Jahss M H
Clin Orthop Relat Res. 1983 Dec(181):52-63.
Each case of cavus and equinovarus foot must be thoroughly assessed prior to operation. Assessment includes diagnosis; electrodiagnostic and muscle testing; and evaluation of the type, location, and severity of the deformities and whether they are flexible or fixed. The vascular status must also be ascertained. The sites of plantar callus are noted, as well as the amount of correction that will be necessary. The integrity of the metatarsal fat pads must be noted. Muscle power is charted, and any sensory loss is mapped. Joints are evaluated clinically to determine the amount of fixed deformity and pain and roentgenographically to determine mainly the effect of prior surgical procedures, the presence of nonunion, and secondary osteoarthritic changes in noninvolved joints. Bone wedges are obtained proximal to any painful callus and should be taken from joints that are painful, stiff, arthritic, unstable, or functionless. Flexible and functional joints, e.g., the subtalar complex, should not be sacrificed for arthrodesis unless the cavus deformity is very severe or fusion is necessary to obtain necessary motors. Appropriate tendon transfers are usually done only after bony correction of fixed deformities but may also be used (along with soft tissue releases) to balance muscle power before deformities become fixed.
每一例高弓足和马蹄内翻足病例在手术前都必须进行全面评估。评估包括诊断、电诊断和肌肉测试，以及对畸形的类型、位置和严重程度进行评估，确定其是可复性还是固定性。还必须确定血管状况。记录足底胼胝的部位以及所需的矫正量。记录跖脂肪垫的完整性。记录肌肉力量，并绘制任何感觉丧失的区域图。对关节进行临床评估以确定固定畸形的程度和疼痛情况，进行X线检查主要是为了确定先前手术的效果、骨不连的存在以及未受累关节的继发性骨关节炎变化。在任何疼痛性胼胝近端获取骨楔，应取自疼痛、僵硬、关节炎、不稳定或无功能的关节。除非高弓畸形非常严重或为了获得必要的动力而必须进行融合，否则不应牺牲可复性和功能性关节，如距下关节复合体来进行关节融合术。通常仅在固定畸形进行骨性矫正后才进行适当的肌腱转移，但也可在畸形固定前（与软组织松解一起）用于平衡肌肉力量。
