Cracchiolo A
Instr Course Lect. 1984;33:386-404.
By anticipating the deformities that can occur in the rheumatoid foot and by carefully and compulsively looking for them, we can more effectively deal with the pathologic conditions. Although we usually equate conservative care with nonoperative treatment, and shoe corrections are certainly important, early operative intervention may be essential. Procedures we must use early if indicated are as follows: decompression of the posterior tibialis tendon and other medical structures in the tarsal tunnel, excision of intermetatarsal bursae, and talonavicular arthrodesis. Furthermore, relating forefoot to hindfoot deformities is important. A valgus hindfoot should be corrected before laterally dislocated MTP joints. A great deal can now be accomplished in treating the remaining weight-bearing joints of the lower extremity. The possibility of combining some of these procedures while hips or knees are undergoing surgery also exists. For example, it may certainly be reasonable when performing a knee arthroplasty to consider a hindfoot arthrodesis or a forefoot arthroplasty on the opposite side.
通过预判类风湿性足可能出现的畸形，并仔细且强制地寻找这些畸形，我们能够更有效地应对病理状况。尽管我们通常将保守治疗等同于非手术治疗，并且鞋具矫正固然重要，但早期手术干预可能必不可少。若有指征，我们必须尽早采用的手术如下：跗管内胫后肌腱及其他内侧结构减压、跖间滑囊切除术以及距舟关节融合术。此外，关联前足与后足畸形很重要。在跖趾关节向外侧脱位之前，应先矫正后足外翻。如今在治疗下肢其余负重关节方面可以取得很大成效。在髋部或膝部进行手术时，也存在联合一些上述手术的可能性。例如，在进行膝关节置换术时，考虑对另一侧后足进行关节融合术或前足置换术肯定是合理的。
