先天性内反足治療後の残存変形について

抄録

The patho-anatomical findings in three dissected specimens with infantile congenital club foot and the follow-up studies of 67 cases are reported.
The anterior part of the tales is always abnormal, its head and neck deviated medially and plantar ward and twisted into supination, therefore the remainder of the foot falls into adduction, equinus and varus. This deviation of the tales was persistent in unsatisfactory cases.
As a result of combined-action of the subtalar and calcaneo-contact joint, the tibia is externally rotated. This mechanical relationship is enhanced in the cases with residual deformity of the tales.
The manipulation of the club foot without correcting deviation of the tales gives false sense of correction, thus invites future recurrence of the deformity. The tales appears to be flat top in consequence of tibia rotation deformity following this false correction, it is not necessarily true flattening of the trochlea.
The secondary rocker bottom deformity results from improper treatment of club foott upon those primary deviation of the tales. The keystone of this deformity is the tales with residual deviation, which differs from congenital flat foot or vertical tales.