Hintermann B, Gächter A
Orthopaedic Department, University of Basel, Switzerland.
Foot Ankle Int. 1996 Apr;17(4):236-41. doi: 10.1177/107110079601700410.
Although foot deformation starts in the early stage of tibialis posterior (TP) tendon dysfunction, this condition is often overlooked or misdiagnosed. We observed consistently a clinical sign of TP tendon dysfunction that, to our knowledge, has not yet been described. Patients were tested while they were standing and fully weight-bearing with both feet. When the shank of the affected foot was taken with one hand and externally rotated, or when the heel of the affected foot was taken with one hand and brought passively into a varus position, the head of the first metatarsal raised in the case of TP dysfunction and remained on the ground in normal TP function. The purpose of this prospective study was to validate this clinical finding by surgical exploration, and to compare its sensitivity with other common clinical signs. Our series included 21 consecutive feet with TP tendon dysfunction (19 patients). The deformity was supple in 12 feet and fixed in 9 feet. Radiographs and magnetic resonance imaging were found to be unreliable in diagnosing dysfunction of the TP tendon. While other clinical signs (too many toes, the single-heel rise, and the double-heel rise) were noted to be negative in 20% to 35%, we found our first metatarsal rise sign to be positive in all cases of TP tendon dysfunction. This simple clinical test enables us to recognize and treat a dysfunction of the TP tendon at an early stage, when the foot is still supple. As the foot deformation progresses, early treatment may be the most effective measure in preventing long-term functional impairment.
尽管足部畸形始于胫后肌腱功能障碍的早期阶段，但这种情况常常被忽视或误诊。我们持续观察到一种胫后肌腱功能障碍的临床体征，据我们所知，此前尚未有过描述。对患者进行测试时，让他们双脚站立并完全负重。当用一只手握住患侧足部的小腿并向外旋转时，或者当用一只手握住患侧足部的足跟并被动使其处于内翻位时，在胫后肌腱功能障碍的情况下，第一跖骨头会抬起，而在胫后肌腱功能正常时则保持在地面上。这项前瞻性研究的目的是通过手术探查来验证这一临床发现，并将其敏感性与其他常见临床体征进行比较。我们的系列研究纳入了连续21例患有胫后肌腱功能障碍的足部（19例患者）。其中12只足部的畸形为柔韧性的，9只足部的畸形为僵硬性的。结果发现，X线片和磁共振成像在诊断胫后肌腱功能障碍方面并不可靠。虽然其他临床体征（多趾征、单足跟抬起试验和双足跟抬起试验）在20%至35%的病例中呈阴性，但我们发现第一跖骨头抬起征在所有胫后肌腱功能障碍病例中均为阳性。这项简单的临床检查使我们能够在足部仍为柔韧性时的早期阶段识别并治疗胫后肌腱功能障碍。随着足部畸形的进展，早期治疗可能是预防长期功能损害的最有效措施。
