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足踝外科有哪些容易被误解的知识点？以下总结了几条，未必完全准确，仅供参考。特别是中文是AI翻译的、难免不通顺，以英文为准。有疑问可以到知识星球社群交流，我们汇聚了全球的足踝外科资源。 Examination & Diagnosis: 检查与诊断： 1. Coleman
block test: 科尔曼木块试验： Don't just
look for correction of hindfoot varus, analyze the degree of correction.
Partial correction may still warrant surgery if the deformity is progressing.
不要仅仅寻找后足外翻的矫正，要分析矫正的程度。如果畸形仍在进展，部分矫正也可能需要手术。 
该试验是评估高弓内翻足患者前后足关系及后足柔韧性的很好方法。评估方法是∶
患者侧足跟及前足外侧站立于1.9cm （3/4英寸）的木块，将第1跖列放于木块边缘并使其自然下垂，检查者于患者后边观察后足内翻能否纠正。如果可以，则说明后足具有一定的柔韧性，畸形可以通过矫形器或软组织手术来纠正;如果不能，则说明后足僵硬，须骨性手术治疗。
2. Heel
raise test: 踮脚测试： 
Inability to
perform repeated single heel raises suggests tibialis posterior weakness, even
with normal grade 5 power on manual testing.
无法完成连续的单脚踮脚动作表明胫后肌力量减弱，即使在手动测试中显示正常等级 5 的力量。 3. Silfverskiöld
test: 西尔弗斯凯尔德测试： 
Distinguish
between isolated gastrocnemius tightness and combined gastrocnemius-soleus
tightness as it affects surgical planning.
区分孤立性腓肠肌紧张与联合性腓肠肌-比目鱼肌紧张，这对手术规划有影响。 4. Ankle
instability tests: 踝关节不稳测试： 
These
are subjective and less accurate in chronic instability compared to acute
injury.
这些测试主观性较强，在慢性不稳中相比急性损伤准确性较低。 5. Swelling
in pes planus: 扁平足中的肿胀： Differentiate
between tibialis posterior tenosynovitis (early stage) and generalized medial
soft tissue swelling (later stage).
区分胫后肌腱腱鞘炎（早期）与内侧软组织广泛肿胀（晚期）。 6. Radiographic-clinical
dissociation:
影像学与临床表现不一致： Weight-bearing x-rays may
not always accurately reflect the true degree of flatfoot deformity due to
compensatory muscle action.
负重 X 线片可能无法始终准确反映扁平足畸形的真实程度，因为存在代偿性肌肉作用。 7. MRI for
PTTD: 胫后肌腱功能障碍的 MRI 检查： Findings often have a poor correlation with intra-operative
findings and should not solely guide surgical decisions.
影像学发现与术中发现的关联性往往不佳，不应单独指导手术决策。 8. “Too
many toes sign” “过多脚趾征”: 
Be aware that this sign can be misleading in the presence of
external rotational abnormalities of the leg or ankle.
需注意，在存在腿部或踝关节外旋异常的情况下，此征象可能具有误导性。 9. Accessory
anterolateral talar facet (AATF):
外侧副距骨面（AATF）： Easily
missed on plain radiographs. CT or MRI is essential for diagnosis.
在普通 X 光片上容易被忽视。CT 或 MRI 对于诊断至关重要。 10. Peroneal
spastic flatfoot:
腓骨肌痉挛性扁平足： Not pathognomonic for tarsal
coalition and can be seen in other rigid flatfoot deformities.
并非跗骨联合的特异性表现，也可能出现在其他僵硬性扁平足畸形中。 11. Tarsal
coalition: 跗骨联合： Can present with
normal foot alignment or even cavovarus deformity, not just pes planus.
可能表现为正常足部对齐，甚至出现高弓足畸形，而不仅仅是扁平足。 12. Lateral
ankle pain after inversion injury:
内翻损伤后的外踝疼痛： Don't just assume it's a
sprain. Consider anterior process calcaneal fracture, lateral talar process
fracture, peroneal tendon subluxation or even a subtle Lisfranc injury.
不要仅认为是扭伤。需考虑跟骨前突骨折、外侧距骨突骨折、腓骨肌腱脱位，甚至细微的 Lisfranc 损伤。 13. Paediatric
ankle fractures:
儿童踝关节骨折： A high index of suspicion for
growth plate injuries is necessary, as they may present as ankle sprains.
