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Suy gân chày sau: Chẩn đoán và điều trị

Sau suy gân chày là Nguyên nhân phổ biến KHCN của biến dạng Acquired flatfoot người lớn. Mặc dù nguyên nhân chính xác của rối loạn này là vẫn chưa biết, điều kiện đã-được phân loại, trên Cơ sở của những phát hiện lâm sàng và chụp ảnh phóng xạ, vào các giai đoạn lò. | Posterior Tibial Tendon Insufficiency Diagnosis and Treatment Timothy C. Beals MD Gregory C. Pomeroy MD and Arthur Manoli II MD Abstract Posterior tibial tendon insufficiency is the most common cause of acquired adult flatfoot deformity. Although the exact etiology of the disorder is still unknown the condition has been classified on the basis of clinical and radiographic findings into four stages. In stage I there is no notable clinical deformity patients usually present with pain along the course of the tendon and local inflammatory changes. Stage II is characterized by a dynamic deformity of the hindfoot. Stage III involves a fixed deformity of the hindfoot and typically also a fixed forefoot supination deformity but no obvious evidence of ankle abnormality. In stage IV ankle involvement is secondary to long-standing fixed hindfoot deformities. The initial treatment of patients in any stage should be nonoperative with immobilization a nonsteroidal antiinflammatory drug and perhaps an orthotic device. The role of corticosteroid injections continues to be controversial. When nonoperative management fails the treatment options consist of soft-tissue procedures alone or in combination with osteotomy or arthrodesis. Stage I insufficiency is generally treated with debridement and tenosynovectomy. Soft-tissue transfer does not appear to correct the underlying deformity in stage II disease however there is growing interest in joint-sparing operations that attempt to compensate for the underlying deformities with osteotomies or arthrodeses supplemented with dynamic transfers to replace the insufficient posterior tibial tendon. Subtalar double or triple arthrodesis is the procedure of choice for stage III disease frequently in conjunction with heel-cord lengthening. Tibiocalcaneal arthrodesis or pantalar arthrodesis is most commonly used to treat stage IV disease. J Am Acad Orthop Surg 1999 7 112-118 History The original description of posterior tibialis insufficiency and