臺灣博碩士論文加值系統

足底筋膜炎為足部最為常見之病變之一，其成因包括過度荷重、使用及不當的訓練等因素。由生物力學觀點來看，任何可能導致足底筋膜產生不正常張力之因素，皆會使得足底筋膜與其附著端相連組織產生牽扯與傷害，而導致足底產生病變。對於足底筋膜炎的治療方式，通常會配合物理治療、足弓護墊，及足底筋膜舒張等方式。其中在足底筋膜舒張的各種方式中，以「藉由阿基里斯腱拉力舒張足底筋膜」及「以被動式彎曲趾骨舒緩足底筋膜」兩種方式最為常見。雖知道被動式彎曲趾骨能有效舒緩足底筋膜，卻不知彎曲趾骨角度對於足底筋膜拉力的影響程度，以及到何種程度才可達到有效舒緩。所以針對被動式彎曲趾骨舒緩方式進行研究，探討彎曲腳趾角度及足底筋膜在生物力學行為及其力量傳遞上、應力之走向有何差異，提供臨床醫師復健之參考。研究結合醫學影像處理與逆向工程、電腦輔助模擬分析等技術。利用有限元素軟體，建構出三維足部外型之有限元素模型。針對本研究探討分析重點，在蹠趾關節處給予接觸元素(Contact)，以模擬軟骨之間滑動情形，及足底筋膜材料分別使用線性及非線性模擬。並配合不同趾骨關節彎曲角度(15°、30°、45°)及不同阿基里斯腱拉力(100、200、300、400、500N)下的力學反應，共進行30組電腦模擬分析。本模型已在元素大小0.6時達到收歛，並與Carlson臨床實驗數據比對驗證成功。分析結果發現，在旋轉腳趾與阿基里斯腱拉力下，足底筋膜受力均有上升之表現。進一步觀察，當彎曲腳趾角度達30°時，若角度繼續增大，其足底筋膜受力上升趨緩，此與學者屍骨實驗結果近似。然而，此結果是否與實際舒緩效果相關，仍須與臨床實驗加以比對證實。此外，觀察足底筋膜最大受力值位置，均發生於足跟骨區域。由此可以生物力學行為觀點，解釋足部病變常發生於足跟之成因。

Plantar fasciitisis one of the most common pathology of the foot. It may cause by overuse, excessive weight or improper training. From biomechanical point of view, any factors that may cause excessive strain to the plantar fascia might lead to inflammation and injuries. Treatment protocols for plantar fasciitis generally include physical therapy, assistive orthotics and stretch exercises, etc.. The most frequent used among them are Achilles tendon stretch and direct plantar fascia stretch. Although direct stretch by dorsiflexing the toes was found effective by researchers, the relationship between the toe dorsiflexion angles and the stress onto plantar fascia was not clear. Therefore, the purpose of this study is to find out the relationship between toe dorsiflexion angles and its biomechanical influence onto plantar fascia tension. The results should be able to provide insights to clinicians. The current study integrates imaging processing, reverse engineering and finite element techniques. A three-dimensional finite element foot model was built for biomechanical analysis. The model was tested for its numerical stability and validated with Carlson’s cadaver study results. The main focus of this study was to find out the relationships between toe dorsiflexing angles and its effect onto plantar fascia tension changes. Contact elements were used in metatarsophalangeal joints to simulate the movement between cartilages. Both linear and nonlinear plantar fascia material properties were discussed. Thirty simulations were done in combination of three different toe dorsiflexing angles (15, 30, 45) and five Achilles tendon forces (100,200,300,400,500N). The results indicated that both dorsiflexing the toes and Achilles tendon force increased plantar fascia tension, and the tension increased as the angle and force increased. As the toe dorsiflexed beyond 30, the tension increase slowed down comparatively. This finding was similar to previous research findings. However whether the clinical implication of this results require further validations. Results also indicated the maximum stress located near calcaneal tubercle and this corresponded to plantar fasciitis clinical representations.