对生长板损伤需高度怀疑，因其可能表现为踝关节扭伤。 14. 'C
sign' on lateral radiograph:
侧位 X 线片上的“C 征”： Not specific for talocalcaneal
coalition and can also be present in severe pes planus deformity.
并非特异于距跟联合，也可能出现在严重的扁平足畸形中。 15. Calcaneal
spur: 跟骨刺： Incidental finding and
not the cause of pain in plantar fasciitis.
偶然发现，并非足底筋膜炎疼痛的原因。 Biomechanics:生物力学： 1. Ankle
joint axis: 踝关节轴： Not perfectly
aligned with the cardinal planes, leading to coupled rotations.
并非完全与基本平面对齐，导致耦合旋转。 2. Subtalar
joint: 距下关节： Acts as a torque
converter, translating tibial rotation into inversion-eversion of the
calcaneus.
充当扭矩转换器，将胫骨旋转转化为跟骨的内翻-外翻。 3. Transverse
tarsal joint: 跗横关节： 'Unlocks’ the
midfoot for flexibility and 'locks’ it for rigidity during gait.
在步态中，“解锁”中足以增加灵活性，“锁定”中足以增强刚性。 4. First
metatarsal: 第一跖骨： Bears
approximately 50% of weight acting on the foot. Resection should generally be
avoided.
大约承受脚部所受重量的 50%。通常应避免切除。 5. Second
metatarsal: 第二跖骨： The most
vulnerable to stress fractures due to its length and relative rigidity.
由于其长度和相对刚性，最容易受到应力性骨折的影响。 6. Metatarsal
break: 跖骨骨折： An oblique axis that
allows even weight distribution across the metatarsal heads during heel rise.
一个斜轴，允许在脚跟抬起时均匀分布在跖骨头上的重量。 7. Windlass
mechanism: 锚链机制： The increase in
arch height during push-off is due to plantar fascia tightening, not direct
muscle action.
推离期足弓高度的增加是由于足底筋膜收紧所致，并非直接的肌肉作用。 8. Pronator
and supinator twists:
旋前与旋后扭转： Occur only when transverse
tarsal joint motion is inadequate to align the forefoot.
仅当横弓关节运动不足以使前足对齐时才会发生。 9. Tight
gastrocnemius in pes planus:
扁平足中的腓肠肌紧缩： Blocks ankle dorsiflexion,
forcing compensatory subtalar joint motion and contributing to deformity.
阻碍踝关节背屈，迫使补偿性 subtalar 关节运动并促成畸形。 10. Plantarflexed
first ray in cavus foot:
高弓足中的第一跖骨过度跖屈： Forces the hindfoot into
varus to maintain tripod balance, leading to subtalar joint stiffness.
迫使后足内翻以维持三脚架平衡，导致 subtalar 关节僵硬。 Non-surgical Management:非手术管理： 1. Footwear
advice: 鞋类建议： Can be the only
intervention needed for some foot pathologies, especially with poor footwear
choices.
对于某些足部病理，尤其是因不良鞋履选择引起的，这可能是唯一需要的干预措施。 2. Custom
orthoses: 定制矫形器： Do not guarantee
a better outcome than prefabricated or modular orthoses.
并不保证比预制或模块化矫形器效果更好。 3. Metatarsal
domes: 跖骨垫： Primarily for
offloading metatarsal heads, not for treating hammer toes.
主要用于减轻跖骨头压力，而非治疗锤状趾。 4. Reverse
Morton's extensions:
反向莫顿延长术： Used for either accommodation
or offloading of the first MTPJ, not for correcting pes cavus.
用于第一跖趾关节的适应或减负，而非矫正高弓足。 5. CROW
boots: CROW 靴： Very effective for
managing Charcot foot instability, but patient compliance is crucial.
对管理夏科氏足不稳定非常有效，但患者的依从性至关重要。 6. Rocker
sole modifications:
摇杆底部的改良： Effective for hallux rigidus,
but impracticality and limited footwear choices often lead to poor adherence.
对跖趾关节僵硬有效，但因不实用和鞋款选择有限，常导致依从性差。 7. Conservative
management of tarsal coalition:
跗骨联合的保守治疗： More successful for
talocalcaneal coalitions than calcaneonavicular coalitions.
对于距跟联合比舟楔联合更为成功。 Surgical Management:手术管理： 1. Lateral
extensile approach to the calcaneum:
跟骨的外侧伸展入路： The incision should be open
angled, not 90 degrees, and taken straight to bone over the central third.
