Olgahospital Stuttgart, Kriegsbergstrasse 62, 70174, Stuttgart, Germany.
Arch Orthop Trauma Surg. 2018 Aug;138(8):1037-1043. doi: 10.1007/s00402-018-2932-y. Epub 2018 Apr 9.
Flatfoot is a severe complication of extensive clubfoot surgery. In this retrospective study, we evaluated our results following flatfoot surgery in overcorrected clubfeet. The aim was to analyze the success of different surgical techniques, including tarsal osteotomies and arthrodesis, in correcting different types of flatfeet.
Between January 1, 2011 and December 31, 2015 we treated 25 severe cases of flatfeet after extensive clubfoot surgery. We classified the hindfoot deformities into rotational valgus, hinge valgus or translatory valgus based on AP standing X-rays. Tarsal osteotomies (Mitchell, Evans, Cotton) and arthrodesis were adapted based on age and severity. Age, gender, pain, hindfoot valgus and function were documented. Function and X-rays were compared pre- and postoperatively.
There were 17 male and 4 female patients. Age at operation ranged from 11 to 26 years with an average age of 14.3 years. The mean follow-up was 27.6 months (7-60 months). Primary surgical treatment was a tarsal osteotomy in 19 cases and in six cases it was arthrodesis. Hindfoot valgus (Ø 18.6°-3.2°), calcaneal pitch (Ø 6.2°-14.6°), Costa Bartani angle (Ø155°-142°) and Meary angle (Ø 2.0°-8.8°) improved pre- to postoperatively. Range of motion did not improve after surgical correction. 81% were satisfied with the postoperative results. All flatfeet with translatory valgus, initially treated with a tarsal osteotomy, needed further arthrodesis due to primary undercorrection.
Tarsal osteotomies are successful methods for correcting flatfeet following extensive clubfoot surgery with rotational valgus and mild hinge valgus. Tarsal osteotomies are unable to successfully correct flatfeet that have a translatory valgus. In such cases, we recommend double or triple arthrodesis. The functional outcome is limited by the preop range of motion and the appearance of talus deformities.
平足是广泛的马蹄内翻足手术后的严重并发症。在这项回顾性研究中，我们评估了在过度矫正的马蹄内翻足手术后治疗平足的结果。目的是分析包括跗骨骨切开术和关节融合术在内的不同手术技术在纠正不同类型平足中的效果。
2011 年 1 月 1 日至 2015 年 12 月 31 日，我们治疗了 25 例广泛的马蹄内翻足手术后严重的平足病例。我们根据前后站立位 X 线片将后足畸形分为旋转性外展、铰链性外展或平移性外展。根据年龄和严重程度，采用跗骨骨切开术（Mitchell、Evans、Cotton）和关节融合术。记录年龄、性别、疼痛、后足外展和功能。比较术前和术后的功能和 X 线片。
17 例为男性，4 例为女性。手术时的年龄为 11 至 26 岁，平均年龄为 14.3 岁。平均随访时间为 27.6 个月（7-60 个月）。初次手术治疗为跗骨骨切开术 19 例，关节融合术 6 例。后足外展角（Ø18.6°-3.2°）、跟骨倾斜角（Ø6.2°-14.6°）、Costa Bartani 角（Ø155°-142°）和 Meary 角（Ø2.0°-8.8°）均在术前和术后得到改善。手术后的运动范围没有改善。81%的患者对术后结果满意。所有平移性外展的平足，最初采用跗骨骨切开术治疗，由于初次矫正不足，需要进一步进行关节融合术。
跗骨骨切开术是治疗广泛马蹄内翻足手术后旋转性外展和轻度铰链性外展的平足的成功方法。跗骨骨切开术无法成功矫正具有平移性外展的平足。在这种情况下，我们建议进行双或三关节融合术。功能结果受术前运动范围和距骨畸形的影响。
