[1]郭 朋,罗 聪.儿童扁平足病因、检测方法和治疗现状[J].医学信息,2018,31(05):56-61.[doi:10.3969/j.issn.1006-1959.2018.05.020]
　GUO Peng,LUO Cong.The Cause,Detection Method and Treatment Status of Children's Flat Foot[J].Journal of Medical Information,2018,31(05):56-61.[doi:10.3969/j.issn.1006-1959.2018.05.020]
点击复制

儿童扁平足病因、检测方法和治疗现状()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
31卷
期数:
2018年05期
页码:
56-61
栏目:
综述
出版日期:
2018-03-01

文章信息/Info

Title:
The Cause,Detection Method and Treatment Status of Children's Flat Foot
文章编号:
1006-1959（2018）05-0056-06
作者:
郭 朋; 罗 聪
重庆医科大学附属儿童医院骨科一病房，重庆 400000
Author(s):
GUO Peng; LUO Cong
Department of Orthopaedics,Room One,Children's Hospital,Chongqing Medical University,Chongqing 400000,China
关键词:
儿童; 扁平足; 发育; 病理生理; 检测; 评估
Keywords:
Key words：Children; Flat feet; Development; Pathophysiology; Detection; Assessment
分类号:
R726.8
DOI:
10.3969/j.issn.1006-1959.2018.05.020
文献标志码:
A
摘要:
扁平足在儿童中常见，特别是学龄前儿童。迄今为止扁平足仍没有标准的定义，一般认为，扁平足的形成与足部骨结构异常或肌肉韧带松弛导致内侧纵弓塌陷有关。扁平足一般情况下是生理性的，表现为柔韧性扁平足，绝大部分随着年龄的增加症状会逐渐得到改善。在罕见的情况下，扁平足也可能是病理性的，表现为僵硬性扁平足，如先天性垂直距骨、跗骨联合等。随着生物力学的不断发展，扁平足的检测及评估不仅包括简单的足印分析和X射线平片，还包括足底压力测试、三维激光扫描等，大大提高了检测及评估的准确率及效率。在治疗方面，虽然目前暂没有大型的前瞻性研究肯定保守治疗的疗效，也不能通过现有的检测及评估方法确定哪些患者即使在成年后仍不能缓解疼痛及畸形，但根据生物力学制定的矫形器械如鞋垫等在缓解扁平足的疼痛、改善步态方面确有一定作用。手术的疗效是值得肯定的，手术治疗扁平足主要从软组织、截骨术、关节融合、关节制动术等方面选择或联合，效果良好，需严格掌握手术适应证和禁忌证。
Abstract:
Abstract：Flat feet are common in children,especially preschool children.So far there is no standard definition of flat feet,generally believed that the formation of flat feet and foot bone structure or muscle ligament relaxation causes the medial longitudinal arch collapse related.Flat feet are generally physiological,showing a flexible flat foot,and most of the symptoms gradually improve with age. In rare cases,the flat foot may also be pathological,showing a rigid flat foot,such as congenital vertical talus,zygomatic unity.With the continuous development of biomechanics,the detection and evaluation of flat feet not only include simple footprint analysis and X-ray film,but also include plantar pressure testing and three-dimensional laser scanning,which greatly improves the accuracy and efficiency of detection and evaluation.In terms of treatment,although there is currently no large-scale prospective study confirming the efficacy of conservative treatment,it cannot be determined through existing tests and assessments which patients do not relieve pain and deformity even after adulthood,but according to biomechanics orthopaedics Instruments such as insoles have a certain role in relieving flat foot pain and improving gait.The efficacy of the surgery is worthy of recognition.Surgical treatment of flat feet is mainly selected from the aspects of soft tissue,osteotomy,arthrodesis,etc.The effect is good,and surgical indications and contraindications need to be strictly controlled.

