Lang G, Kehr P, Séjourne P, Paternotte H, Mathevon H, Pointu J
J Radiol Electrol Med Nucl. 1978 Aug-Sep;59(8-9):497-504.
After a precise review of the numerous parameters studied classically in AP and lateral films of the feet under load, the authors emphasis 5 measurements which are easy to determine and which they feel to objectively cover all the deformities which may be found in the static flat foot. These are: Talo-calcaneal divergence in AP and lateral views, the angle between the calcaneum and the floor, the lateral cavitation index and, finally, the angle of the axis of the talus and of the 2nd metatarsal in AP. A score of 20 is attributed to each. A score of 0 to 20 is attributed to each of these points, with a possible total, therefore, of 100. A study of 119 cases of flat foot in the child treated surgically over a period of 6 years made it possible to draw the distinction between the severe flat foot requiring operation and with a total of less than 45 points, and flat foot requiring medical orthopaedic treatment only (more than 45), the score for the normal foot being of the order of 90 points. This radiological study also makes it possible to distinguish, amongst flat feet in children, straight flat foot with collapse of the medial arch but no valgus of the forefoot and valgus flat foot where there is pronation of the calcaneum and abduction of the forefoot. This distinction is important since it determines the choice of operation. Thus in a case of valgus flat foot Judet's so-called "horseman" operation is indicated whilst in a flat foot without valgus, transposition of the tibialis anterior is preferable. In many cases, the lesion is mixed and both surgical gestures are required.
在对负重状态下足部前后位和侧位X线片中传统研究的众多参数进行精确回顾后，作者强调了5项易于测定的测量指标，他们认为这些指标能客观涵盖静态扁平足可能出现的所有畸形情况。这些指标分别是：前后位和侧位片上的距跟骨分离度、跟骨与地面的夹角、外侧空洞指数，以及最后前后位片上距骨轴线与第二跖骨轴线的夹角。每项指标的满分是20分。这些指标每项的得分范围是0至20分，因此总分可能为100分。对6年间接受手术治疗的119例儿童扁平足病例进行研究后发现，能够区分出需要手术治疗的重度扁平足（总分低于45分）和仅需医学矫形治疗的扁平足（总分超过45分），正常足的得分约为90分。这项影像学研究还能够在儿童扁平足中区分出内侧足弓塌陷但前足无外翻的直扁平足，以及跟骨内旋和前足外展的外翻扁平足。这种区分很重要，因为它决定了手术方式的选择。因此，在外翻扁平足的情况下，建议采用朱代特所谓的“骑手”手术，而在无外翻的扁平足情况下，胫前肌移位术更为可取。在许多情况下，病变是混合型的，两种手术方式都需要。
