腓肠肌内侧头前移治疗足下垂畸形

腓肠肌内侧头前移治疗足下垂畸形陈步俊，李新忠小儿麻痹后遗足下垂或伴有足内外翻畸形极其常见，为足背伸肌、内外翻肌瘫痪的结果。脑性瘫后遗足下垂内翻畸形，是小腿三头肌、胫后肌及腓骨肌过强的结果。无论是那一种畸形，其根本原因是肌力不平衡。对广泛性肌瘫痪的治疗...     

改良腓骨长肌内移术治疗足外翻50例

改良腓骨长肌内移术治疗足外翻５０例田乃宜，贾明锁，孙凤琴本组男２０例，女３０例。年龄１０～２０岁，１５岁以下３６例，占７２％，１６岁以上１４例，占２８％。左胫前肌瘫１６例，左胫后肌瘫１２例，右胫前肌瘫１８例，右胫后肌瘫１０例。腓骨长肌腱肌力术前为Ⅴ级...     

胫后肌骨瓣外移治疗足内翻畸形

胫后肌骨瓣外移治疗足内翻畸形黄义昌，张治国小儿瘫后遗症，胫骨前肌合并腓骨长、短肌瘫所致足内翻畸形，一般通过腔后肌腱止点外移来矫正。按照传统的方法，将该肌腱自舟状骨止点切断后，通过骨孔将该腱缝合固定在骰骨或第三楔骨上，以增进足外翻肌力。但由于胫后肌腱经...     

改良腓骨长肌移位术重建胫前肌肌力

目的探讨改良腓骨长肌移位术在治疗胫前肌瘫痪导致的足功能障碍的临床疗效。方法笔者自1999-11—2015-04采用保留腓骨长肌原附着点的改良腓骨长肌内移术治疗因胫前肌瘫痪导致的足功能障碍77例。结果77例均获随访12~36个月,平均20个月。术后足外翻畸形完全矫正70例,7例残留部分足下垂畸形。全部患者足部内外翻肌力不平衡现象得到明显改善。术前JOA评分为(32±3)分,术后JOA评分为(76±4)分。术后与术前JOA评分比较有明显改善,差异有统计学意义(t=81.973,P0.001)。结论改良腓骨长肌内移术,操作安全,效果可靠,是有效的重建因胫前肌瘫痪导致的足功能障碍手术方法。     

第三腓骨肌的解剖及其临床应用（附13例报告）

第三腓骨肌的解剖及其临床应用（附１３例报告）秦泗河，孙廷先，宁栓虎作者应用第三腓骨肌移位术矫正足的动力性畸形，获得良好效果。本组男９例，女４例，年龄４～２４岁，其中１５岁以下者１１例。术前胫前肌瘫形成马蹄外翻足３例，跟腱延长的同时行第三腓骨肌内置代胫...     

跟腱替代术治疗仰足畸形的体会

临床资料本组,男43例,女35例,年龄3.5～28岁。仰足仰趾畸形31例,小腿三头肌肌力0级,胫前肌,胫后肌,腓骨肌,伸(足母)长肌及伸趾总肌肌力均在4级以上。仰足合并外翻畸形28例,小腿三头肌、胫前肌和胫后肌肌力均     

隐性脊椎裂合并马蹄内翻足的显微外科治疗

我们在应用显微外科技术治疗隐性脊椎裂尿失禁中,遇到同时合并马蹄内翻足11例,在施行显微外科马尾松解术后足部畸形都得到迅速和较完全的矫正。临床资料本组男6例,女5例,其中2～5岁者3例,5～8岁者4例,9～11岁者4例。手术前均有不同程度的尿失禁,单侧或双侧马蹄内翻足畸形,但是足畸形均为弹性畸形,在手法背伸或外翻足时畸形可被矫正,所以都属于足背伸肌和足外翻肌不全麻痹。伸趾肌和腓骨肌肌力都在3级以下,其中伸趾肌肌力在2～3级者8例,1级者3例;腓骨肌肌力在2～3级者7例,1级者4例。足背及足外侧痛觉减弱,膝腱反射正常而跟腱反射均明显减弱,…     

儿童脑性瘫马蹄内翻足治疗方法的改进

本文报告采用胫后肌、腓骨长肌转移至胫前肌，三肌腱联合缝合的新方法治疗小儿马蹄内翻足３０例，获得满意疗效，尤其是对脑性瘫后遗马蹄内翻足患儿疗效更佳。因而作者主张在临床上推广应用     

改良腓骨长肌内移治疗第1跖骨头下垂型足外翻畸形

目的 介绍改良腓骨长肌内移治疗第１跖骨头下垂型足外翻畸形的方法及优点。方法 采用以导引管抽取肌健法及保留腓骨长肌原附着点的改良腓骨长肌内移术,治疗第１跖骨头下垂型足外翻畸形４８例。结果 随访１～３年,足外翻完全矫正４２例,残留部分足下垂畸形６例,无并发足内翻畸形。结论 该方法操作简单,设计合理,相对提高了排骨长肌的肌力,减少了并发症,效果满意。     

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.     

Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency.

Ten patients were identified with traumatic, complete common peroneal nerve palsy, with no previous foot or ankle surgery or trauma distal to the knee, who had undergone anterior transfer of the posterior tibial tendon to the midfoot. Six of these patients had a transfer to the midfoot and four had a Bridle procedure with tenodesis of half of the posterior tibial tendon to the peroneus longus tendon. Average follow-up was 74.9 months (range, 18-351 months). All patients' feet were compared assessing residual muscle strength, the longitudinal arch, and motion at the ankle, subtalar, and Chopart's joint. Weightbearing lateral X-rays and Harris mat studies were done on both feet. In no case was any valgus hindfoot deformity associated with posterior tibial tendon rupture found. It seems that the pathologic condition associated with a posterior tibial tendon deficient foot will not manifest itself if peroneus brevis function is absent.     

The pathogenesis of hallux valgus

The first ray is an inherently unstable axial array that relies on a fine balance between its static (capsule, ligaments, and plantar fascia) and dynamic stabilizers (peroneus longus and small muscles of the foot) to maintain its alignment. In some feet, there is a genetic predisposition for a nonlinear osseous alignment or a laxity of the static stabilizers that disrupts this muscle balance. Poor footwear plays an important role in accelerating the process, but occupation and excessive walking and weight-bearing are unlikely to be notable factors. Many inherent or acquired biomechanical abnormalities are identified in feet with hallux valgus. However, these associations are incomplete and nonlinear. In any patient, a number of factors have come together to cause the hallux valgus. Once this complex pathogenesis is unraveled, a more scientific approach to hallux valgus management will be possible, thereby enabling treatment (conservative or surgical) to be tailored to the individual.     

Pathophysiology of Charcot-Marie-Tooth disease

The etiology of the foot deformity in patients with Charcot-Marie-Tooth disease has not previously been discussed in relation to the extrinsic muscle function around the foot and ankle. Eight adult patients with a strong familial history were evaluated, and their foot findings were remarkably similar. All demonstrated a marked cavus deformity that was secondary to a forefoot equinus associated with contracture of the plantar fascia and a varus deformity of the calcaneus. The muscle function demonstrated marked weakness of the tibialis anterior and peroneus brevis muscles, whereas the peroneus longus and posterior calf muscles were rated as good to normal. Based on the relative strengths of these muscles and the progression of weakness, the authors hypothesize that the deformity observed in patients with Charcot-Marie-Tooth disease is secondary to the weakness of the tibialis anterior, peroneus brevis, and the intrinsic muscles, with their natural antagonists, the peroneus longus and the tibialis posterior muscles causing most of the deformity noted in these adult patients.     

Function after correction of a clawed great toe by a modified Robert Jones transfer

We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically. The overall rate of patient satisfaction was 86%. The deformity of the hallux was corrected in 80 feet. Catching of the big toe when walking barefoot, transfer lesions and metatarsalgia, hallux flexus, hallux limitus and asymptomatic nonunion of the interphalangeal joint were the most frequent complications. Hallux limitus was more likely when elevation of the first ray occurred (p = 0.012). Additional transfer of the tendon of peroneus longus to peroneus brevis was a significant risk factor for elevation of the first metatarsal (p < 0.0001). The deforming force of extensor hallucis longus is effectively eliminated by the Jones transfer, but the mechanics of the first metatarsophalangeal joint are altered. The muscle balance and stability of the entire first ray should be taken into consideration in the management of clawed hallux.     

Intrauterine structure of foot muscles in talipes equinovarus due to high-level myelomeningocele: a light microscopic study in fetal cadavers

The purpose of this study was to investigate the light microscopic structure of extrinsic foot muscles in talipes equinovarus (TEV) deformity that developed during intrauterine life due to high-level myelomeningocele. Ten feet of five fetal cadavers ranging in age from 18 to 20 weeks were dissected. Five feet had typical TEV deformity and the other five feet did not have any deformity (control group). Under light microscopic examination quantitative measurement of both muscle fiber sizes and fibrosis in the muscle tissue were performed to investigate the denervation muscle atrophy. Mean muscle fiber size of the TEV group was found to be significantly lower than that of the control group in all foot muscles except the gastrocnemius muscle. The proportion of fibrosis due to denervation atrophy was significantly higher in the TEV group than in the control group in all muscles. This situation was most evident in the peroneus longus muscle. It was concluded that muscular imbalance due to significant muscular atrophy might be the cause of TEV deformity that developed during intrauterine life due to high-level myelomeningocele.     