参考文献/References:

[1]陈善本,鲍琨,陈博昌.儿童足弓发育与扁平足的研究进展[J].临床小儿外科杂志,2016,15(06): 610-613. [2]Chen KC,Tung LC,Yeh CJ,et al.Change in flatfoot of preschool-aged children:a 1-year follow-up study[J].Eur J Pediatr,2013,172(2):255-260. [3]李玉红,梁燕清,陈瑞巧.社区4~6岁儿童扁平足临床分析及手法矫治效果[J].广东医学,2015,36(13): 2071-2073. [4]隋月林,回俊岭,夏风歧,等.沧州市1001名3~12岁儿童扁平足发生情况观测[J].现代预防医学,2008, 35(07):1246-1247. [5]Carr JB,Yang S,Lather LA.Pediatric Pes Planus:A State-of-the-Art Review [J].Pediatrics,2016, 137(3):e20151230. [6]Stolzman S,Irby MB,Callahan AB,et al.Pes planus and paediatric obesity:a systematic review of the literature[J].Clin Obes,2015,5(2):52-59. [7]Pourghasem M,Kamali N,Farsi M,et al.Prevalence of flatfoot among school students and its relationship with BMI[J].Acta Orthop Traumatol Turc,2016,50(5):554-557. [8]Chen KC,Yeh CJ,Tung LC,et al.Relevant factors influencing flatfoot in preschool-aged children [J].Eur J Pediatr,2011,170(7):931-936. [9]Mosca VS.Flexible flatfoot in children and adolescents[J].J Child Orthop,2010,4(2):107-121.[10]Chang CH,Chen YC,Yang WT,et al.Flatfoot diagnosis by a unique bimodal distribution of footprint index in children[J].PLoS One,2014,9(12):e115808. [11]杨蔡伟,熊敏.扁平足的外科治疗进展[J].中国当代医药,2015,22(22):15-17. [12]贺金国,陈涛平,张奉琪.先天性平足与青少年平足症的治疗进展[J].医学综述,2014,20(18): 3362-3364. [13]Gonul Y,Yucel O,Eroglu M,et al.Ultrasonographic evaluation of Achilles tendon in children with flatfoot:A case-control morphometric study[J].Diagn Interv Imaging,2016,97(9):907-913. [14]Bourdet C,Seringe R,Adamsbaum C,et al.Flatfoot in children and adolescents.Analysis of imaging findings and therapeutic implications[J].Orthop Traumatol Surg Res,2013,99(1):80-87. [15]Dunn SP,Meyer J.Displacement of the anterior process of the calcaneus after Evans calcaneal osteotomy[J].J Foot Ankle Surg,2011,50(4):402-406. [16]Alvarado DM,McCall K,Hecht JT,et al.Deletions of 5 HOXC genes are associated with lower extremity malformations,including clubfoot and vertical talus[J].J Med Genet,2016,53(4):250-255. [17]Shih YF,Chen CY,Chen WY,et al.Lower extremity kinematics in children with and without flexible flatfoot:a comparative study[J].BMC Musculoskelet Disord,2012(13):31. [18]Han Y,Duan D,Zhao K,et al.Investigation of the Relationship Between Flatfoot and Patellar Subluxation in Adolescents[J].J Foot Ankle Surg,2017,56(1):15-18. [19]Sheikh TAM,Feldman DS.Painful Flexible Flatfoot[J].Foot Ankle Clin,2015,20(4):693-704. [20]Lee JS,Kim KB,Jeong JO,et al.Correlation of foot posture index with plantar pressure and radiographic measurements in pediatric flatfoot[J].Ann Rehabil Med,2015,39(1):10-17. [21]Chang HW,Lin CJ,Kuo LC,et al.Three-dimensional measurement of foot arch in preschool children[J].Biomed Eng Online,2012(11):76. [22]Watanabe K,Kitaoka HB,Fujii T,et al.Posterior tibial tendon dysfunction and flatfoot: analysis with simulated walking[J].Gait Posture,2013,37(2):264-268. [23]Benedetti MG,Berti L,Straudi S,et al.Clinicoradiographic assessment of flexible flatfoot in children[J].J Am Podiatr Med Assoc,2010,100(6):463-471. [24]何凯,王愉思,刘宏.关于扁平足测量方法及评估指标的研究与进展[J].