正常足与(*母)外翻足跖骨头下压力与足部负重比例变化的关系

目的 :从生物力学角度探讨外翻足前足横弓跖骨头下压力的改变情况。方法 :运用本所生物力学室研制的足底压力测试系统 ,对正常足与外翻足足底压力进行测试 ,并将结果进行统计分析。结果 :随着足部负重比例的增加 ,外翻足前足中间跖骨头下压力的变化较快 ,与正常足相比具有显著差异。结论 :从生物力学角度证明 ,正常足前足具有横弓结构 ,外翻足前足存在横弓塌陷。     

正常足与外翻足前足承重比例与跖骨头下压力的研究

目的从生物力学角度探讨外翻足前足承重比例及跖骨头下压力的改变情况.方法将测试对象分为正常组(160足)、轻中度外翻组(100足)、重度外翻组(56足)三组,运用我所生物力学室研制的足底压力测试系统,对正常足与外翻足足底压力进行测试,并将结果进行统计分析.结果轻中度外翻足前足承重比例较正常足增加,重度外翻足前足承重比例介于正常足与轻中度外翻足之间.外翻足存在着前足压力外移的趋势,这种改变和畸形的程度相关.结论从生物力学角度证明,外翻前足承重比例及各跖骨头下压力的变化随外翻畸形程度增加出现不同程度的变化.     

正常足与拇外翻足前足承重比例与跖骨头下压力的研究

目的 从生物力学角度探讨外翻足承重比例及跖骨头下压力的改变情况。方法将测试对象分为正常组(160足)、轻中度(足母)外翻组(100足)、重度(足母)外翻组(56足)三组,运用我所生物力学室研制的足底压力测试系统,对正常足与(足母)外翻足足底压力进行测试,并将结果进行统计分析。结果 轻中度(足母)外翻足前足承重比例较正常足增加,重度(足母)外翻足前足承重比例介于正常足与轻中度(足母)外翻足之间。(足母)外翻足存在着前足压力外移的趋势,这种改变和畸形的程度相关。结论 从生物力学角度证明,(足母)外翻前足承重比例及各跖骨头下压力的变化随(足母)外翻畸形程度增加出现不同程度的变化。     

正常足与(足母)外翻足横弓形态的对比性研究

[目的]比较研究正常足和外翻足横弓的形态,探讨横弓在外翻发生发展中的作用。[方法]对35名外翻患者65只足和30名正常人60只足,在负重位和非负重位足正位X线片和前足轴位X线片上分别测量外翻角(hallux valgus angle,HVA),第1、2跖骨间角(fist intermetatarsalangle,IMA),各跖骨头、籽骨到足底的距离。[结果]外翻足HVA平均30·8±8.9°,第1、2跖骨间角为16.5±2·6°;正常足HVA为10·2±2·0°,第1、2跖骨间角7·9±1·6°。外翻足与正常足比较第1跖骨头向下移位,第2、3跖骨头距足底的距离明显低于正常足。腓侧籽骨向外上方移位,胫侧籽骨向外侧移位。[结论]外翻足横弓塌陷,籽骨脱位,第2、3跖骨头过早、过重负重易产生疲劳性骨折、跖骨痛和足底胼胝体。     

第一,二跖骨头间捆绑术治疗扇形足Mu外翻：附5例报告

单纯扇形足仅为５个跖骨头分离，临床症状多较轻微，并发Ｍｕ外翻后，跖趾痛加重，不能长距离行走，我们将Ｃａｓｔｅｌａｎａ治疗Ｍｕ外翻的方法，即第一、二跖骨头间捆绑术与Ｍｕ囊，骨赘切除和第一跖趾关节囊成形联合应用治疗扇形足Ｍｕ外翻，经治患者５例９足，平均随访１年４月，全部结果优良。初步体会本方法具有操作简单，疗效可靠，并发症少等优点。     

正常足与拇外翻足的足底压力研究

目的 对正常足与拇外翻足的足底压力进行测量。方法 运用自行研制的足底生物力学测试系统对３０名健康人６０足,４５例拇外翻患者８９足进行了行走时足底压力的测试。结果 重度拇外翻组３１足和正常组相比,第一跖骨头下压力明显减低,第二跖骨头下明显增另,第三,五跖骨头下压力有增高的趋势。结论正常人前足第一跖骨关下压力最高,并向外侧递减,重度拇外翻足前足第一跖骨头下压力明显减低,第二跖骨头下压力明显增高。     

