, a horseshoe varus foot and correction method (
15 years of age, and technique in the treatment of the losers, or untreated patients, soft tissue release surgery treatments are available.
The procedure includes the following steps: (
Achilles tendon extended: Achilles tendon extended technique should be on correct the front foot with varus deformity, because the tension of Achilles tendon can rectify the front foot deformity of the lever arm, otherwise the lost heel bone nodules, the support of the extension of commonly used method, has the following two kinds: 1)
Direct extension: at the end of the hard outer or general anesthesia.
Along the tendon of the lateral side, arc incision, muscles and tendons on abdomen place, next stop at heel bone nodules, incision length about 8 & ndash;
18 cm, cut the skin and subcutaneous tissue and the sheath, and then use a sharp knife, perpendicular to the Achilles tendon, Pierce its central, by down, longitudinal cutting the Achilles tendon, cut off the inside of the half, along with nodules muscle belly side cut off the outer half, after being foot deformity correction, extended 2 glyph.
Subcutaneous Achilles tendon extended: general anesthesia, children with stomach, under aseptic operation, assistant to support the knee joint, keep straight, another hand holding the front foot to foot dorsiflexion, Achilles tendon is quite tight, its method is as follows: oblique extension method: by clear skin month knife will be along with bone and tendon from down to up into a frontal face shape cut and retained by the tibialis anterior tendon membrane, keep the blood supply of the Achilles tendon, the foot back and force to extend.
Straight cut extension method: on the lower end of the Achilles tendon and muscle belly side, with a sharp knife center at the ends of the up and down vertically Pierce the Achilles tendon, muscle belly side to cut off the Achilles tendon lateral half, with the medial half nodules end, foot dorsum and pull, lengthen Achilles tendon in the scabbard film, extend the Achilles tendon.
Joint capsule incision and ligament cut: correct calcaneal varus deformity, and with the distance of the deltoid ligament, joint capsule must be cut off, not suture, after being technique in the heel points correction, rely on fibrous healing, in order to prevent shortly after the tibialis posterior and long toes bend, long hallux flexor tendon and the neurovascular to shift between distance, heel bone, deltoid ligament and joint capsule should be cut in different plane is advisable.
4, plantar fascia cut look next calcaneal tubercle amputation: incision, the assistant will sufficient evaginate outreach back stretch tight when the plantar fascia, the tip of the plantar fascia, to by disconnecting the aponeurosis along with bone nodules starting point, to the foot plantar surface flat, plantar fascia completely cut off.
Percutaneous plantar fascia amputation: assistant one hand feet part, another lever the heel, the plantar fascia is quite tight, easy to understand, under aseptic operation, the performer puts his left hand touch the plantar fascia, right hand holding a small sharp knife, by the side of the medial plantar fascia and skin, and between the parallel percutaneous Pierce beneath the plantar fascia, rotated 90 degrees, and then the tip of the blade to the aponeurosis, with little see-saw action gently cut, until the foot plantar surface relaxation, arches tend to normal, blade Pierce shoulds not be too deep, to prevent the damage of foot plantar blood vessels and nerves.
Injection after completion of the soft tissue release step sustains the mixed lateral knee to unbend, performer puts the heel, with his left hand hard outer, correct heel bone deformities, right hand pushed the front foot and back stretch, outreach, outer, according to the correct location, stitching all extended tendons, closing the wound, step by step a sterile dressing, 15 degrees with a plaster cast tube type limb knees, enough to overdo, gypsum type pipe on the upper thighs subordinates to plantar toe joint, in case of loss, for severe congenital foot turn prolapse deformity, 2 & ndash;
Gypsum replaced every 3 months, each time all should correct deformities in anesthesia, until the foot deformity disappear completely, switching to orthopaedic foot and a half years, day and night wear, six months after a change in orthopedic shoes, the shoes outside slightly tall, base slightly outward the deflection, heel edge slightly higher and longer than the ongoing.
5, with foot deformity correction success indicators: a passive, active, foot freely in all directions.
B should be located in the lower leg, foot vertical axis outreach about 40 degrees & ndash;
C, foot plantar surface is flat,
Original foot sag)
D, X-ray: basic returned to normal, longitudinal arch and transverse arch foot heel bone longitudinal axis and vertical axis of talus form normal Angle.
E, the back of the heel slightly to the outside.
6, prevention of complications, prevention of local skin necrosis, extend the tibialis posterior, flexor long and long hallux flexor tendon of the medial incision with Achilles tendon to extend incision, skin flap to compare between the two incision narrow easy ischemic necrosis, preventive measures: soft tissue jieshou preoperative, often massage the foot inside the skin, promote blood circulation, secondly the Achilles tendon extended as far as possible to the Achilles tendon and longitudinal axis of the lateral incision, an arc incision.
Between the two incision flap relative broadening.
B, calf greenstick fracture or ankle epiphyseal separation, gimmick is designed. it is, should be gradual, press gently, not too hard and second assistant in close coordination with the performer, in case of an accident.
C, gypsum oppression, formation pressure ulcers: a plaster cast, bone protruding points with skimmed pads, but shoulds not be too thick so as not to affect to record straight effect, gypsum type tube has not been solidified in shaping, avoid by all means with finger pressure, gypsum after drying, children crying, namely gypsum may there is oppression, should be timely medical treatment, cheek bone observation window.
D, blood circulation obstacle: when a plaster cast, must show five digits, tell parents strict observation.
If the digit is pale, children shout feet hemp pain, probably ischaemia, toes swelling, green, purple, and blisters, prompt venous reflux obstacle.
Whether arterial ischemia or venous reflux disorder, all can lead to foot or limb necrosis, immediate measures should be taken, light person local windowing decompression, serious, temporarily take the gypsum type tube, observe carefully, after being blood supply recovery, gypsum type pipe correction again, fixed.
7, 15 years after treatment, the correction technique are not satisfied, also cannot achieve expected purpose of soft tissue release, or severe strephenopodia prolapse deformity untreated, adapt to three joints fusion surgery (
With distance, is apart from the boat and the hub joint)
Until, plaster fixation, postoperative joint osseous fusion.
Need special attention is, whether it is taken gypsum conservative therapy or surgical therapy, in plaster to dismantle and postoperative orthopaedic footwear must be worn to correct.
Orthopedic shoes is maintaining gypsum and operation effect of an important auxiliary equipment, if don't wear after orthopedic shoes for consolidation, will cause the result of the wasted effort, even cause the failure of the operation and recurrence.
The choice of orthopedic shoes need a doctor or orthopedic technician according to the circumstance of children choose, different situations need to choose different types of orthopedic shoes.
So parents before buying orthopedic shoes, need to consult orthopaedic doctor or orthopedic engineer, in determining the rear can buy.
Correct shoes custom-made center is committed to the domestic medical orthopedic system construction, strive to Canada mature ankle orthopaedic system introduced into China.
In clinical medical institutions at all levels to carry out extensive cooperation, helping to build their own medical institutions orthopaedic department, for all levels of hospital culture, full-time or part-time orthopedic medical staff to make medical institutions at all levels have some diagnosis, detection, data acquisition, scheme design, curative effect evaluation.
Will provide professional technology, services, and products, improve the structure of the medical institutions at all levels, for the majority of patients to provide reasonable and effective corrective work.
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