Lawrence S J, Botte M J
Department of Orthopaedics, UCSD Medical Center 92103.
Foot Ankle Int. 1994 Jun;15(6):340-6. doi: 10.1177/107110079401500610.
Management of the persistent, acquired, neurogenic equinovarus foot may be a confounding rehabilitative dilemma. Victims of cerebrovascular accidents and traumatic brain injury commonly develop this neurogenic deformity. The plantarflexed and inverted foot position results from an imbalance of forces about the hindfoot due to exaggerated muscle tone and hyperactive stretch reflexes. Significant functional impairment may ensue if a plantigrade foot position cannot be achieved and maintained. Surgical correction may be necessary if conservative measures fail. Determination of the dynamic and static components contributing to the equinovarus deformity is difficult. Gait analysis and dynamic electromyographic studies are valuable adjuncts for operative planning. The wide-ranging goals of surgery vary from improving transfer and ambulation skills, to assisting wheelchair positioning, to facilitating use of braces and/or shoe wear.
持续性后天性神经源性马蹄内翻足的治疗可能是一个令人困惑的康复难题。脑血管意外和创伤性脑损伤的患者常出现这种神经源性畸形。由于肌肉张力过高和牵张反射亢进，后足周围力量失衡导致足跖屈和内翻。如果不能实现并维持足底行走位，可能会导致严重的功能障碍。如果保守治疗失败，可能需要手术矫正。确定导致马蹄内翻畸形的动态和静态因素很困难。步态分析和动态肌电图研究对手术规划很有帮助。手术的广泛目标各不相同，从改善转移和行走技能，到辅助轮椅定位，再到便于使用支具和/或鞋子。