指導教授推薦書 i
口試委員會審定書 ii
博碩士論文電子檔案授權書 iii
長庚大學博碩士紙本論文著作授權書 iv
誌謝 v
中文摘要 vi
英文摘要 viii
目錄 x
表目錄 xiv
圖目錄 xv
第一章 緒論 1
1.1研究背景 1
1.1.1足部結構概述 1
1.1.2足底筋膜簡介 4
1.1.3足底筋膜炎 4
1.1.4足底筋膜炎治療方式 6
1.2有限元素法 10
1.3研究動機 12
1.4文獻回顧 13
1.4.1探討彎曲趾骨角度對足底筋膜受力的影響 13
1.4.2足部三維有限元素模型 14
1.4.3足底筋膜非線性材料設定 15
1.4.4文獻總結 17
1.5研究目的 18
第二章 材料與方法 19
2.1研究流程 19
2.2電腦斷層與逆向工程處理 21
2.2.1電腦斷層影像拍攝及擷取 21
2.2.2電腦斷層影像重組 21
2.2.3曲面切割擷取點資料 23
2.3三維足部有限元素模型建構 25
2.4足底筋膜非線性材料給定 27
2.5邊界及負荷條件設定 29
2.6模型驗證 31
2.6.1收斂性測試 31
2.6.2有限元素模型與文獻比對 32
2.7電腦模擬分析參數設計 33
第三章 結果 35
3.1三維足部有限元素模型之建構 35
3.2三維足部有限元素模型之收斂性測試 36
3.2.1總應變能結果觀測 36
3.2.2位移量結果觀測 36
3.3三維足部有限元素模型之模型驗證 37
3.4三維足部有限元素模型之分析結果 38
3.4.1足底筋膜應變量 38
3.4.2足底筋膜應力、應變分布 38
3.4.3旋轉腳趾與足弓高度變化 40
第四章 討論 41
4.1有限元素模型 36
4.1.1研究重要性 41
4.1.2電腦模擬分析 42
4.4.3有限元素模型驗證 44
4.2三維足部有限元素模型之分析 45
4.2.1足底筋膜應變量 45
4.2.2足底筋膜應力、應變分布討論 46
4.2.3旋轉腳趾與足弓高度變化討論 47
4.3有限元素模型分析假設與限制 48
第五章 結論 50
參考文獻 51




表目錄
表一、足部骨骼概述與數目 54
表二、本研究之元素形式與材料特性表 54
表三、本研究規劃之參數表 55
表四、模型總應變能56
表五、收斂性測試之硬骨位移量 56
表六、模型驗證之足底筋膜應變量 56
表七、模型靜態分析之足底筋膜應變量 57
表八、足底筋膜在旋轉腳趾15°-30°與30°-45°下受力比 58
表三、旋轉腳趾角度與足弓高度變化 58





圖目錄
圖一、足部骨骼構造圖 59
圖二、足部關節與軟骨 60
圖三、右小腿肌肉 61
圖四、足部韌帶 62
圖五、足底解剖圖 62
圖六、絞盤機制示意圖 63
圖七、足底筋膜承重示意圖 63
圖八、足跟骨骨質增生之X光片 64
圖九、足底超音波圖像顯示 65
(a)正常人足底筋膜 65
(b)足底筋膜病變 65
圖十、(a)被動式彎曲蹠骨關節舒張足底筋膜動作 66
(b)動作示意圖 66
圖十一、(a)藉由阿基里斯腱拉力舒張足底筋膜動作圖解 66
(b)動作示意圖 66
圖十二、有限元素分析流程圖 67
圖十三、設定彎曲腳趾不同角度 68
圖十四、足底筋膜張力 68
圖十五、Chen等學者三維足部有限元素模型 69
圖十六、Camacho等學者三維足部有限元素模型 69
圖十七、Thomas等學者三維足部有限元素模型 70
圖十八、Cheung等學者三維足部有限元素模型 70
圖十九、肌肉橫向圖 71
圖二十、遲滯現象示意圖 71
圖二十一、研究流程圖 72
圖二十二、足部電腦斷層影像 73
圖二十三、調整影像對比閥值 74
圖二十四、選取所需硬骨部分 74
圖二十五、足部三維立體影像 75
圖二十六、三維立體影像表面積切割 75
圖二十七、AVS UCD ascii (.inp)格式76
圖二十八、逗點分隔值(.CSV)格式 76
圖二十九、特徵曲面輪廓點資料 77
圖三十、足部有限元素模型線段 77
圖三十一、足部有限元素模型體積 78
圖三十二、足部有限元素模型-足底筋膜 78
圖三十三、人體足底筋膜應力應變圖79
圖三十四、二階Mooney-Rivlin程式曲線圖79
圖三十五、定義矩陣維度 80
圖三十六、實驗數據輸入矩陣 80
圖三十七、矩陣運算後所得五參數 81
圖三十八、輸入Mooney-Rivlin材料參數 81
圖三十九、Mooney-Rivlin材料設定完成曲線圖81
圖四十、空間中節點對於一假想軸旋轉示意圖82
圖四十一、假想軸於空間座標投影之示意圖82
圖四十二、負荷條件之給定83
圖四十三、四組不同網格大小的模型83
圖四十四、收斂性測試觀測之節點84
圖四十五、模型驗證觀測足底筋膜之位置84
圖四十六、足部三維有限元素模型85
圖四十七、收斂性測試之硬骨位移量86
圖四十八、模型驗證之足底筋膜應變量87
圖四十九、靜態模擬分析之應變值趨勢圖88
圖五十、足底筋膜在旋轉腳趾15°-30°與30°-45°下受力比例89
圖五十一、固定阿基里斯腱拉力500N，不同旋轉腳趾角度下足底筋
膜應力、應變分布圖90
圖五十二、不同阿基里斯腱拉力與不同旋轉腳趾角度下足底筋膜應
力、應變分布圖91
圖五十三、靜態模擬分析與學者實驗之應變值趨勢比較圖92
附錄A英文論文文稿
附錄B已發表之研討會論文文稿

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