Der erworbene Plattfuß: mittelfristige Ergebnisse der medialisierenden Kalkaneusosteotomie mit Flexor digitorum longus-Sehnentransfer

Zusammenfassung

Studienziel: Diese retrospektive Studie untersucht die mittelfristigen klinischen Ergebnisse der medialisierenden Kalkaneusosteotomie mit Flexor digitorum longus-Transfer bei erworbenem Plattfuß, bedingt durch eine Tibialis posterior Sehnen-Insuffizienz II. Grades (Johnson und Strom Klassifikation). Methode: 30 Füße bei 29 Patienten (6 männlich, 23 weiblich) mit einem Durchschnittsalter von 58 Jahren (zwischen 43 und 68 Jahren) wurden zwischen 1995 und 2001 operiert und nach durchschnittlich 58,5 Monaten (von 35-97 Monaten) nachuntersucht und mit dem Score der Amerikanischen Fußgesellschaft (AOFAS) evaluiert. Ergebnisse: Der AOFAS-Score zeigte durchschnittlich 88,8 ± 10,7 Punkte (von 48-100 Punkte) bei der Nachuntersuchung. Der Score der AOFAS-Schmerz-Subskala war 34 ± 6,2 Punkte. 14 Füße (47 %) waren zum Nachuntersuchungszeitraum vollkommen schmerzfrei, 14 Füße (47 %) zeigten bei starker Belastung gelegentliche Schmerzen, und 2 Füße (6 %) hatten regelmäßige oder starke Schmerzen. Bei einem Fuß luxierte die Sehne des Musculus flexor digitorum longus nach ventral (3 %), bei dem zweiten Fuß war ein kontraktes Chopart'sches Gelenk die Schmerzursache (3 %). Weitere Komplikationen waren schmerzhafte prominente Schrauben (17 %) und Neuralgien des Nervus suralis (7 %). Schlussfolgerung: Bei rechtzeitiger und richtiger Indikation ist die medialisierende Kalkaneusosteotomie mit Flexor digitorum longus transfer eine empfehlenswerte Operation zur Korrektur der erworbenen Plattfußdeformität.

Abstract

Aim: The present retrospective study investigates the mid-term results after medial displacement calcaneal osteotomy combined with flexor digitorum longus transfer for the treatment of acquired flatfoot deformity due to posterior tibial tendon insufficiency at stage II (Johnson and Strom Classification). Method: 30 feet in 29 patients (6 male, 23 female) with an average age of 58 years (from 43 to 68 years) had surgery between 1995 and 2001. All feet were examined at an average follow-up of 58.5 months (range 35-97 months) and were evaluated with the American-Orthopaedic-Foot and Ankle Society (AOFAS) Hindfoot-Score. Results: The average AOFAS-Score was 88.8 ± 10.7 points (range 48 to 100) at final follow-up. The AOFAS-pain-subscale score was 34 ± 6.2 points. At the latest follow-up were 14 feet (47 %) painfree, 14 feet (47 %) noted mild pain and 2 feet (6 %) had daily pain. One foot (3 %) had pain due to subluxation of the musculus flexor digitorum longus tendon, in another one pain was caused by a contract Chopart joint (3 %). Further complications were painful prominent hardware (17 %) and neuralgia of the sural nerve (7 %). Conclusion: The authors conclude that the combination of the medial calcaneal displacement osteotomy with flexor digitorum longus transfer may provide optimal results in patients with adult acquired flatfoot deformity and posterior tibialis tendon dysfunction.

Schlüsselwörter

erworbener Plattfuß - Tibialis posterior Sehnen-Dysfunktion - Kalkaneusostetomie - Flexor digitorum longus Transfer

Key words

acquired flatfoot - posterior tibialis tendon dysfunction - calcaneal osteotomy - flexor digitorum longus transfer

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