Horton G A, Myerson M S, Parks B G, Park Y W
Orthopaedics, Kansas University Medical Center, Kansas City, USA.
Foot Ankle Int. 1998 Jun;19(6):370-3. doi: 10.1177/107110079801900605.
Medial calcaneal displacement osteotomy or lateral column lengthening fusion has been advocated to augment tendon transfer in planovalgus foot deformity associated with chronic posterior tibial tendon insufficiency. It is hypothesized that plantar fascia tightening occurs with these procedures, helping to restore a more normal longitudinal arch. To investigate this further, nine fresh-frozen cadaver below-knee specimens were used. A flatfoot model was created by sectioning of the posterior tibial tendon, spring ligament, talonavicular capsule, and deltoid ligament. A liquid-metal strain gauge, calibrated to measure fractional changes in length, was sutured proximally to the origin and distally into the thickest portion of the medial band of the plantar fascia. Specimens were axially loaded to 400 N and plantar fascia strain was measured. Fractional length changes in the plantar fascia were then measured after a medial displacement calcaneal osteotomy and after a lateral column lengthening through the calcaneocuboid joint. Tightening of the plantar fascia did not occur with either medial calcaneal displacement or lateral column lengthening. The plantar fascia became significantly less taut with both medial displacement and lateral column lengthening. We found that lateral column lengthening produced significantly looser plantar fascia than did medial displacement of the calcaneal tuberosity.
内侧跟骨移位截骨术或外侧柱延长融合术已被提倡用于增强与慢性胫后肌腱功能不全相关的扁平外翻足畸形中的肌腱转移。据推测，这些手术会使足底筋膜收紧，有助于恢复更正常的纵弓。为了进一步研究这一点，使用了九个新鲜冷冻的尸体膝下标本。通过切断胫后肌腱、弹簧韧带、距舟关节囊和三角韧带建立扁平足模型。一个校准用于测量长度分数变化的液态金属应变仪，近端缝合到起点，远端缝合到足底内侧筋膜带最厚的部分。标本轴向加载至400 N并测量足底筋膜应变。然后在跟骨内侧移位截骨术后和通过跟骰关节进行外侧柱延长后测量足底筋膜的长度分数变化。内侧跟骨移位或外侧柱延长均未导致足底筋膜收紧。内侧移位和外侧柱延长均使足底筋膜明显松弛。我们发现，外侧柱延长比跟骨结节内侧移位产生的足底筋膜明显更松弛。
