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研究生:吳心慈
研究生(外文):Hsin-Tzu Wu
論文名稱:內側足弓墊於扁平足病例站立平衡之效應
論文名稱(外文):The efficiency of medial longitudinal inserts for standing balance in flatfoot patients
指導教授:鄭誠功鄭誠功引用關係李宏滿李宏滿引用關係
指導教授(外文):Cheng-Kung ChengHung-Maan Lee
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫學工程研究所
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:63
中文關鍵詞:扁平足平衡內側足弓墊
外文關鍵詞:flatfootbalanceinserts
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足部的過度旋前會造成站立平衡和本體感覺不佳及較差的生物力學表現而且扁平足孩童行走時常會有笨拙或步態零散、平衡不佳的情形。但並無研究文獻確切證明扁平足病例於站立平衡與正常足部間的差異,因此本研究欲找出其間之差異。此外,內側足弓墊是否能對扁平足靜態平衡之表現有所助益更是此研究的另一個重點。
使用足弓指標來判定受測者為扁平足,足弓指標(Arch Index)數值<=0.21為高弓足;0.211-0.259為正常足;>=0.26為扁平足。受測對象分為兩組:柔軟性扁平足青年(Arch Index >0.26;平均足弓指標R=0.35、L=0.35,N=16)及正常足青年(Arch Index 0.211-0.259,N=14)。測試儀器及設備包括:由桃園國軍總醫院骨科部李宏滿主任自行研發的電腦化平衡感測試機及Con-Trex肌力測試機。平衡測試包括:雙腳開眼站立、雙腳閉眼站立、慣用側及非慣用側單腳開眼站立,收集靜止站立於平衡台上1分鐘之傾斜角度。肌力測試包括:膝關節及踝關節兩部分,膝關節肌力測試是採用(Isokinetic Testing)膝關節屈曲0-90度;速度為180度/秒;而踝關節則是(Isokinetic Testing)踝關節背屈15度-蹠屈45度;速度為120度/秒。
扁平足與正常足間於年齡、身高、體重下肢肌力並無差異性。結果發現扁平足與正常足間除了雙腳閉眼站立並無統計上之差異外(p=0.193>0.05),其餘三種測試扁平足表現皆較正常足差(p=0.0009;0.0002;0.0001<0.05)。在內側足弓墊效應方面,扁平足於平均傾斜角度這個參數無論穿著內側足弓墊與否其平衡表現皆無差異性(p>0.05),然而卻發現雙腳開眼站立穿著內側足弓墊後內外方向傾斜角度減低(p=0.034)但前後方向傾斜角度則有增加的情形(p=0.026)。慣用側與非慣用側單腳站立亦有如雙腳開眼站立內外方向傾斜角度減低及前後方向傾斜角度增加之趨勢但其間不具統計上差異。另外,扁平足與正常足無論是否穿著內側足弓墊其慣用側與非慣用側平衡表現並無統計上之差異。然而扁平足慣用側或非慣用側單腳站立平衡與足弓指標數值並無相關性,無法由足弓指標數值來看出扁平足病例站立平衡之表現。
扁平足於雙腳開眼站立、慣用側及非慣用側單腳站立平衡較正常足差。使用內側足弓墊可減低內外方向傾斜角度和疼痛、限制其後足過渡的活動並提供扁平足病例於正常的足部結構下行走生活進而舒緩足部疼痛改善其生活品質。
Hyperpronative feet could cause poor standing balance and poor proprioception. Adults with flat feet demonstrate several biomechanical inefficiencies in the foot and ankle, and a variety of gait abnormalities. While watching the child walk, there may be clumsiness or looseness to their gait or poor balance. But there was no literatures to prove the difference between flatfoot and normal feet in standing balance. In this study we hope to identify the difference in dynamic balance between 2 groups and to determine the efficiency of medial longitudinal inserts in flatfoot. Arch Index greater than 0.26 was defined as flatfoot. Sixteen young men were included in this study(mean values of Arch Index: R=0.354、L=0.347)and fourteen normal individuals were as a control group(values of Arch Index between 0.211-0.259). The Computerized Balanced-test Machine(self designed)and Isokinetic Dynanometer(Con-Trex system) were using for measurement. Balance test included double-legs opened eyes、double-legs closed eyes, dominated side single-leg standing and non-dominated side single-leg standing. Muscle strength testing included isokinetic testing with speed 180o /s for knee and speed 120o /s for ankle. There is no difference between flatfoot and normal feet in ages、height、weight and lower limbs strength. Flatfoot were poor balance performance than normal feet statistically except double-legs closed eyes this subtest(p=0.193>0.05). There is no difference in mean tilt angle in flatfoot with/without inserts(p>0.05). M-L tilt angle was decreased and A-P tilt angle increased found flatfoot with inserts. There was no significant difference between dominated and non-dominated side in single-leg with/without inserts in both group statistically. It had no correlation with Arch Index value between dominated and non-dominated side single-leg standing performance. Flatfoot has poor balance performance than normal group. The medial longitudinal inserts can reduce M-L tilt angle. This also can relieve pain, restrict hindfoot over motions and then provide flatfoot with normal foot structure walking in their life span.
目錄
中文摘要 Ⅰ
英文摘要 III
目錄 V
圖目錄 VIII
表目錄 XI
第一章 前言 1
1-1足骨與足關節簡介 1
1-1.1足部骨骼簡介 2
1-1.2足關節簡介 5
1-2 足部與踝關節的運動生物力學 8
1-2.1足部運動學 8
1-2.2 步態週期 10
1-2.3 足部運動力學 12
1-2.4 踝關節運動學 15
1-2.5 踝關節運動力學 16
1-3 扁平足 17
1-4平衡與姿勢控制 20
1-5 文獻回顧 21
1-5.1 足印參數回顧 21
1-5.2 平衡參數之相關研究 25
1-5.3 足部裝具於平衡表現相關研究 26
1-6 研究動機與目的 28
第二章 材料與方法 29
2-1定點足印判定扁平足 29
2-2 測試對象 29
2-3 測試儀器及設備 30
2-4 測試項目 35
2-4.1 電腦化平衡感測試機 35
2-4.2 Con-Trex肌力測試機 35
2-5 測試流程 36
2-6 資料分析 38
2-6.1電腦化平衡感測試機資料分析 38
2-6.2 下肢肌力資料分析 39
2-6.3統計方法 39
第三章 結果 40
3-1 參與受測對象 40
3-2 扁平足與正常受測者平衡之比較 41
3-3 內側足弓墊於平衡之效應 44
3-3.1 扁平足(實驗組) 44
3-3.2 正常受測者(對照組) 47
3-4 慣用側與非慣用側平衡表現之比較 50
3-5 足印與站立平衡之相關性 53
第四章 討論 55
4-1 扁平足與正常足平衡表現之討論 55
4-2 內側足弓墊平衡效應之討論 56
4-3足印與站立平衡相關性之討論 57
4-4 研究限制 58
第五章 結論 59
參考文獻 60
參考文獻
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