世界最新医学信息文摘,2014,14(07):58-59. [25]赵丽,张国强,代志超,等.性别与BMI对中学生足底压力的影响[J].廊坊师范学院学报(自然科学版),2016,16(04):87-90. [26]Lee JH,Sung IY,Yoo JY.Clinical or radiologic measurements and 3-D gait analysis in children with pes planus[J].Pediatr Int,2009,51(2):201-205. [27]Yang CH,Chou KT,Chung MB,et al.Automatic Detection of Calcaneal-Fifth Metatarsal Angle Using Radiograph:A Computer-Aided Diagnosis of Flat Foot for Military New Recruits in Taiwan [J].PLoS One,2015,10(6):e0131387. [28]Sánchez-Rodríguez R,Martínez-Nova A,Escamilla-Martínez E,et al.Can the Foot Posture Index or their individual criteria predict dynamic plantar pressures[J].Gait Posture,2012,36(3):591-595. [29]Morrison SC,Ferrari J.Inter-rater reliability of the Foot Posture Index(FPI-6)in the assessment of the paediatric foot [J].J Foot Ankle Res,2009(2):26. [30]Halabchi F,Mazaheri R,Mirshahi M,et al.Pediatric flexible flatfoot;clinical aspects and algorithmic approach [J].Iran J Pediatr,2013,23(3):247-260. [31]Chen KC,Yeh CJ,Kuo JF,et al.Footprint analysis of flatfoot in preschool-aged children[J].Eur J Pediatr,2011,170(5):611-617. [32]Levinger P,Murley GS,Barton CJ,et al.A comparison of foot kinematics in people with normal-and flat-arched feet using the Oxford Foot Model[J].Gait Posture,2010,32(4):519-523. [33]高艳玲,张志广,付磊磊.某县960例小学生扁平足患病情况及发生影响因素分析[J].实用预防医学,2014,21(10):1210-1212. [34]Jane MA,Rome K,Evans AM.The efficacy of nonsurgical interventions for pediatric flexible flat foot:a critical review[J].J Pediatr Orthop,2012,32(8):830-834. [35]Kurup HV,Clark CI,Dega RK.Footwear and orthopaedics[J].Foot Ankle Surg,2012,18(2):79-83. [36]Sinha S,Song HR,Kim HJ,et al.Medial arch orthosis for paediatric flatfoot[J].J Orthop Surg(Hong Kong),2013,21(1):37-43. [37]Lee HJ,Lim KB,Yoo J,et al.Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet[J].Ann Rehabil Med,2015,39(6):905-913. [38]Kanatl U,Aktas E,Yetkin H.Do corrective shoes improve the development of the medial longitudinal arch in children with flexible flat feet[J].J Orthop Sci,2016,21(5):662-666. [39]Kido M,Ikoma K,Hara Y,et al.Effect of therapeutic insoles on the medial longitudinal arch in patients with flatfoot deformity:a three-dimensional loading computed tomography study[J].Clin Biomech(Bristol,Avon),2014,29(10):1095-1098. [40]Chen KC,Tung LC,Tung CH,et al.An investigation of the factors affecting flatfoot in children with delayed motor development[J].Res Dev Disabil,2014,35(3):639-645. [41]Yontar NS,Ogut T,Guven MF,et al.Surgical treatment results for flexible flatfoot in adolescents[J].Acta Orthop Traumatol Turc,2016,50(6):655-659. [42]Marengo L,Canavese F,Mansour M,et al.Clinical and radiological outcome of calcaneal lengthening osteotomy for flatfoot deformity in skeletally immature patients[J].Eur J Orthop Surg Traumatol,2017,27(7):989-996. [43]高雷,闫桂森,郭源,等.跟骨延长截骨术与跟骨骰骨楔骨截骨术治疗儿童柔韧性扁平足效果比较[J].山东医药,2016,56(48):47-49. [44]李欣,刘宏.距下关节制动术在儿童扁平足治疗中的应用进展[J].中国矫形外科杂志,2013,21(01): 47-49. [45]Ozan F,Doar F,Gener K,et al.Symptomatic flexible flatfoot in adults:subtalar arthroereisis [J].Ther Clin Risk Manag,2015(11):1597-1602.

