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Abstract：
UNASSIGNED: Peritalar subluxation represents an important hindfoot component of progressive collapsing foot deformity, which can be associated with a breakdown of the medial longitudinal arch. It results in a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and pronation. Loss of peritalar stability allows the talus to rotate and translate on the calcaneal and navicular bone surfaces, typically moving medially and anteriorly, which may result in sinus tarsi and subfibular impingement. The onset of degenerative disease can manifest with stiffening of the subtalar (ST) joint and subsequent fixed and possibly arthritic deformity. While ST joint fusion may permit repositioning and stabilization of the talus on top of the calcaneus, it may not fully correct forefoot abduction and it does not correct forefoot varus. Such varus may be addressed by a talonavicular (TN) fusion or a plantar flexion osteotomy of the first ray, but, if too pronounced, it may be more effectively corrected with a naviculocuneiform (NC) fusion. The NC joint has a curvature in the sagittal plane. Thus, preserving the shape of the joint is the key to permitting plantarflexion correction by rotating the midfoot along the debrided surfaces and to fix it. Intraoperatively, care must be also taken to not overcorrect the talocalcaneal angle in the horizontal plane during the ST fusion (eg, to exceed the external rotation of the talus and inadvertently put the midfoot in a supinated position). Such overcorrection can lead to lateral column overload with persistent lateral midfoot pain and discomfort. A contraindication for an isolated ST fusion may be a rupture of posterior tibial tendon because of the resultant loss of the internal rotation force at the TN joint. In these cases, a flexor digitorum longus tendon transfer is added to the procedure.
UNASSIGNED: Level V, consensus, expert opinion.
UNASSIGNED: Level V, consensus, expert opinion.
摘要：
■Peritalar半脱位是进行性塌陷性足部畸形的重要后足组成部分，这可能与内侧纵向弓的破裂有关。它会导致复杂的三维畸形，并伴有不同程度的后足外翻，前脚绑架,和内旋。周围稳定性的丧失允许距骨在跟骨和舟骨表面上旋转和平移，通常向内和向前移动，这可能会导致arsi窦和腓骨下撞击。退行性疾病的发作可表现为距下（ST）关节的硬化以及随后的固定和可能的关节炎畸形。虽然ST关节融合可以使跟骨顶部的距骨重新定位和稳定，它可能不能完全纠正前脚外展，也不能纠正前脚内翻。可以通过第一射线的距骨（TN）融合或足底屈曲截骨术来解决这种内翻。但是,如果太明显，它可以更有效地纠正与naviculocuneiform（NC）融合。NC关节在矢状平面中具有曲率。因此，保持关节的形状是通过沿着清创表面旋转中足并固定它来进行plant屈矫正的关键。术中,在ST段融合过程中，还必须注意不要过度校正水平面中的距骨角度（例如，超过距骨的外部旋转，无意中将中足置于仰卧位置）。这种过度矫正会导致侧柱过载，并伴有持续的中足外侧疼痛和不适。孤立性ST融合的禁忌症可能是胫骨后肌腱断裂，因为TN关节的内部旋转力损失。在这些情况下,在手术中增加了指长屈肌腱转移。
■V级,共识,专家意见。
■V级,共识,专家意见。
