Caravaggi Paolo, Sforza Chiarella, Leardini Alberto, Portinaro Nicola, Panou Artemisia
1Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
2Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy.
J Foot Ankle Res. 2018 Oct 1;11:55. doi: 10.1186/s13047-018-0297-7. eCollection 2018.
Plano-valgus is a common alteration of the paediatric foot, characterized by valgus hindfoot, foot pronation and drop of the medial longitudinal arch. Despite their importance in the diagnosis and classification of plano-valgus foot condition, little information is available on functional alterations of the major joints spanning the medial longitudinal arch - i.e. midtarsal and tarso-metatarsal. Aim of the study was to provide objective description of the alterations in plano-valgus midfoot joints with respect to those in an age-matched normally-developed feet population.
Twenty adolescents (13.3 ± 0.8 years) with bilateral plano-valgus feet underwent clinical examination and were gait-analysed via a validated 4-segment foot model. This allowed to measure static foot posture, kinematics of the main foot joints, and medial longitudinal arch deformation during walking at comfortable speed. Range of motion and temporal profiles of joint rotations were compared to those from a control population of age-matched adolescents with normally-developed feet.
The plano-valgus midtarsal joint was more dorsiflexed, everted and abducted than that in the control group, and showed reduced sagittal-plane RoM (plano-valgus = 15.9 degrees; control = 22.2 degrees; < 0.01). The tarso-metarsal joint was more plantarflexed and adducted, and showed larger frontal-plane RoM. The MLA showed larger RoM and was lower throughout the stance phase of the gait cycle.
Significant postural and kinematic alterations are present at the midtarsal and tarso-metarsal joints of adolescents with plano-valgus feet. Objective identification and quantification of plano-valgus foot alterations, via non-invasive gait-analysis, is relevant to improving the diagnosis of this condition and to evaluating the effect of conservative treatments and of surgical corrections by different techniques.
扁平外翻是小儿足部常见的一种改变，其特征为后足外翻、足内旋以及内侧纵弓下降。尽管这些特征在扁平外翻足状况的诊断和分类中很重要，但关于跨越内侧纵弓的主要关节（即中跗关节和跗跖关节）功能改变的信息却很少。本研究的目的是针对年龄匹配的正常发育足部人群，对扁平外翻中足关节的改变进行客观描述。
20名双侧扁平外翻足的青少年（13.3±0.8岁）接受了临床检查，并通过一个经过验证的四段足部模型进行步态分析。这使得能够测量静态足部姿势、主要足部关节的运动学以及以舒适速度行走时内侧纵弓的变形情况。将关节旋转的运动范围和时间曲线与年龄匹配的正常发育足部青少年对照组的进行比较。
扁平外翻中跗关节比对照组的更背屈、外翻和外展，并且矢状面活动度降低（扁平外翻组=15.9度；对照组=22.2度；<0.01）。跗跖关节更跖屈和内收，并且额状面活动度更大。内侧纵弓在步态周期的整个支撑期活动度更大且位置更低。
扁平外翻足青少年的中跗关节和跗跖关节存在明显的姿势和运动学改变。通过非侵入性步态分析对扁平外翻足改变进行客观识别和量化，对于改善这种状况的诊断以及评估不同技术的保守治疗和手术矫正效果具有重要意义。
