遲緩兒童扁平足篩檢探討

Investigation of Flatfoot Screening in Developmentally Delayed Children

董莉貞(Li-Chen Tung) ； 蕭珮琦(Pei-Chi Hsiao) ； 周偉倪(Willy Chou) ； 許正澂(Cheng-Cheng Hsu) ； 林彣芷(Wen-Chih Lin) ； 杜詠文(Isbel Tou)

《台灣復健醫學雜誌》 36卷1期 (2008/03) Pp. 31-37

https://doi.org/10.6315/2008.36(1)04

摘要

扁平足乃指足部內側縱弓消失或異常塌陷所致，大部分的扁平足屬於可回復性之扁平足(flexible flatfoot)，遲緩兒童因下肢肌肉無力導致肌肉間彼此不協調或關節攣縮，也會產生扁平足。根據2001 Chii-Jeng Lin 之研究指出扁平足會影響步態以及單腳站、跳躍能力表現，其認爲扁平足不單純只是骨骼結構問題，也會影響足部動態功能表現。遲緩兒童本身動作已有顯著障礙，若再合併扁平足，將可能進一步影響動作表現能力。
本研究乃針對機構中遲緩兒童採集足印(footprint)進行扁平足篩檢，以瞭解其發生扁平足之比率，另對於關節鬆弛度與扁平足之相關性以Beighton score進行統計分析。研究結果共收集77位遲緩兒童足印記錄，將其依據年齡作分組，根據arch index 評估結果，一至不足二歲發生扁平足比率爲100%（全爲重度），二至不足三歲100%（輕至中度10%，重度90%），三至不足四歲98%（輕至中度7%，重度91%)，四至不足五歲98%（輕至中度31%，重度67%），五至不足六歲90%（輕至中度7%，重度83%），六歲以上85%（輕至中度30%，重度55%）。若以Chippaux-Smirak index評估則各組比率分別爲100%（全爲重度），100%（全爲重度），98%（全爲重度），89%（中度10%，重度79%），87%（中度7%，重度80%），80%（中度5%，重度75%）。以Clarke's angle評估各組比率爲100%（全爲重度），90% （全爲重度），100%（全爲重度），93%（中度8%，重度85%），83%（全爲重度），85%（中度5%，重度80%）。研究結果與Dr Lin研究比較顯示遲緩兒童發生扁平足之比率較同齡正常兒童高出許多，另關節鬆弛度與扁平足相關性的統計分析結果顯示Beighton score與扁平足比率並無統計意義，兩者無顯著關連性。由於遲緩兒童扁平足比率偏高，其對遲緩兒動作表現應有一定程度的影響，是否需要積極介入扁平足的矯治，有必要審慎考量。

關鍵字

扁平足 ； 足印 ； 遲緩兒童

並列摘要

Flatfoot disease is caused by disappearance or collapse of the medial longitudinal arch of the foot. Most of patients with flatfoot disease have what is known as ”flexible flatfoot”. Flatfoot in developmentally delayed children, however, is due to muscle weakness of lower limbs, which leads to disproportionate muscle growth or joint contracture. A study conducted by Chii-Jeng Lin in 2001 indicated that flat-footedness may influence gait, single-foot standing, and jumping ability. The author considered that flat-footedness was not only a problem in skeletal structure but that it may also be a consequence of dynamic foot function. Children with developmental delays have significant difficulties in movement expression. If these children also have flatfoot disease, their movement expression might be further negatively impacted.
Methods: In this study we collected the footprints of 77 developmentally delayed children in a specialeducation school to screen for flatfoot disease to ascertain the rate of flat-footedness in this population. A statistical analysis of the correlation between joint laxity and flat-footedness was then performed by Beighton score.
Results: The rate of flatfoot disease in the age groups evaluated by arch index were as follows: ages 1 to＜2 years, 100% (all are severe); ages 2 to＜3 years, 100% (mild to moderate 10%, severe 90%); ages 3 to＜4 years, 98% (mild to moderate 7%, severe 91%); ages 4 to＜5 years, 98% (mild to moderate 31%, severe 67%); ages 5 to＜6 years, 90% (mild to moderate 7%, severe 83%); and ages 6 years and older, 85% (mild to moderate 30%, severe 55%). If the data were evaluated by Chippaux-Smirak index, the rate in each age group were as follows: ages 1 to＜2 years, 100% (all are severe); ages 2 to＜3 years, 100% (all are severe); ages 3 to＜4 years, 98% (all are severe); ages 4 to＜5 years, 89% (moderate 10%, severe 79%); ages 5 to＜6 years, 87% (moderate 7%, severe 80%); and ages 6 years and older, 80% (moderate 5%, severe 75%). If the Clarke's angle was used for data evaluation, the rate in each age group were as follows: ages 1 to＜2 years, 100% (all are severe); ages 2 to＜3 years, 90% (all are severe); ages 3 to＜4 years, 100% (all are severe); ages 4 to＜5 years, 93% (moderate 8%, severe 85%); ages 5 to＜6 years, 83% (all are severe); and ages 6 years and older, 85% (moderate 5%, severe 80%). There were no significant differences between the Beighton score and the rate of flat-footedness in this population of children.
Conclusions: The results of this study compared with the results of Chii-Jeng Lin showed that there was a higher rate of flatfoot in developmentally delayed children than in normal children in the same age groups. The results of statistical analysis showed that there were no connection between joint laxity and the rate of flat-footedness. Flatfoot interrention must be actively considered in developmentally delayed children because of the higher rate of flat-footedness, as this disease influences these children's movement expression to some extent.

並列關鍵字

flatfoot ； footprint ； developmentally delayed children