Kitaoka H B, Luo Z P, An K N
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA.
Foot Ankle Int. 1997 Jan;18(1):8-15. doi: 10.1177/107110079701800103.
The change in position of the bones of the foot was studied in three dimensions after plantar fascia release in intact and destabilized feet. Fifteen fresh-frozen human foot specimens were used. Physiologic loads of 445 newtons were applied axially to simulate standing at ease, and the three-dimensional position of tarsal bones was determined with a magnetic tracking device. The positions were presented in the form of screw axis displacements, quantitating rotation, and axis of rotation orientation. After fasciotomy in the six intact feet, significant differences in rotation were observed at the talotibial and calcaneotalar levels. After fasciotomy in the four unstable feet with three supporting elements sectioned, significant differences in position were observed at the talotibial joint and a significant decrease in arch height was observed. After fasciotomy in the five unstable feet with five supporting elements sectioned, significant differences in rotation were observed at the talotibial joint (mean, 5.5 +/- 1.6 degrees; P = 0.001), calcaneotalar joint (mean, 6.1 +/- 2.1 degrees; P = 0.003), and metatarsotalar level (mean, 9.3 +/- 4.1 degrees; P = 0.007). The average decrease in arch height was 7.4 +/- 4.1 mm (P = 0.015). Displacement of all joints tested occurred after fasciotomy, with rotation about all three axes. These changes in displacement were more pronounced in unstable or destabilized feet. The data suggest that operations involving fasciotomy affect arch stability and should not be performed in patients with evidence of concomitant pes planus deformity, because of the likelihood of further deformation.
在完整和不稳定的足部进行足底筋膜松解术后，对足部骨骼的位置变化进行了三维研究。使用了15个新鲜冷冻的人足标本。轴向施加445牛顿的生理负荷以模拟轻松站立，并使用磁跟踪装置确定跗骨的三维位置。这些位置以螺旋轴位移的形式呈现，量化旋转和旋转轴方向。在六只完整足部进行筋膜切开术后，在距胫关节和跟距关节水平观察到旋转有显著差异。在四只切断三个支撑结构的不稳定足部进行筋膜切开术后，在距胫关节观察到位置有显著差异，并且足弓高度显著降低。在五只切断五个支撑结构的不稳定足部进行筋膜切开术后，在距胫关节（平均值为5.5±1.6度；P = 0.001）、跟距关节（平均值为6.1±2.1度；P = 0.003）和跖跗关节水平（平均值为9.3±4.1度；P = 0.007）观察到旋转有显著差异。足弓高度平均降低7.4±4.1毫米（P = 0.015）。所有测试关节在筋膜切开术后均发生位移，围绕所有三个轴旋转。这些位移变化在不稳定或失稳的足部更为明显。数据表明，涉及筋膜切开术的手术会影响足弓稳定性，对于有扁平足畸形证据的患者不应进行此类手术，因为有进一步变形的可能性。
