Larivière J Y, Miladi L, Dubousset J F, Seringe R
Rev Chir Orthop Reparatrice Appar Mot. 1985;71(8):563-73.
The authors have performed 34 Dwyer's calcaneal osteotomies in children with pes cavus confined to the medial arch in non-paralytic lesions (poliomyelitis and spina bifida were excluded). In 12 cases it was associated with osteotomy of the 1st metatarsal or with plantar release. No arthrodeses were performed in these 34 cases. After an average follow-up of five years the results were doubtful: in 24 instances the deformity was the same or worse. In 21 cases a secondary operation was necessary. The authors considered that the Dwyer's procedure corrects only the varus of the heel which is a secondary deformity. They believe that, in pes cavus, there is a dynamic clawing of the toes in the swing phase of gait. This produces secondary deformities. In the sagittal plane there is a synergic or paralytic imbalance at the metatarso-phalangeal level leading to vertical displacement of the 1st metatarsal and deepening of the medial arch. In the frontal plane, this vertical displacement leads to an irreducible pronation of the forefoot with secondary varus of the heel. In the horizontal plane a lateral rotation of the talus results in varus of the calcaneum.
作者对34例非麻痹性病变（排除小儿麻痹症和脊柱裂）且足弓内翻局限于内侧足弓的儿童进行了德怀尔跟骨截骨术。其中12例与第一跖骨截骨术或足底松解术联合进行。这34例均未行关节融合术。平均随访五年后，结果令人怀疑：24例畸形情况相同或更严重。21例需要二次手术。作者认为，德怀尔手术仅能矫正足跟内翻这一继发畸形。他们认为，在高弓足中，步态摆动期存在动态足趾爪形畸形。这会产生继发畸形。在矢状面，跖趾关节水平存在协同或麻痹性失衡，导致第一跖骨垂直移位和内侧足弓加深。在额状面，这种垂直移位导致前足不可复位的旋前并继发足跟内翻。在水平面，距骨外侧旋转导致跟骨内翻。
