Lalevée Matthieu, Dagneaux Louis, Lintz François, de Cesar Netto Cesar
Normandie Univ, UNIROUEN, CETAPS UR3832, Groupe d'Etude Normand Interdisciplinaire de l'Appareil Locomoteur (GENIAL) F-76000 Rouen, France; Rouen University Hospital, Orthopedic and Trauma Surgery Department, 37 Boulevard Gambetta, 76000 Rouen, France.
Hôpital Lapeyronie, CHU de Montpellier, Service de Chirurgie Orthopédique et Traumatologie du Membre Inférieur, 371, Avenue Gaston-Giraud, 34295 Montpellier, France; Université de Montpellier, Montpellier University of Excellence (MUSE), Laboratoire de Mécanique et Génie Civil (LMGC), Montpellier, France.
Orthop Traumatol Surg Res. 2025 Sep 9:104415. doi: 10.1016/j.otsr.2025.104415.
Adult acquired flatfoot deformity, recently renamed Progressive Collapsing Foot Deformity (PCFD), is challenging to diagnose and treat due to the still poorly understood nature of its pathogenesis, which involves a complex interaction between soft tissues and bony structures. Long regarded as being primarily linked to posterior tibial tendon dysfunction, PCFD is now considered a multifactorial deformity (osseous dysplasia, joint malposition, tendon muscle imbalance, etc.), with many aspects yet to be explored. This study aims to provide an update on this pathology by addressing the following five key questions: (1) Is flatfoot truly a problem? A stable congenital flatfoot is generally asymptomatic. However, a sagging foot, regardless of its flatness, characterized by a progressive arch collapse (PCFD), is painful. (2) What role do soft tissues play in its pathogenesis? The previously central role attributed to the posterior tibial tendon and its rupture, which was thought to trigger a chronological cascade of deformations, is now being reconsidered. (3) How should we classify a flatfoot? The Progressive Collapsing Foot Deformity (PCFD) classification distinguishes five types of deformities: hindfoot valgus, midfoot abduction, forefoot varus, peritalar subluxation, and tibiotalar valgus. These deformities can occur in isolation or in combination, without a predetermined chronological order, and each of them can be either flexible or rigid. (4) What is the contribution of modern imaging? Weightbearing Cone Beam CT enables the early identification of subluxations and joint impingements, clarifying the distinction between a stable flatfoot and PCFD while revealing complex deformities that conventional methods may not detect. (5) What are the current perspectives and future directions? Research aims to differentiate stable congenital flatfeet from PCFD in order to better identify risk factors for symptomatic progression. Dynamic imaging techniques, such as biplanar fluoroscopy, offer real time analysis of bone motions, while computational simulations, integrating both soft tissues and bony structures, contribute to a deeper understanding of the onset and progression of deformities. LEVEL OF EVIDENCE: >V.
成人获得性平足畸形，最近更名为进行性塌陷性足畸形（PCFD），由于其发病机制的本质仍未得到充分理解，涉及软组织和骨结构之间的复杂相互作用，因此诊断和治疗具有挑战性。长期以来，PCFD主要被认为与胫后肌腱功能障碍有关，现在被认为是一种多因素畸形（骨发育异常、关节位置异常、肌腱肌肉失衡等），许多方面仍有待探索。本研究旨在通过回答以下五个关键问题来提供关于这种病理的最新信息：（1）平足真的是个问题吗？稳定的先天性平足通常无症状。然而，以进行性足弓塌陷（PCFD）为特征的下垂足，无论其扁平程度如何，都会引起疼痛。（2）软组织在其发病机制中起什么作用？以前认为胫后肌腱及其断裂起核心作用，认为会引发一系列按时间顺序的变形，现在正在重新考虑。（3）我们应该如何对平足进行分类？进行性塌陷性足畸形（PCFD）分类区分了五种畸形类型：后足外翻、中足外展、前足内翻、距骨周围半脱位和胫距外翻。这些畸形可以单独出现或合并出现，没有预定的时间顺序，并且每种畸形可以是柔性的或刚性的。（4）现代影像学有什么贡献？负重锥形束CT能够早期识别半脱位和关节撞击，明确稳定平足和PCFD之间的区别，同时揭示传统方法可能无法检测到的复杂畸形。（5）当前的观点和未来的方向是什么？研究旨在区分稳定的先天性平足和PCFD，以便更好地识别症状进展的风险因素。动态成像技术，如双平面荧光透视，可对骨骼运动进行实时分析，而整合软组织和骨结构的计算模拟有助于更深入地理解畸形的发生和进展。证据水平：>V。
