楔型鞋墊於內側退化性膝關節炎患者行走時之立即療效

內側退化性膝關節炎為中老年族群常見之關節退化疾患，嚴重地影響患者的社會參與、情緒、睡眠與肢體功能。患者行走時的關節疼痛不僅會改變行走時下肢的運動學及力動學狀態，行走時整體的穩定度也會受到影響。患者亦會以外八步態企圖減輕膝關節關節力矩。外側楔型鞋墊藉由改變行走時地面反作用力的壓力中心位置，縮短地面反作用力與膝關節中心之間的力臂，進而減少患者的膝關節關節力矩、降低關節疼痛；而足弓墊能夠加強上述效果。本研究利用配備六台紅外線攝影機之動作分析系統量測運動學資料，輔以兩塊測力板量測地面反作用力，比較一款可增加行走時外八角度之後足外側暨前足內側楔型墊搭配足弓墊，與全足長外側楔型鞋墊搭配足弓墊於內側退化性膝關節炎患者行走時減輕膝關節外展力矩的效果；並探討此兩款鞋墊對於行走時步態的影響。結果發現穿戴全足長外側楔型鞋墊搭配足弓墊能夠藉由增加外八角度使壓力中心外移、減少地面反作用力與膝關節中心之間的力臂，進而減輕膝關節外展力矩，且有助於單腳站立期與雙腳站立期轉換時的穩定度；但踝關節內翻力矩顯著上升。而後足外側暨前足內側楔型墊搭配足弓墊雖亦能增加行走時的外八角度，但因內側楔型墊無法使壓力中心外移，且髖關節內收角度與踝關節外翻力矩的增加使膝關節外展力矩上升。全足長外側楔型鞋墊搭配足弓墊能立即降低輕微與中度內側退化性膝關節炎患者的膝關節負擔與疼痛，但長期追蹤效果未知，且需注意穿戴時對於踝關節的副作用；後足外側暨前足內側楔型墊搭配足弓墊則無減輕膝關節負擔的助益。

關鍵字

楔型鞋墊；足弓墊；退化性膝關節炎

並列摘要

Medial knee osteoarthritis (MKOA), the most common joint disease among the middle-aged adults and the elderly, seriously affects the function of daily living. The patients tend to adopt toe-out gait to reduce knee joint pain. Laterally-wedged insole may reduce knee joint moments and joint pain through laterally-shifting COP and decreasing lever arm between knee joint center and ground reaction force; furthermore, the arch support might enhance these effects. The aims of the current study were investigate that the differences in effect of reducing knee abductor moments in patients with mild-to-moderate MKOA between hind-laterally-wedged and fore-medially-wedged insole with arch support (HFW), the new-designed insole for increasing foot progression angle, and full-length laterally-wedged insole with arch support (FLW) through motion analysis techniques. The results indicated that FLW would reduce peak knee abductor moment through increasing foot progression angle and lateral-shifted COP. Also, it was helpful to the stability. Furthermore, ankle invertor moments were increased. In contrast, although increasing foot progression angle, HFW would increase peak knee abductor moment through increased lever arm between knee joint center and ground reaction force due to failing to make COP lateral-shifted induced by medial wedge. Therefore, compared with HFW, it is recommended that FLW is suitable for patients with mild-to-moderate MKOA but with cautioned about increased ankle loading.

並列關鍵字

Wedged insole ； Arch support ； Medial knee osteoarthritis

參考文獻

Abdallah, A. A., & Radwan, A. Y. (2011). Biomechanical changes accompanying unilateral and bilateral use of laterally wedged insoles with medial arch supports in patients with medial knee osteoarthritis. Clinical Biomechanics, 26(7), 783-789.

Al-Zahrani, K. S., & Bakheit, A. M. O. (2002). A study of the gait characteristics of patients with chronic osteoarthritis of the knee. Disability & Rehabilitation, 24(5), 275-280.

Astephen, J. L., Deluzio, K. J., Caldwell, G. E., & Dunbar, M. J. (2008). Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. Journal of Orthopaedic Research, 26(3), 332-341.

Baker, K., Goggins, J., Xie, H., Szumowski, K., LaValley, M., Hunter, D. J., & Felson, D. T. (2007). A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis & Rheumatism, 56(4), 1198-1203.

Baliunas, A. J., Hurwitz, D. E., Ryals, A. B., Karrar, A., Case, J. P., Block, J. A., & Andriacchi, T. P. (2002). Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis and Cartilage, 10(7), 573-579.

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楔型鞋墊於內側退化性膝關節炎患者行走時之立即療效

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