymptomatic 2.5 years after the initial surgery of the left foot and 11 months after surgery on the right. Talocalcaneal coalition can cause moderate to severe hindfoot deformity, leading to fibulocalcaneal impingement. Hence, treatment should be determined accordingly.
扁平足患者中已描述有腓骨下撞击。它可能与距下关节联合相关的外翻畸形一起出现。我们观察到一名11岁女性最初在左足出现有症状的单侧腓骨撞击，其双侧距下关节联合在其他方面无症状。从8岁起，她就抱怨左腓骨尖周围疼痛。磁共振成像显示部分距下关节联合。10岁时，有人质疑疼痛是否与关节联合有关。然而，无症状的右脚成像也显示有距下关节联合，双脚的关节联合看起来相同。此外，腓骨滑车显得特别突出，左脚比右脚更明显。因此，怀疑症状仅是由相对较长的腓骨导致的腓骨 - 跟骨撞击引起的。她11岁时进行了腓骨骨膜下缩短术。在腓骨剩余骨骺周围为腓骨肌腱创建了一个床，并使用Arthrex锚钉（Arthrex，那不勒斯，佛罗里达州）重新附着腓骨韧带。术后14个月，患者活动不受限且无疼痛，尽管后续成像研究显示距骨和跟骨之间关节联合内侧方面完全骨融合。手术约1.5年后，我们12.5岁的女性患者抱怨右脚出现同样的问题，肯定仅发生在腓骨周围。对她实施了与左脚相同的手术。在最后一次随访检查时，她在左脚初次手术后2.5年以及右脚手术后11个月均无症状。距下关节联合可导致中重度后足畸形，进而导致腓骨 - 跟骨撞击。因此，应相应地确定治疗方法。
