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Der erworbene Knick-Plattfuß

Eine Fußdeformität des Übergewichtigen?

Can flatfoot deformity be attributed to obesity?

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Zusammenfassung

Die Knick-Plattfuß-Deformität ist eine erworbene mehrdimensionale Rückfußfehlstellung, die zu erheblichen funktionellen Beeinträchtigungen führen kann. Die Ursache der Deformität ist in einer verminderten kapsuloligamentären Stabilisierung und einer Dysfunktion der Tibialis-posterior-Sehne zu sehen. Bei unklarer Ätiologie der Erkrankung wird das Übergewicht als disponierender Faktor diskutiert. In einer Vergleichsstudie einer Patientengruppe (n=75) mit Knick-Plattfuß-Deformität im Stadium 2 (nach Johnson u. Strom) und einer Kontrollgruppe (n=75) mit physiologischer Rückfußkonstellation konnte nachgewiesen werden, dass sowohl das Körpergewicht (p=0,034) als auch der Body-Mass-Index (p<0,001) in der Patientengruppe signifikant erhöht war. Diese Korrelation sollte bei der Therapieplanung Berücksichtigung finden. Weichteilrekonstruktionen, die im Stadium 2 meist mit Rückfußosteotomien kombiniert werden, sollten bei übergewichtigen oder adipösen Patienten eher mit einer knöchernen Rückfußstabilisation verbunden werden.

Abstract

Flatfoot deformity is characterized by a multiplanar hindfoot malalignment. Although the etiology remains unclear, the deformity is mainly attributed to ligamentous laxity and dysfunction of the posterior tibial tendon. Obesity is thought to be a risk factor that additionally impairs hindfoot stability. Performing a retrospective clinical and radiological study, we compared two groups, each with 75 patients. One group included patients with a flatfoot deformity stage 2, while the other group showed no hindfoot malalignment. Reviewing the weight and calculating the body mass index revealed significantly increased values for those patients with flatfoot deformity (P=0.034 and P>0.001, respectively). This correlation should be considered during the decision-making process on surgical strategies. In obese patients with flatfoot deformity, stage 2 soft tissue reconstruction and hindfoot osteotomies should be combined with hindfoot arthrodeses, i.e. subtalar fusion, to maintain sufficient and durable stability.

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Authors and Affiliations

  1. Klinik für Orthopädie der Friedrich-Schiller-Universität Jena

    R. A. Fuhrmann, T. Trommer & R. A. Venbrocks

  2. Lehrstuhl für Orthopädie der Friedrich-Schiller-Universität Jena, Rudolf-Elle-Krankenhaus, Klosterlausnitzerstr. 81, 07607, Eisenberg

    R. A. Fuhrmann

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  1. R. A. Fuhrmann
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  2. T. Trommer
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  3. R. A. Venbrocks
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Correspondence to R. A. Fuhrmann.

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Fuhrmann, R.A., Trommer, T. & Venbrocks, R.A. Der erworbene Knick-Plattfuß. Orthopäde 34, 682–689 (2005). https://doi.org/10.1007/s00132-005-0823-8

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