臺灣博碩士論文加值系統

兒童扁平足相關因素包括年齡、性別、體重等個人因素，及跟腱緊度、足跟外翻角度、全身韌帶鬆弛度、平衡能力等身體功能。兒童彈性扁平足可能會導致足痛及平衡不佳等身體功能(body function)問題，或體適能等活動(activity)問題，因而一直是家長關心的議題之一。幼稚園兒童為對象的先前相關研究中發現，追蹤一年內扁平足轉為非扁平足兒童，足弓改善與單腳平衡能力進步二者息息相關。基於此身體結構及運動功能的相關性，本研究的目的在驗證短期平衡訓練是否能改善身體功能(足弓指數、足踝結構)及活動功能(單腳平衡、牛津足踝功能問卷)。
本研究招募31名5-7歲彈性扁平足兒童，給予為期六週之單腳平衡運動訓練。評估內容包括身高、體重、足印資料、韌帶鬆弛度、足踝背屈角度、動態足壓、單腳平衡及足踝功能問卷。運動訓練是讓家長帶回長30公分、寬3公分、高3公分之木棒與運動訓練手冊，每日於家中訓練單腳平衡2回，每回須訓練兩腳各滿60秒 (以單腳站立於木棒上，不論次數，所有站立時間加起來須滿60秒)，訓練為期6週。組內比較將以成對T檢定、Wilcoxon檢定分析。
研究結果顯示在家運動訓練6週後，彈性扁平足兒童在足跟外翻角度減少1.5∘、足弓指數(CSI)進步5%、足弓指數FAI進步2%、單腳平衡能力進步16.5秒，單腳平衡運動介入對促進足弓發展有其效益；在動態足壓評估中，彈性扁平足兒童顯著減少內側中足的壓力面積、最大地面反作用力、及尖峰壓力值。足踝功能問卷腳顯示這些扁平足兒童腳痛、腳容易疲勞、無法長時間站立等項目的發生率及頻率較高；運動訓練後，各題項人數與發生頻率皆降低。
運動訓練6週後，扁平足兒童在足弓結構上有顯著差異，在耐力及兒童感受上像是對不耐站、腳痛、疲勞感狀況都有減少趨勢。由於取樣上的限制，在使用結果推論上仍須謹慎，未來需要更長的運動訓練期與追蹤，證實單腳平衡運動對彈性扁平足兒童活動及身體功能之效益。

Introduction and objectives :
Age, gender and weight, Achilles tendon tightness, ligament laxity, heel valgus angle, and balance ability are factors influencing the development of foot arch. Flatfoot in children is associated with foot pain, fatigue, and poor physical performance, therefore flatfoot has been a major concern of parents. In the previous study, children who had flatfeet were found to converted to arch feet after one year follow-up. We found that not only the arch improved, but also the one leg balance ability enhanced. Therefore, the purposes of this study are to understand the effectiveness of balance exercises on the change of the body function and activity performance in children with flexible flatfeet.
Material and Methods:
Thirty-one 5 to 9 years old typically developed children with flatfeet were enrolled and then underwent balance trainingmfor 6 weeks. The assessments include height, weight, weight bearing footprint, Carter and Wikinson’s scale of laxity, passive ankle dorsiflexion, dynamic foot pressure, one leg balance, and the Foot and Ankle Questionnaire (children version). Balance training was standing on a 3x3x30 cm3 long rectangular rod by one leg and maintaining not touching floor for a sum of 60 seconds twice sessions a day. Comparison of background data and 6-week change were performed using paired T test, Wilcoxon analysis.
Results:
After at-home training for 6 weeks, children had significant improvement in heel valgus angle (-1.5∘), one-leg balance (+16.5 sec), footprint index (-0.05), and foot arch index (-2%). In the dynamic foot pressure assessment, the medial midfoot showed significant improvement in pressure area, maximal force, and peak pressure after training. The Foot and Ankle Questionnaire (children version) showed flatfeet children were prone to fatigue and could not stand for a long time. After one leg balance exercise, the number and frequency of each item decreased.
Conclusion:
Training of one-leg balance for 6 weeks resulted in significant differences in foot and ankle structure and caused improvements in endurance and limitations in daily life. Due to the limitations of sampling, a longer period of balance training and follow up are required for a clinically significant change in activity and foot arch development.

