Department of Orthopaedic Surgery and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Rumeli Hisari Cad. Baltalimani, Sariyer, Istanbul, Turkey.
Department of Orthopaedic Surgery and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Rumeli Hisari Cad. Baltalimani, Sariyer, Istanbul, Turkey.
J Orthop Sci. 2021 Nov;26(6):1081-1084. doi: 10.1016/j.jos.2020.10.027. Epub 2021 Feb 18.
Although Achilles tenotomy is performed to increase the ankle dorsiflexion in clubfoot patients, it may also increase the amount of the foot abduction due to the unique oval field of motion property of the ankle and subtalar joint complex. This study investigated the effect of Achilles tenotomy on foot abduction in patients with clubfoot.
Equinus deformity before tenotomy (EBT), equinus deformity after tenotomy (EAT), abduction before tenotomy (ABT), and abduction after tenotomy (AAT) were measured. The decrease in the amount of equinus after tenotomy (Δ equinus) and the increase in the amount of abduction (Δ abduction) after tenotomy were then calculated.
The Achilles tenotomy was performed on 22 feet of 16 patients. The results (Mean ± standard deviation) were as follows: EBT: 28° ± 19 (range, 8-76), EAT: -27° ± 7 (-36- -11), ABT: 54° ± 16 (21-72), AAT: 77° ± 5 (66-85), Δ equinus: 55° ± 15 (38-87), Δ abduction: 23° ± 15 (5-51). The change between EBT-EAT and ABT-AAT was statistically significant (both p < 0.001). EBT was correlated negatively with ABT (r = -0.648; p = 0.001) and Δ equinus was correlated positively with Δ abduction (r = 0.522; p = 0.013).
The Achilles tenotomy in clubfoot patients not only increases ankle dorsiflexion but also increases the foot abduction due to oval field of motion of the ankle and subtalar joint complex. It should be considered that an increase of the foot abduction may be achieved after the Achilles tenotomy. Therefore, the maximum foot abduction may be achieved after the Achilles tenotomy, not before the Achilles tenotomy.
虽然跟腱切断术可用于增加马蹄足患者的踝关节背屈度，但由于踝关节和距下关节复合体的椭圆形运动范围，它也可能增加足的外展度。本研究旨在探讨跟腱切断术对马蹄足患者足外展的影响。
测量跟腱切断术前（EBT）、跟腱切断术后（EAT）的马蹄畸形、跟腱切断术前（ABT）、跟腱切断术后（AAT）的足外展度。然后计算跟腱切断术后马蹄畸形的减少量（Δ equinus）和外展度的增加量（Δ abduction）。
16 名患者的 22 只脚接受了跟腱切断术。结果（平均值±标准差）如下：EBT：28°±19°（范围 8-76°），EAT：-27°±7°（范围-36°至-11°），ABT：54°±16°（范围 21°-72°），AAT：77°±5°（范围 66°-85°），Δ equinus：55°±15°（范围 38°-87°），Δ abduction：23°±15°（范围 5°-51°）。EBT-EAT 和 ABT-AAT 之间的变化具有统计学意义（均 p<0.001）。EBT 与 ABT 呈负相关（r=-0.648；p=0.001），Δ equinus 与 Δ abduction 呈正相关（r=0.522；p=0.013）。
马蹄足患者的跟腱切断术不仅增加了踝关节背屈度，而且由于踝关节和距下关节复合体的椭圆形运动范围，还增加了足的外展度。因此，跟腱切断术后可能会增加足的外展度。因此，跟腱切断术后，而不是切断术前，可能达到最大的足外展度。
