Patel Yogesh, Barik Sitanshu, Agarwal Anil
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India.
Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
Int Orthop. 2023 Apr;47(4):1109-1114. doi: 10.1007/s00264-023-05703-2. Epub 2023 Jan 30.
There is however gross ambiguity regarding the use of term "foot abduction" in clubfoot treatment. We measured below defined angles at different stages of clubfoot treatment to decipher their precise interpretation.
In a prospective evaluation of 25 unilateral clubfeet in infants' age less than six months treated with Ponseti technique, clinical leg foot and thigh foot angle were measured at talar head reduction (LHT0), pre-tenotomy, and post-tenotomy stage. A "normal" reference was available in the form of measurements of contralateral limb.
Talar head (LHT0) was reduced at mean leg foot angle of 26 degrees. The corresponding pre- and post-tenotomy angles were 42.6 and 50.0 degrees, respectively. The reference leg foot angles for contralateral limb were 49.8 degrees. The thigh foot angle for LHT0, pre-tenotomy, post-tenotomy, and contralateral side were, respectively, 39.2, 56, 68, and 65.6 degrees. There was an additional tibial external rotation component of mean 13.4 degrees (SD 4.5) in the thigh foot angle when compared to the leg foot angle at tenotomy. This increased to 18 degrees (SD 3.4) post-tenotomy.
The study suggested that the foot abduction described in the "Ponseti Manual" probably intends thigh foot rather than leg foot angles. There was a significant difference in the angles when talar head reduced and tenotomy was decided. The foot abduction is an ambiguous term which should be replaced by the more specific leg or thigh foot abduction angle.
然而，在马蹄内翻足治疗中，“足外展”一词的使用存在很大的歧义。我们在马蹄内翻足治疗的不同阶段测量了以下定义的角度，以解读其确切含义。
对25例年龄小于6个月的单侧马蹄内翻足婴儿采用Ponseti技术进行前瞻性评估，在距骨头复位（LHT0）、跟腱切断术前和跟腱切断术后阶段测量临床腿-足和大腿-足角度。以对侧肢体的测量值作为“正常”参考。
距骨头（LHT0）复位时，平均腿-足角度为26度。跟腱切断术前和术后相应的角度分别为42.6度和50.0度。对侧肢体的参考腿-足角度为49.8度。LHT0、跟腱切断术前、跟腱切断术后和对侧的大腿-足角度分别为39.2度、56度、68度和65.6度。与跟腱切断时的腿-足角度相比，大腿-足角度平均有额外13.4度（标准差4.5）的胫骨外旋成分。跟腱切断术后这一角度增加到18度（标准差3.4）。
该研究表明，《庞塞蒂手册》中描述的足外展可能指的是大腿-足角度而非腿-足角度。距骨头复位和决定进行跟腱切断时的角度存在显著差异。足外展是一个模糊的术语，应由更具体的腿或大腿-足外展角度来取代。
