拇外翻外科手术医治的依据:脚孤拐外科手术的医治的目的,首先是解除患者以疼痛为主的症状与恢复前足的功能;其次是矫正畸形。如果无临床症状就给予矫形,从长远看不一定是好事。脚孤拐术式选择主要依据患者的病理变化,同时结合患者年龄、身体状况、工作生活需要等因素综合考虑。当前,有些医生在直流奥脚孤拐时对第一跖趾部的外形异常注意较多,但对患者其他病理变化却关注较少。结果手术医治偏重于矫形,忽视了对患者其他病理变化的医治,这是某些患者术后疗效欠佳的重要原因之一。

脚孤拐的病理变化主要有以下几个方面:第一跖骨内收,部分伴有旋前或抬高;跖骨头内侧骨赘形成,甚至发生拇囊炎。第一趾内翻、部分伴有旋前(个别旋后)。籽骨,尤其是腓侧籽骨向外侧移位。在软组织方面,跖趾内侧关节囊松弛,外侧关节囊挛缩,拇内收肌腱与屈拇长肌腱外侧头挛缩。前足横弓减弱或消失,前足增宽等。

上述病理变化就个体患者而言不一定全部发生,可因病程长短、畸形程度等而有不同表现。术者应该了解患者的病理变化,并对一些较为严重的不可逆转的变化予以手术干预,方可获得较好的疗效。

 Our feet consist of 26 bones, held together through a web of muscles and ligaments. The foot is not flat on the ground but is held up in the middle forming two arches: the Longitu dinalarch  (or instep) running along the foot from the heel to the toes and theTransversearch which runsacrossthe foot.Five metatarsal bones run from the middle of the foot to your toe joints. Over-pronationmeans the  Longtudinal  arch collapses and the ankle joint rolls inwards, every time the foot lands on the ground. A common side-effect of over-pronation is excess pre ssure on the metatarsals, which in turn leads to lowering (or collapsing) of the Transverse arch. The forefoot structure is severely weakened, causing pain in the ball of the foot and inflammation at the metatarsal joints.Wearing hard, flat shoes and walking on hard surfaces such as concrete, pavements, tiled floors etc will make this problem even worse. 

如患者因脚孤拐发生第一跖骨头上抬并发足横弓塌陷,致使第二跖骨头过度负重而发生跖侧胼胝。术中除矫正第一跖骨内收和拇指外翻的病理变化外,还应纠正其上抬,使第一跖骨头下沉恢复正常的生理结构及其负重功能,这样术后第二跖骨头下的胼胝可自行消失。

苏敬达大脚骨案例