First Tarsometatarsal Joint Derotational Arthrodesis—A New Operative Technique for Flexible Hallux Valgus without Touching the First Metatarsophalangeal Joint

No operative technique for hallux valgus has been introduced in which the first metatarsophalangeal joint is not touched. We report the first tarsometatarsal joint derotational arthrodesis in which we mimic the function of the peroneus longus tendon without involving the first metatarsophalangeal joint, allowing function of the windlass mechanism without interference. We treated 66 patients (62 women and 4 men) with 84 flexible hallux valgus feet using our new operative technique. Preoperative and postoperative follow-up weightbearing radiographs were evaluated. Most patients had a pronation type foot (78%) preoperatively, and mean correction in hallux valgus and intermetatarsal angle was 20° and 9°, respectively (p < .001). The LaPorta classification showed a median change of 2.5 U (p < .001). We have described a new operative technique for flexible hallux valgus. The first tarsometatarsal joint derotational arthrodesis showed notable correction angles in hallux valgus, although the first metatarsophalangeal joint was left intact.     

Contributions of active and passive toe flexion to forefoot loading.

Toe flexion during terminal stance has an active component contributed by the muscles that flex the toes and a passive component contributed by the plantar fascia. This study examined the relative importance of these two mechanisms in maintaining proper force sharing between the toes and forefoot. Thirteen nonpaired cadaver feet were tested in a dynamic gait stimulator, which reproduces the kinematics and kinetics of the foot, ankle, and tibia by applying physiologic muscle forces and proximal tibial kinematics. The distribution of plantar pressure beneath the foot was measured at the terminal stance phase of gait under normal extrinsic muscle activity with an intact plantar fascia, in the absence of extrinsic toe flexor activity (no flexor hallucis longus or flexor digitorum longus) with an intact plantar fascia, and after complete fasciotomy with normal extrinsic toe flexor activity. In the absence of the toe flexor muscles or after plantar fasciotomy the contact area decreased beneath the toes and contact force shifted from the toes to the metatarsal heads. In addition, pressure distribution beneath the metatarsal heads after fasciotomy shifted laterally and posteriorly, indicating that the plantar fascia enables more efficient force transmission through the high gear axis during locomotion. The plantar fascia enables the toes to provide plantar-directed force and bear high loads during push-off.     

Control of the medial-lateral balance in walking

Eleven normal adults had their gait tested from the viewpoint of ground reaction force, myoelectric activity, and the motion of pronation-supination in the foot. There were marked differences in the myoelectric activity between the large lateral component force and the smaller one during the midstance phase. When the lateral component force was large, the pronation of the foot was small; the peroneus longus was active during the midstance phase; and the activity of the tibialis posterior disappeared earlier than in the small component. On the other hand, when the lateral component force was small, the pronation was large; the tibialis posterior, flexor digitorum longus, and extensor hallucis longus were all active; but the peroneus longus remained inactive during the midstance phase. Based on these findings, it is suggested that the leg muscles and the motion of the foot take part in controlling the medial lateral balance in walking.     

Hindfoot alignment of hallux valgus evaluated by a weightbearing subtalar x-ray view.

A new radiographic view was proposed to evaluate alignment of the hindfoot under weightbearing condition. The ankle joint and the middle and posterior facets of the subtalar joint were clearly visualized in all radiographs. A comparative study was made of 104 feet with hallux valgus in 58 female patients and 67 normal feet in 57 normal female subjects (control group). The mean value of the angle between the axis of the tibia and a line on the surface of the ankle joint on the talus was significantly larger in the group with hallux valgus than in the control group. Likewise, the mean value of the angle between the axis of the tibia and a line on the surface of the posterior facet of the subtalar joint on the calcaneus in the group with hallux valgus was 95.3 degrees, significantly larger than the 87.9 degrees in the control group. These findings showed that the ankle joint and the posterior facet of the subtalar joint in hallux valgus have valgus deviation. The hindfoot in a foot with hallux valgus has a tendency toward pronation. No previous study has measured the inclination of the posterior facet of the subtalar joint directly in weightbearing.     

Control of the medial-lateral balance in walking

Eleven normal adults had their gait tested from the viewpoint of ground reaction force, myoelectric activity, and the motion of pronation-supination in the foot. There were marked differences in the myoelectric activity between the large lateral component force and the smaller one during the midstance phase. When the lateral component force was large, the pronation of the foot was small; the peroneus longus was active during the midstance phase; and the activity of the tibialis posterior disappeared earlier than in the small component. On the other hand, when the lateral component force was small, the pronation was large; the tibialis posterior, flexor digitorum longus, and extensor hallucis longus were all active; but the peroneus longus remained inactive during the midstance phase. Based on these findings, it is suggested that the leg muscles and the motion of the foot take part in controlling the medial lateral balance in walking.