臺灣博碩士論文加值系統

研究背景及目的：下肢受傷及疼痛在長跑選手中是相當常見的。造成下肢受傷或功能不良的原因之ㄧ是內旋足（ponated foot）。內旋足可定義為距下關節（subtalar joint）或中跗骨關節（midtarsal joints）在步態行走中或執行日常生活中各式活動時產生過多的代償性旋前（ponation）所造成的。過多的代償性旋前，除了可能影響足踝關節的功能外，更可能藉由閉鎖動作鏈進而影響膝關節、髖關節、骨盆及腰椎之功能及傷害的產生。內旋足的保守性治療方法有運動、貼紮及足部輔具等等。許多研究指出藉由不同材質的矯形支具(orthoses)可有效降低活動時下肢所產生的疼痛及增進其生活功能。除此之外，亦有研究指出足部輔具的介入的確影響了走路及跑步時的關節活動狀況。然而，目前仍尚未有實驗性質研究，探討足部輔具對於長跑選手在跑步中產生之下肢疼痛及相關失能之治療效果。因此本實驗研究目在於探討足部輔具矯治長跑選手之內旋足，對於選手們下肢功能不良的情形有無改善，包含在疼痛參數（強度、發生時間）的改變狀況。實驗設計及方法：本研究為採用隨機分配的實驗，共有二十四位有內旋足之長跑選手，跑步時伴隨有前膝痛或足痛情形者收取至本實驗，所有受測者將接受隨機分配至足部輔具介入治療組及控制組各十二人。受測者以書面同意進入本實驗後，填寫跑步習慣相關問卷且接受一般肌肉骨骼的理學檢查及跑步機的跑步測試（60分鐘、速度自訂、坡度零），以紀錄選手們跑步中所產生疼痛的時間點及疼痛強度。在間隔一週的第二次跑步測試，依隨機分配的組別介入不同的鞋墊，探討鞋墊之立即效果。治療組為一般軟式鞋面加上半硬式內側腳跟楔型足墊；控制組則僅接受軟式鞋面。即二次測試後，所有受測者帶回鞋墊，並穿戴於例行的跑步練習中。間隔兩週後進行最後一次跑步機測試，紀錄疼痛相關參數，探討鞋墊之短期療效。疼痛程度以VAS（visual analog scale）量表表示。統計分析上包含：針對所有受測者基本資料作描述性統計分析，並以獨立t檢定（independent t test）來比較兩組在起始狀況有無差異，以卡方檢定（chi-square test）探測兩組對於症狀解除的效益，另外以二維重複共變數分析（two-way repeated measures analysis of covariance）之測試法來檢測足部輔具介入在不同時間點上兩組減輕疼痛之效益比較。α值設定為0.05，而對於重複共變數分析結果校正α值為0.02以避免重覆分析可能帶來的Ι類錯誤。結果：卡方檢定結果顯示治療組相對於控制組在疼痛解除上有立即效果（p=0.04）及短期效果（p=0.01）。對於兩組在疼痛強度的差異上，二維重複共變數分析結果顯示時間效果在起始測試及第三次測試間；在疼痛產生的時間上，兩組雖無統計之顯著差異，但兩組跑者均有延長跑步中發生疼痛時間的趨勢。討論及結論：本實驗結果支持實驗假說，即藉由楔型足墊介入將減輕疼痛發生的強度。此實驗可提供臨床上有內旋足之長跑選手併發有前膝痛或足痛之處置參考，亦能將簡易型楔型足墊更廣泛運用在臨床上或運動場上。

Background: Lower extremity injury and pain are common among long distance runners. One of the major contributing factors for these problems is pronated foot. Pronated foot is defined as excessive compensatory pronation of subtalar joint or midtarsal joint during walking, running, or other weight-bearing tasks. Conservative managements for the pronated foot often involve exercise, taping, and foot orthotics. It has been shown that the use of foot orthoses significantly reduced lower extremity pain during activities and increased functional level. In addition, the changes in joint motion were identified with the use of foot orthotics. However, there is still no experimental study examing the effect of orthosis intervention on lower extremity dysfunction in long distance runners. Purpose of the study: This study was designed to evaluate the effects of orthoses in runners with pronated foot related lower extremity dysfunction. Study design: Randomized control trail design. Method: Twenty-four long distance runners with pronated foot and associated anterior knee pain or foot pain during running were included in this study. After the evaluation of the basic data, including lower extremity alignment, flexibility, musculoskeletal characteristics, and running habits, all subjects performed the first 60 minutes treadmill test to record the baseline data. The subjects were then randomized into the treatment group or the control group. After one week, the subjects had the second visit, and the orthosis was applied. The 2nd treadmill test was administered right after the orthosis application to examine the immediate effect of the foot orthosis. A soft insole with a semi-rigid rearfoot medial wedge was given to the treatment group, and a soft insole was to the control group. The short term effect was examined at the 3rd treadmill test after two weeks of orthosis application. Pain intensity (VAS, visual analog scale) and onset time were recorded during the treadmill test. Statistical Analysis: Descriptive statistics were used to express individual basic data, and the independent t test was performed for the comparison of running habits, lower extremity alignment, and flexibility between two groups. Chi-square test was used to determine the between-group differences of the presence of the symptom during the running test. Two-way repeated measures analysis of covariance (ANCOVA) was used to determine the between- and within-group differences in pain intensity and onset time. The level of statistical significance was set at 0.05 for t test and Chi-square test, and the adjusted level of statistical significance was set at 0.02 for repeated measures analysis. Results: The results of chi-square showed a statically significant pain reduction at the immediate (p=0.04) and short-term (p=0.01) effect of foot orthosis in the treatment group as compared to the control group. The result of ANCOVA showed a significant difference in the pain intensity between the baseline and the 3rd test (short-term effect). Conclusion: The use of the rearfoot medial-wedged insole in long distance runners with pronated foot related anterior knee pain or foot pain effectively decreased the pain. Further research should focus on the exploration of the mechanism of the orthotic effect and its relation to the performance outcome.

Acknowledgements…………………………………………………i
Table of Contents………………………………………………ii
List of Tables…………………………………………………iii
List of Figures…………………………………………………iv
Abstract (Chinese)……………………………………………vi
Abstract (English)……………………………………………viii
Chapter 1 Introduction………………………………… 1
Chapter 2 Literature Review………………………… 3
Chapter 3 Pilot Studies…….……………………… 15
Chapter 4 Methods……………………………………… 23
Chapter 5 Results……………………………………… 28
Chapter 6 Discussion……………………………………30
Chapter 7 Conclusion……………………………………37
References…………………………………………………38
Tables………………………………………………………46 Figures…………………………………………………… 54
Appendices…………………………………………………72

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