行政院國家科學委員會專題研究計畫成果報告:足底板對髕骨外傾症候群患者下肢橫面旋轉動作與足底壓力的影響（2/2）

Abstract

髕股關節疼痛症候群常見於年輕 女性與運動員，其主要症狀為前膝部產 生疼痛，以致不良於行，形成功能障 礙。髕股關節疼痛症候群與髕骨排列位 置有關，其中以髕骨外傾造成外側軟骨 磨損最常見，降低髕骨外傾現象為治療 之首要目標。臨床上，足底板提供極佳 之療效，但缺乏實證研究，故本研究將 以二年時間完成其使用後一年的臨床 療效評估，並以步態分析、足底壓力、 足底評估來了解足部畸型與髕骨外傾 之相關性。 由於病患收集不易，本研究以一年 半時間完成20 例髕骨外傾症候群患者 的足底板製作，及基本資料之蒐集。而 能完成使用足底板一年後的個案僅有8 名。基本資料包括基本人體測量學資 料、舟狀骨突高度、放鬆站立、及襯以 足底板站立時之下肢橫面旋轉角度、在 不同足底狀況步行時足部橫面旋轉的 變化，及其與健康人之間的差異。足底 狀況包括赤足、穿便鞋、或使用足底板 等三種狀況。 結果發現實驗組之放鬆站立時，舟 狀骨突高度有明顯的低於控制組，但在矩 下正中站立時，二者之舟狀骨突高度極近 似，表示其足弓消失之原因來自於矩下關 節無法維持在正中位置。如使用足底板則 可增高舟狀骨突的位置，但仍比健康人 低。一年後，其患者之舟狀骨突高度在赤 足時，並未與一年前有顯著的不同，表示 足底板僅提供支撐作用，並未改變其腳弓 結構。兩組受試者在靜止站立時，無論是 放鬆站立或是一年後追蹤，其足底壓力中 心並無明顯的差異。脛骨橫面旋轉角度無 路在放鬆站立或正中站立時，實驗組與控 制組間成顯著的差異，實驗組在一年後則 無明顯的變化，但使用足底板時，脛骨外 轉角度較小。本研究結論髕骨外傾患者多 伴隨內旋足，因此使用足底板可以減輕髕 骨外傾所造成的壓力。然而使用足底板的 作用可能僅在於控制過度內旋的動作，即 使長期使用並未改善足底的結構。

Patellofemoral pain dysfunction is common in young females and athletes. Retropatellar pain during walking and inclination results in functional and social disability. It has been documented that patellofemoral pain syndrome is highly correlated to the malposition or malalignment of the patella, especially lateral tilt of the patella. The possible mechanism is that lateral force pulling patella outwards in patients with laterally tilted patella increases compression force on the lateral facet of the patella, leading to wear in the articular cartilage. Therefore, controlling the lateral pulling force of the patella is the main strategy to treat patients with patellofemoral pain syndrome. Clinically, functional foot orthoses have been reported to have dramatic effect in treating patellofemoral pain, but none of them is done on the base on the controlled studies. The purpose of this research, therefore, was to investigate the effect of functional foot orthoses on transverse rotation and foot structure in patients with patellofemoral syndrome. The specific aim of the first-year research was to investigate the immediate effect of functional foot orthosis on transverse rotation of the lower extremity in patients with patellofemoral pain syndrome and that of the second-year research was to investigate the effect after 1 year. All of research variables were measured for 3 different conditions, including barefoot, wearing shoes, or wearing functional foot orthoses. The patella position, navicular height, both in relaxed and in subtalar neutral positions, were measured using Vicon 250 system. The trajectory of the tibial rotation and foot pronation was analyzed to understand the relationship of foot deformity and patellar lateral tilt. Results showed that there was singnificant difference in the navicular height and tibial rotation between the experimental and control group, but not in the percent of the center of pressure relative to the foot length during quiet stance. It implies that patients with patella tilt syndrome may have a pronated foot that exaggerates the clinical symptoms. Functional foot orthoses can relieve their symptoms through controlling excessive foot pronation but doesn’t change the whole structure of the foot.