相似文献/References:

[1]韩晓利.含氟泡沫预防儿童乳牙龋齿的临床效果研究[J].医学信息,2018,31(02):7.[doi:10.3969/j.issn.1006-1959.2018.02.003]
　HAN Xiao-li.Study on the Clinical Effect of Fluoride Foam in Preventing Deciduous Dental Decay in Children[J].Journal of Medical Information,2018,31(05):7.[doi:10.3969/j.issn.1006-1959.2018.02.003]
[2]唐朝.儿童先天性脊柱侧弯诊疗现状的临床研究[J].医学信息,2018,31(01):61.[doi:10.3969/j.issn.1006-1959.2018.01.022]
　TANG Chao.Clinical Study on Diagnosis and Treatment of Congenital Scoliosis in Children[J].Journal of Medical Information,2018,31(05):61.[doi:10.3969/j.issn.1006-1959.2018.01.022]
[3]李 娟,田 鹏,刘 琦,等.血清降钙素原在儿童发热性疾病中的应用价值分析[J].医学信息,2018,31(04):102.[doi:10.3969/j.issn.1006-1959.2018.04.034]
　LI Juan,TIAN Peng,LIU Qi,et al.Analysis of the Value of Serum Procalcitonin in Children with Febrile Diseases[J].Journal of Medical Information,2018,31(05):102.[doi:10.3969/j.issn.1006-1959.2018.04.034]
[4]许海泉.生酮饮食治疗儿童难治性癫痫的临床研究[J].医学信息,2018,31(06):83.[doi:10.3969/j.issn.1006-1959.2018.06.026]
　XU Hai-quan.Clinical Study of Ketogenic Diet in Children with Refractory Epilepsy[J].Journal of Medical Information,2018,31(05):83.[doi:10.3969/j.issn.1006-1959.2018.06.026]
[5]许海泉.生酮饮食治疗儿童难治性癫痫合并智力低下的研究[J].医学信息,2018,31(07):57.[doi:10.3969/j.issn.1006-1959.2018.07.019]
　XU Hai-quan.Study on the Ketogenic Diet in the Treatment of Refractory Epilepsy in Children with Mental Retardation[J].Journal of Medical Information,2018,31(05):57.[doi:10.3969/j.issn.1006-1959.2018.07.019]
[6]许海泉.生酮饮食对不同病因及发作形式儿童难治性癫痫 疗效差异的临床观察[J].医学信息,2018,31(08):88.[doi:10.3969/j.issn.1006-1959.2018.08.027]
　XU Hai-quan.Clinical Observation of the Effect of Ketogenic Diet on the Efficacy of Children with Refractory Epilepsy Due to Different Causes and Attacks[J].Journal of Medical Information,2018,31(05):88.[doi:10.3969/j.issn.1006-1959.2018.08.027]
[7]阙禧韬.咬合诱导在牙源性错牙合畸形中的早期应用分析[J].医学信息,2018,31(10):184.[doi:10.3969/j.issn.1006-1959.2018.10.064]
　QUE Xi-tao.Early Application of Occlusal Induction in Odontogenic Malocclusion[J].Journal of Medical Information,2018,31(05):184.[doi:10.3969/j.issn.1006-1959.2018.10.064]
[8]李振宏,施海龙,林思名,等.伴中央颞区棘波的儿童良性癫痫与 微量元素的关系研究[J].医学信息,2018,31(12):90.[doi:10.3969/j.issn.1006-1959.2018.12.027]
　LI Zhen-hong,SHI Hai-long,LIN Si-ming,et al.Study on the Relationship between Children's Benign Epilepsy and Trace Elements in the Central Temporal Spikes[J].Journal of Medical Information,2018,31(05):90.[doi:10.3969/j.issn.1006-1959.2018.12.027]
[9]胡 帅,张 蕾,罗荣华.呼出气一氧化氮浓度检测在儿童咳嗽变异性哮喘中的应用[J].医学信息,2018,31(13):91.[doi:10.3969/j.issn.1006-1959.2018.13.026]
　HU Shuai,ZHANG Lei,LUO Rong-hua.Determination of Exhalation Nitric Oxide Concentration in Children with Cough Variant Asthma[J].Journal of Medical Information,2018,31(05):91.[doi:10.3969/j.issn.1006-1959.2018.13.026]
[10]远 颖.黄芪注射液治疗儿童肺炎的Meta分析[J].医学信息,2019,32(02):95.[doi:10.3969/j.issn.1006-1959.2019.02.027]
　YUAN Ying.Meta-analysis of Huangqi Injection in the Treatment of Children with Pneumonia[J].Journal of Medical Information,2019,32(05):95.[doi:10.3969/j.issn.1006-1959.2019.02.027]

更新日期/Last Update: 2018-03-01