Instr Course Lect. 2023;72:555-563.
The complex adult acquired flatfoot deformity involves progressive collapse of the foot with attenuation of medial soft tissues such as the posterior tibialis tendon and spring ligament complex. Multiple deformities at different levels can coexist in the collapsed foot, including hindfoot valgus, midfoot abduction, forefoot varus, and valgus ankle instability. Definitions of flatfoot have evolved to encapsulate the peritalar basis of the deformity, with instability around the talus as the fulcrum. The goals of treatment are to minimize pain, dysfunction, and progressive deformity. Some treatment options directly address the pathologic areas, such as tendon transfer for posterior tibialis tendon dysfunction and spring ligament reconstruction. Others such as calcaneal osteotomies secondarily counteract the primary ligamentous dysfunction and realign the foot to neutralize deforming forces. Selective fusions of the hindfoot and medial column are also viable options to correct the deformity at the joint level when appropriate. The treatment selected depends on flexibility and locations of the deformity, and ultimately patient-specific factors.
成人获得性扁平足畸形较为复杂，涉及足的进行性塌陷，内侧软组织如胫后肌腱和弹簧韧带复合体变弱。塌陷足可同时存在多种不同水平的畸形，包括后足外翻、中足外展、前足内翻和外踝不稳定。扁平足的定义已经发展为包含距下基础的畸形，以距骨为支点的不稳定。治疗的目标是尽量减少疼痛、功能障碍和进行性畸形。一些治疗方法直接针对病变部位，例如后胫肌腱功能障碍的肌腱转移和弹簧韧带重建。其他方法，如跟骨截骨术，可继发对抗主要的韧带功能障碍，并重新排列足部以中和变形力。对于适当的关节水平的畸形，选择性的后足和内侧柱融合也是可行的选择。选择的治疗方法取决于畸形的柔韧性和位置，最终取决于患者的具体情况。
