Pavone Vito, Testa Gianluca, Vescio Andrea, Wirth Thomas, Andreacchio Antonio, Accadbled Franck, Canavese Federico
Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
Orthopaedic Department, Olgahospital, Stuttgart, Germany.
J Pediatr Orthop B. 2021 Sep 1;30(5):450-457. doi: 10.1097/BPB.0000000000000849.
The aim of the study was to evaluate flexible flatfoot (FFF) diagnostic and current therapeutic modalities, as well as treatment expectations, among members of the European Paediatric Orthopaedic Society (EPOS). A 59-questions survey on FFF diagnosis and treatment preferences was distributed to EPOS members. The survey consisted of six sections (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; and (6) management options. Descriptive statistics were performed. A total of 93 responses were analysed. In general, clinical parameters, age (91.4% of cases), laxity (81.7%), diffuse pain (84.9%), and pain at the ankle joint (81.7%) were rated as 'average' and 'crucial importance' by the vast majority of respondents. Meary's angle (47.3% of cases), talonavicular coverage (35.5%), and lateral talocalcaneal angle (35.5%) were assessed as main radiological tools in the FFF evaluation. Among respondents, 61.3% rated 'improved ability to walk longer without symptoms' as of 'crucial importance'. Eighty-two percent of the respondents felt less than 10% of patients with FFF are candidates for corrective surgery. Arthroereisis (29.3%) was the most common surgical procedure (16.4% for subtalar and 12.9% for extra-articular arthroereisis, respectively), followed by lateral column lengthening (17.9%) and medializing calcaneal osteotomy (12.3%). There is great variation among respondents in diagnostic and treatment preferences in the management of children with FFF. The results of the EPOS 2019 FFF survey clearly show that large-scale, multicentric, international studies are necessary to elucidate which diagnostic and treatment practices lead to the best outcomes.
本研究旨在评估欧洲小儿骨科学会（EPOS）成员对柔性扁平足（FFF）的诊断方法、当前治疗方式以及治疗期望。一项关于FFF诊断和治疗偏好的59个问题的调查问卷被分发给EPOS成员。该调查问卷由六个部分组成：（1）一般临床参数；（2）足部情况；（3）X线角度（或线）；（4）期望；（5）标准临床评估；以及（6）治疗选择。进行了描述性统计分析。共分析了93份回复。总体而言，绝大多数受访者将临床参数、年龄（91.4%的病例）、松弛度（81.7%）、弥漫性疼痛（84.9%）以及踝关节疼痛（81.7%）评为“一般”和“至关重要”。Meary角（47.3%的病例）、距舟覆盖度（35.5%）以及跟骨外侧角（35.5%）被评估为FFF评估中的主要影像学工具。在受访者中，61.3%将“无症状行走更长距离能力的改善”评为“至关重要”。82%的受访者认为FFF患者中不到10%适合进行矫正手术。关节制动术（29.3%）是最常见的手术方式（距下关节制动术占16.4%，关节外关节制动术占12.9%），其次是外侧柱延长术（17.9%）和跟骨内移截骨术（12.3%）。在FFF患儿的管理中，受访者在诊断和治疗偏好方面存在很大差异。EPOS 2019年FFF调查结果清楚地表明，有必要开展大规模、多中心的国际研究，以阐明哪种诊断和治疗方法能带来最佳效果。
