Erworbener Plattfuß: Diagnose und chirurgische Behandlung

Zusammenfassung

Der erworbene Plattfuß des Erwachsenen präsentiert sich als langsam progrediente Deformität, die unbehandelt zu quälenden Schmerzen und Einschränkungen der Aktivitäten des täglichen Lebens führen kann. Die Therapiemaßnahmen sind vielfältig und abhängig von klinischer und radiologischer Präsentation, sodass für jeden Patienten eine individuelle Versorgung geplant werden muss. Dieser Beitrag spannt einen Bogen von der Ätiopathogenese über die chirurgische Therapie bis hin zur postoperativen Mobilisierung und Rehabilitation.

Abstract

The adult acquired flatfoot is a deformity with slow progression, which may leads to pain and restrictions of activities of daily living if untreated. Various treatment strategies, depending on the clinical and radiological presentation, exist. Therefore, an individual therapy approach is necessary for optimal treatment. This article covers etiopathologic aspects, conservative and operative treatments as well as postoperative mobilization and rehabilitation.

Kernaussagen

• Im Fokus der Entstehung des erworbenen Plattfußes steht die Dysfunktion der Sehne des M. tibialis posterior (PTT), sodass es im Verlauf der Erkrankung zu einem Einbruch des medialen Längsgewölbes mit konkomitantem Fersenvalgus sowie Supination im Vorfuß und Abduktion im Mittelfuß kommt.

• Klinisch präsentiert der Patient langsam progrediente Schmerzen im Verlauf der PTT, ein „Too-many-Toes Sign“ und ist bei zunehmender Deformität unfähig, den Einbeinzehenstand durchzuführen.

• Radiologisch lassen sich im Röntgen unter Belastung sowohl der Fersenvalgus als auch die Subluxation im talonavikularen Gelenk verifizieren. Weitere Fehlstellungen sowie arthrotische Veränderungen müssen ausgeschlossen werden. Ein MRT kann zur Beurteilung der Weichteilstrukturen hilfreich sein.

• Zur Planung des operativen Prozedere dient die Klassifikation nach Johnson, Strom und Myerson. Stadium I und II beschreiben flexible Veränderungen, Stadium III eine fixierte Veränderung des USG, Stadium IV eine Beteiligung des OSG.

• Die chirurgische Versorgung richtet sich nach der Schwere der Deformität und reicht von einer einfachen Tenosynovektomie bis zur Sprunggelenkprothese oder pantalaren Arthrodese.

• Postoperativ muss der Fuß bis zur Heilung der betroffenen Strukturen entlastend im Gips oder Walker mobilisiert werden.

Schlüsselwörter

Fersenvalgus - Fehlstellung - Fußdeformität - Fußgewölbe - Pes planovalgus

Key words

valgus heel - malalignment - foot deformity - arch of the foot - pes planovalgus - flat feet

Publikationsverlauf

Artikel online veröffentlicht:
10. Februar 2021

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