目錄
指導教授推薦書
口試委員會審定書
序言 iii
中文摘要 v
Abstract vii
第一章 研究背景 1
1.1 前言 2
1.2 研究目的與問題 4
1.2.1 研究目的 4
1.2.2 研究問題 4
1.2.3 研究假設 4
第二章 文獻探討 5
2.1 何謂彈性扁平足 6
2.2扁平足盛行率 7
2.3影響相關因子 7
2.3.1 年齡 9
2.3.2 體重 9
2.3.3 關節活動度 10
2.3.4 肌力 10
2.3.5 體適能 11
2.4 扁平足的評估分類方法 12
2.5 扁平足造成的影響 16
2.6扁平足兒童感受 17
2.7 兒童扁平足之介入與治療 17
2.7.1 手術 18
2.7.2 科技輔具 19
2.7.3 運動訓練介入及追蹤 20
2.8 相關研究與動機啟發 22
2.9 前驅試驗 22
2.9.1 彈性扁平足兒童於6週觀察期之變化 25
2.9.2 彈性扁平足兒童於6週觀察期足壓面積、地
面反作用力、壓力尖峰值之變化 27
第三章 材料與方法 29
3.1 研究對象 30
3.2 評估項目與工具 31
3.2.1 足印分析 31
3.2.2 韌帶鬆弛度評估 32
3.2.3 足踝背屈角度評估 33
3.2.4 動態足壓測試 33
3.2.5 單腳平衡測試 35
3.2.6牛津足踝問卷 (兒童板) 35
3.3單腳平衡運動訓練 37
3.4 實驗設計 37
3.5 實驗方法與步驟 38
3.6 資料處理 40
第四章 研究結果 41
4.1 單腳平衡運動對彈性扁平足兒童日常生活活動之
改變 42
4.2 單腳平衡運動與足弓發展之關聯性 45
4.2.1運動訓練介入後各變項6週之變化 46
4.3 單腳平衡運動與足壓面積、地面反作用力、尖峰
值之關聯性 48
4.3.1單腳平衡運動於足壓面積之改變 48
4.3.2單腳平衡運動於足底最大地面反作用力之改變 49
4.3.3單腳平衡運動於足底壓力尖峰值之改變 50
第五章 討論 52
第六章 結論 58
第七章 研究限制 60
參考文獻 62
附錄 68

圖目錄
圖一、足部三足弓位置示意圖…………………………………. 6
圖二、足跟外翻示意圖………………………………………….. 12
圖三、Chippaux-Smirak 指數…………………………………… 13
圖四、足弓指標（arch index）…………………………………. 14
圖五、先前相關試驗追蹤流程圖……………………………….. 23
圖六、足弓指數CSI計算方式：中足弓的數值除以前足蹠骨
部位最寬的百分比數值（d/c*100％）…………………. 31
圖七、Harris and Beath足印墊………………………………….. 31
圖八、韌帶鬆弛度評估………………………………………….. 32
圖九、足踝背屈角度評估……………………………………….. 33
圖十、EMED動態足底壓力評估系統…………………………. 34
圖十一、EMED動態足底壓力面積區域劃分…………………. 34
圖十二、兒童版足踝問卷……………………………………….. 36
圖十三、平衡棍及運動紀錄手冊……………………………….. 37
圖十四、研究流程圖…………………………………………….. 39
圖十五、牛津足踝問卷(兒童版) 平衡運動前調查結果………. 43
圖十六、牛津足踝問卷(兒童版) 平衡運動後調查結果………. 43
圖十七、牛津足踝問卷(兒童版) 兒童版牛津足踝問卷各領域
在前後測得分情形…………………………………….. 44
圖十八、牛津足踝問卷(兒童版)各題項在前後測得分情形…... 45
圖十九、以國際健康功能分類為中心思想架構圖…………….. 56

表目錄
表一、不同受試者年齡、樣本數、扁平足鑑別診斷與評估方
法，回顧扁平足盛行率文獻 (範圍16.1% ~ 82.8% )… 8
表二、彈性扁平足兒童在運動訓練加強面向之各式活動…….. 21
表三、第一年橫斷分析各因子於平衡能力佳與否兩組比較….. 23
表四、第一年扁平足兒童，於第二年足弓發展與否兩組之各
因子比較…………………………………………………. 24
表五、前驅研究彈性扁平足兒童各變項於6週觀察期前後的變化.. 26
表六、彈性扁平足兒童於6週觀察期前後足底壓力面積(cm2)、最
大地面反作用力(N)、足底壓力尖峰值(kPa)之變化………… 28
表七、各變項之常態分佈檢測結果…………………………….. 46
表八、受試者各變項於平衡運動介入6週前後的變化……….. 47
表九、平衡運動介入6週前後足底壓力面積變化(cm2)………. 49
表十、平衡運動介入6週前後足底最大地面反作用力變化(N) 50
表十一、平衡運動介入6週前後足底壓力尖峰值變化(pKa)… 51

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