切口应为开放角度，非 90 度，直接切至中三分之一处的骨面。 2. Posterior
approaches to the ankle:
踝关节后侧入路： Careful dissection is required
to avoid injury to the tibial nerve and posterior tibial artery.
需要仔细解剖以避免损伤胫神经和胫后动脉。 3. Dorsal
approaches to the foot:
足背入路： The relationship between EHL and
the neurovascular bundle is crucial to avoid iatrogenic injury.
EHL 与神经血管束之间的关系至关重要，以避免医源性损伤。 4. Morton's
neuroma excision:
莫顿神经瘤切除术： Ensure complete resection to
the level of the plantar branches to reduce recurrence risk.
确保完全切除至足底分支水平，以降低复发风险。 5. Arthroereisis
for pes planus:
扁平足的关节固定术： Ideal patient is an active
child with subtalar hyperlaxity and minimal forefoot abduction, not severe pes
planus.
理想患者是活动性强的儿童，伴有距下关节过度松弛和轻微前足外展，而非重度扁平足。 6. Calcaneal
lengthening for pes planus:
扁平足的跟骨延长术： Often needs to be combined
with gastrocsoleus lengthening and medial cuneiform osteotomy for full
correction.
通常需要与腓肠肌延长术和内侧楔骨截骨术结合使用，以实现完全矫正。 7. Talar
neck fracture fixation:
距骨颈骨折固定： Anterograde screw fixation is
preferred over retrograde fixation due to the lower risk of head displacement.
顺行螺钉固定优于逆行固定，因为前者距骨头移位的风险较低。 8. Medial
malleolar osteotomy for talar body fracture:
距骨体骨折的内侧踝截骨术： Pre-drill holes for screw
fixation prior to performing the osteotomy.
在进行截骨术之前，预先钻孔以进行螺钉固定。 9. Lateral
talar process fracture:
外侧距骨突骨折： Easily missed and often
misdiagnosed as an ankle sprain. CT is essential for accurate diagnosis.
常被忽视且易误诊为踝关节扭伤。CT 检查对于准确诊断至关重要。 10. Syndesmosis
fixation: 韧带联合固定： Screws should be
placed following open or arthroscopic syndesmotic reduction to minimize
malreduction risk.
应按照开放或关节镜下韧带联合复位的方式放置螺钉，以降低复位不良的风险。 11. Suture
button for syndesmosis:
韧带联合的缝合钮扣： Not suitable for vertical or
multiplanar instability.
不适用于垂直或多方位的失稳情况。 12. Plantar
fasciotomy: 跖腱膜切开术： Release no
more than 50% of the plantar fascia to avoid medial arch collapse and lateral
column overload.
释放不超过足底筋膜的 50%，以避免内侧纵弓塌陷和外侧柱过载。 13. Achilles
tendinopathy surgery:
跟腱病手术： Direct tendon corticosteroid
injections are contraindicated.
直接向肌腱内注射皮质类固醇是禁忌的。 14. Chronic
Achilles tendon rupture:
慢性跟腱断裂： The choice of reconstructive
technique depends on defect size, patient factors and surgeon experience.
重建技术的选择取决于缺损大小、患者因素及外科医生经验。 15. Lisfranc
injury fixation:
Lisfranc 损伤固定： Anatomical reduction is
critical for good outcome. Intra-articular screw fixation is associated with
higher articular damage compared to bridging plates.
解剖复位对良好预后至关重要。与桥接板相比，关节内螺钉固定与更高的关节损伤相关。 16. Amputation
level: 截肢水平： Aim for the most
distal level that achieves good healing and function.
力求达到既能良好愈合又能保证功能的最远端水平。 Postoperative Care & Complications:
术后护理与并发症： 1. Hawkins
sign: 霍金斯征： Indicates
revascularisation of the talus after fracture, but its absence does not confirm
avascular necrosis.
指示距骨骨折后血供重建，但其缺失并不证实缺血性坏死。 2. Rigid
dressing after below knee amputation:
小腿截肢后的硬质包扎： Can be useful, but requires
close monitoring for potential swelling and compartment syndrome.
可能有用，但需要密切监测潜在的肿胀和间室综合征。 本文由九楼骨科老王业余时间编辑，九楼老王是一个热爱互联网医学资源发掘、热爱分享、热爱人工智能技术的骨科80后，医学硕士。欢迎点这里订阅 九楼老王设立的知识星球“骨科医生爱科技”- 这个星球推荐有有骨科和相关（如康复、影像等）专业的朋友加入，目前已经有330+朋友，还在不断增加中。
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