Samuelson K M, Freeman M A, Tuke M A
Clin Orthop Relat Res. 1983 Jul-Aug(177):67-75.
In patients with mild to moderate valgus deformity and localized pain due to lateral impingement, the subtalar implant has been effective in controlling position and relieving localized pain. When used in conjunction with a talonavicular resurfacing prosthesis in the absence of talonavicular subluxation, the implant has been effective in relieving pain and maintaining the foot in a normal or nearly normal position. In feet with valgus deformity and talonavicular subluxation, both the subtalar implant and the talonavicular prosthesis with a built-in stop must be used. Use of these implants requires that the foot be supple and correctable to at least neutral position at surgery. The valgus hindfoot with a subluxated but otherwise normal talonavicular joint presents a greater problem. In this condition correction can be maintained only if the subtalar implant is used in conjunction with the modified talonavicular joint with a built-in stop. External supports in the shoe have not been routinely used in all patients after operation for a variety of reasons (mostly nonmedical). It may be advisable in patients who have had correction of a deformity to continue to use some sort of support in the shoe for most ambulation. Arthroplasty early in the disease course, before severe deformities develop, may prevent progression of the disorder, but more experience is necessary to validate clinical impressions.
对于存在轻至中度外翻畸形且因外侧撞击导致局部疼痛的患者，距下植入物在控制位置和缓解局部疼痛方面已被证明有效。在不存在距舟半脱位的情况下，当与距舟表面置换假体联合使用时，该植入物在缓解疼痛和使足部保持正常或接近正常位置方面已被证明有效。对于存在外翻畸形和距舟半脱位的足部，必须同时使用距下植入物和带有内置止动装置的距舟假体。使用这些植入物要求足部在手术时具有柔韧性且至少可矫正至中立位。外翻后足合并距舟关节半脱位但其他方面正常的情况则带来更大问题。在这种情况下，只有将距下植入物与带有内置止动装置的改良距舟关节联合使用，才能维持矫正效果。由于各种原因（大多与医学无关），术后并非所有患者都常规使用鞋内外部支撑。对于已矫正畸形的患者，在大多数行走时继续在鞋内使用某种支撑可能是明智的。在疾病病程早期，在严重畸形出现之前进行关节成形术，可能会阻止病情进展，但需要更多经验来验证临床观察结果。