正常足与踇外翻足第一序列的测量及其临床意义

目的探讨踇外翻的病理、发病机制、分型以及手术方式的选择。方法对正常足245足和踇外翻足141足进行以下参数的测量和统计学分析踇外翻角(HVA)、跖间角(IMA)、趾间角(IPA)、近侧关节固角(PASA)、远侧关节固角(DASA)、跖楔角(MCA)。结果踇外翻组PASA、MCA均大于正常组,IPA却小于正常组,而两组DASA比较差异无显著性意义。两组均可见随着HVA的增大,IPA减小。踇外翻组可见(1)随着HVA的增大,PASA有增大的趋势,而IMA无明显的变化规律;(2)IMA增大者,MCA也增大,差异具有统计学意义,而HVA与MCA无统计学的联系。结论踇外翻的病理因素包括IPA、PASA及IMA。踇外翻可分为六型Ⅰ型,IPA增大为主,IPA≥22°,而PASA、IMA均在正常值范围内;Ⅱ型,单纯HVA增大,HVA≥20°,而IPA、IMA、PASA均在正常值范围内;Ⅲ型,以PASA增大为主,IMA可以正常或轻度增大,PASA≥11°,而IMA≤15°;Ⅳ型,以IMA增大为主,其又可分为两个亚型,Ⅳa型,10°≤IMA≤15°,Ⅳb型,IMA>15°,而PASA在正常值范围内;Ⅴ型,混合型,IMA>15°,PASA≥11°;Ⅵ型,跖趾骨关节炎型。每一型各有不同的发病机制,应采用不同的手术方式。     

(足母)外翻及相关畸形的综合手术治疗探讨

目的：评价综合手术治疗Mu外翻与前足相关畸形的效果。方法：回顾性分析本院收治的中、重度Mu外翻合并前足畸形患者289例307足的临床资料，应用综合矫形手术治疗效果。结果：优良率：85．6％，患者对术后足外形及功能满意，前足痛改善。结论：对于中、重度Mu外翻患者，除纠正Mu趾外展外翻外，还应注意伴发畸形的处理，综合矫形手术不失为一种可以考虑的手术方法。     

(足,母)外翻合并第二跖骨头下疼痛的生物力学定量研究

目的探讨跖骨头下压力变化与蹰外翻合并跖骨头下疼痛的关系，并对引起第二跖骨头下疼痛的跖骨头下压力进行定量分析。方法采用由中国中医研究院骨伤科研究所生物力学实验室研制的足底压力测试系统，对58名正常人（116足），32例（45足）拇外翻单纯合并第二跖骨头下疼痛患者，56例（102足）拇外翻无足底疼痛患者进行足底压力测试，将三组跖骨头下压力进行比较。采用病例一对照设计，研究压力与疼痛的关系，并对引起第二跖骨头下疼痛的压力进行定量分析。结果（1）蹲外翻单纯合并第二跖骨头下疼痛组分别与拇外翻无足底疼痛组及正常组比较，第二跖骨头下压力均明显增高（均P〈0．05）；（2）第二跖骨头下压力高于正常组与第二跖骨头下压力不高于正常组比较，疼痛的发生率明显增加（P〈0．05，OR〉3，OR95％CI〉1）；（3）拇外翻合并第二跖骨头下疼痛组第二跖骨头下压力占体重的5．20％-7．29％。结论跖骨头下压力异常增高是跖骨头下疼痛的危险因素，第二跖骨头下压力超过体重的5．20％，极易出现跖骨头下疼痛。     

足横弓形态的动态分析与踇外翻关系研究

目的观察正常步态周期中跖骨头平面足横弓的运动形态 ,探讨跖骨头平面足横弓在行走过程中的重要意义及与外翻的关系。方法正常足 13足,外翻足 12足,应用" C"型臂 X线机观察跖骨头平面足横弓在步态周期中的运动形态、空间位置变化,并用录像机记录。电脑工作站与 C＋＋ Builder下精确的计时器相连接,记录足横弓塌陷时间。结果跖骨头平面存在由五个跖骨头构成的足横弓 ,以第一、五跖骨头为底,第二、三跖骨头为顶;在步态周期中,由站立相到推离相时,第二、三跖骨头逐渐塌陷,负重份额渐增加;足横弓指数 Q与外翻角 (HVA)相关, HVA越大, Q值越小,步态周期中第二、三跖骨头下降到地面的时间越短,第二、三跖骨头就越早负重,负重时间延长,导致其过度负重和第二、三跖骨头下疼痛性胼胝体形成。结论跖骨头平面足横弓在正常步态周期中发挥重要作用,由站立相至推离相,随重心前移,第二、三跖骨头的负重增加,跖骨头下移而与地面接触导致足横弓的塌陷。外翻患者中,足横弓塌陷时间早,跖骨头负重时间长,可以导致前足功能紊乱。     

正常足与外翻足的足底压力研究

目的　对正常足与外翻足的足底压力进行测量。方法　运用自行研制的足底生物力学测试系统对30 名健康人60 足,45 例外翻患者89 足进行了行走时足底压力的测试。结果　重度外翻组31 足和正常组相比,第一跖骨头下压力明显减低( P< 0.001),第二跖骨头下压力明显增加(P< 0 .05),第三、五跖骨头下压力有增高的趋势。结论　正常人前足第一跖骨头下压力最高,并向外侧递减。重度外翻足前足第一跖骨头下压力明显减低,第二跖骨头下压力明显增高     

Relationship Between Plantar Callosity and Foot Deformity in Hallux Valgus Using Weightbearing Computed Tomography

Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity, such as the metatarsal length discrepancy, the abnormal metatarsal head height, cavus, flat foot, and rheumatoid conditions. However, it is unclear which variable is most involved in the cause of callosity in hallux valgus deformity. To clarify the factors associated with the callosity with hallux valgus deformity, we conducted multiple image assessments based on weightbearing radiography and computed tomography. A retrospective review was performed based on the collection of clinical records from all patients with hallux valgus treated from 2010 to 2019 in our institution. We measured the hallux valgus angle, intermetatarsal angles, calcaneal pitch angles, talo-first metatarsal angles, metatarsal length, metatarsal head height, first metatarsal pronation angles, and sesamoid position with weightbearing radiography and computed tomography. We analyzed the relation between callosity formation and imaging assessments using univariate and multivariate logistic regression models. Fifty feet were retrospectively evaluated, and multiple logistic analyses by the stepwise method revealed that the first metatarsal-lateral-sesamoid distance was the only radiographical variable associated with callosity formation among all the tested variables (p < .001). As the grade of the callosity became more severe, the lateral shift of the lateral sesamoid increased. The position of the sesamoid bone appears to have a critical role in the assessment and choice of treatment protocols and further research needs to be conducted on the relationship with the position of sesamoid bone to elucidate the mechanism of callus formation.     

Mechanics of the Hallux Valgus Foot and the Effect of Keller's Operation

Using a system for measuring the load distribution under the foot, patients with hallux valgus were compared, before and after undergoing Keller's operation, with a group of normal subjects. Preoperatively the patients showed reduced loading under all their toes and increased loading under their lateral metatarsal heads; the decrease under the hallux was found to correlate with an increase in hallux valgus angle. Postoperatively there was a further decrease in loading under the hallux and an increase under the first metatarsal head.     

Relationship between Foot Width Reduction and Clinical Outcomes after Chevron Osteotomy for Hallux Valgus Deformity

BackgroundRadiological correction of hallux valgus deformity is the objective of operation and related to successful outcomes. Nonetheless, footwear problems related to foot width can also affect the clinical outcome. Few studies have analyzed changes in foot width, and data on clinical outcomes after correction of hallux valgus deformity are scarce.MethodsThe study included 159 cases with symptomatic hallux valgus deformity who underwent proximal or distal chevron metatarsal osteotomy and were followed up for a mean of 32.8 months. Radiologically, the hallux valgus angle, intermetatarsal angle, first metatarsal head width, bony foot width, and soft-tissue foot width were analyzed. Clinically, the visual analog scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score were evaluated.ResultsThe preoperative hallux valgus was corrected radiologically at the last follow-up. The bony foot width was reduced by 9.4%, and the soft-tissue foot width was reduced by 7.1% (p < 0.001 for all). The mean AOFAS score improved from 51.2 preoperatively to 89.4 at the final follow-up (p < 0.001). In multiple regression, the perioperative changes of bony foot width were associated with final AOFAS score (p = 0.029).ConclusionsChevron osteotomy performed for hallux valgus deformity resulted in satisfactory radiological and clinical outcomes. Perioperative changes in bony foot width showed a significant correlation with AOFAS score. Therefore, to correct hallux valgus deformity, it is necessary to correct known radiological indicators sufficiently and make efforts simultaneously to reduce the foot width optimally.     

正常足与踇外翻足的足横弓三维形态比较

运用Ｘ线片、ＣＴ及计算机图像处理技术，了解正常足横弓的三维形态，探讨外翻三维畸形的检测方法。对３２５例正常人和５７例外翻足的足正位Ｘ线片进行测量，检测五个跖骨和籽骨的相对位置关系及两组的异同；对２４例正常足和１６例外翻足进行ＣＴ扫描，经计算机图像处理，观测正常足横弓的冠状面形态和外翻足的足横弓的畸形表现。结果发现：７４．８６％的正常实验对象第一跖骨短于第二跖骨；外翻足的籽骨不随内翻的第一跖骨内移，相对处于稳定的位置；正常人组足横弓指数Ｈ＝０．２０９±０．０５１，第一跖骨旋前角度Ｐ＝８．７５°±１４．６°；第一跖骨籽骨滑车系统功能丧失是外翻足足横弓塌陷的重要原因。     

足横弓重建法治疗外翻

目的 :介绍一种伴有足横弓塌陷的严重外翻的手术方法。方法 :12例伴有足横弓塌陷的严重的外翻足首先经X线、CT检测其三维畸形程度 ,而后手术中采用第一跖骨基底截骨 ,远端外推、下压、外旋以纠正第一跖骨的三维畸形 ,恢复足横弓正常形态 ,矫形位置以克氏针固定 :对外翻角 (HVA)的纠正采用常规第一跖趾关节软组织手术。结果 :术后 3～ 12月随访 ,优 6例、良 4例、中 2例 ,优良率 83 % ,其中 ,前足底中部痛性胼胝均有明显减轻。结论 :足横弓重建手术是严重外翻较好的选择术式。