彈性低位岱氏貼紮對第一趾節活動度之影響

Effect of Elastic Low-Dye Taping on First Ray Mobility

戴瑞敏(Jui-Min Tai)

指導教授 ： 柴惠敏

共同指導教授 ： 王淑芬

國立臺灣大學/醫學院/物理治療學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.00972

摘要

第一趾節係指由第一蹠骨及第一楔狀骨所組成的足部功能單位，在足部承重活動時扮演極重要的角色。內旋足者的第一趾節處於較背屈位置，其過大的活動度影響足部的正常活動，進而形成傷害。常見的保守療法是低位岱氏貼紮，雖可改善足底內側過多的壓力、支撐內縱足弓，以改善臨床症狀；但貼紮對第一趾節功能的影響從未有實證研究佐證。主要是因缺乏良好的量測第一趾節的工具，過去雖有數名學者提出量測方法，但有些過於複雜，有些則信度不高，故本研究團隊研發出信、效度較高的改良式趾節量尺。本研究即使用改良式趾節量尺與三維動作分析系統來測量第一趾節活動度與推蹬動作時的功能角度，藉以探討彈性低位岱氏貼紮對內旋足者第一趾節的影響。其具體目標有二：其一是探討彈性低位岱氏貼紮對內旋足者於無承重時之第一趾節位置與活動度的影響；其二是探討彈性低位岱氏貼紮對內旋足者於承重時之第一趾骨肢節角度與第一蹠趾關節角度的影響。

本研究屬於便利抽樣、前瞻性研究、擬試驗分析、順序隨機、前後測研究的設計。總計收集受試者23名，皆為內旋足者。本研究主要測試項目為使用改良式趾節量尺於坐姿進行第一趾節活動度測試與使用三維動作分析系統於站立進行推蹬測試，所有測試皆在同一日進行。每名受試者以隨機順序方式，在有貼紮與無貼紮的兩個狀況下接受測試，中間間隔20分鐘。兩個狀況的量測內容相同，皆為先接受第一趾節活動度測試，量測矩下正中位置時的第一趾節位置與活動度；再接受推蹬測試，分析第一蹠骨肢節角度與第一蹠趾關節角度。所有的常態分佈的連續數資料皆以配對t檢定分析贴紮的效益，而非常態分佈則以曼惠特尼U檢定分析。所有的統計皆在SAS9.13版中進行，顯著水準訂在α= 0.05，而檢定力則訂在0.8。
本研究結果顯示，彈性低位岱氏貼紮使內旋足者於無承重時之第一趾節位置改變至較接近正中的位置，並顯著的降低其過多的背屈活動度。於承重時，第一蹠骨與地面間的肢節角度不會有變化，但是貼紮則會顯著的增加內旋足者第一蹠趾關節角度。顯示在第一蹠骨與地面的角度不變的狀況下，從皮膚黏貼的彈性低位岱氏貼紮會改變第一蹠趾關節的使用情形，而使之不易出現夾擠的現象，而利於行走的推進。本研究的前導研究，為改良式趾節量尺於第一趾節活動度測試的高信效度，也提供佐證。

關鍵字

彈性貼紮 ； 第一趾節 ； 改良式趾節量尺 ； 推蹬動作

並列摘要

First ray is defined as a functional unit which is composed of the first metatarsal and first cuneiform bones. It plays an important role during weight-bearing activities, especially at the midstance and propulsive phases during ambulation. A pronated foot is usually associated with dorsiflexed first ray, developing foot pain, abnormal gait pattern, or injuries to other weight-bearing joints. Although low-Dye taping is used clinically to treat first ray disorders, there has been no evidence-based research to explore its effects on first ray mobility. Lack of a valid and reliable clinical measurement tool makes the research be difficult. In literature review, some authors used a complicated setup to measure first ray mobility while some used less reliable tools. Our research team modified the first ray ruler and found its high reliability in 2007. Therefore, the purpose of this research was to examine the effects of elastic low-Dye taping on first ray mobility using modified first ray ruler and motion analysis system in individuals with pronated foot. The objectives were (1) to compare the differences in first ray position and mobility between with and without elastic low-Dye taping in individuals with pronated foot and (2) to compare the differences in the segmental angle of the first metatarsal bone and the angle of the metatarsophalangeal joint between with and without elastic low-Dye taping in individuals with pronated foot.

The present research was a convenience sampling, prospective, quasi-experimental, randomized-order, and pretest/posttest design. Twenty-three persons with pronated foot participated in this study. The position of the first ray at the subtalar neutral position as well as dorsal and plantar mobility of the first ray were measured at the sitting position using a modified first ray ruler while the segmental angle of the first metatarsal bone and first metatarsophalangeal angles during push-off were measured using motion analysis system on the same day. Each participant received those two tests under two conditions, with or without taping, in a random order and with a 20-min rest interval in between. For each condition, the first ray mobility test was performed first and then the push-off test. All data with normal distribution were examined using the paired t-tests to compare the differences between taping and non-taping conditions whereas those with non-normal distribution were tested using the Mann-Whitney U test. All statistical analyses were executed using SAS v.9.13. The significant level was set at α = 0.05 while the power was at 0.8.

The results showed that application of elastic low-Dye taping changed the first ray position to a more plantarflexed position for these participants and returned to their nearly normal mobility in non-weight–bearing condition. Elastic low-Dye taping also significantly increased first metatarsophalangeal joint angle in weight–bearing condition only based on the similar segmental angle of the first metatarsal bone during push-off motion. Additionally, the reliability and validity tests for the modified ruler prior to this experiment also provides a powerful evidence to support that the modified first ray ruler presents a high reliability and validity.

並列關鍵字

elastic taping ； first ray ； modified first ray ruler ； push-off

參考文獻

Allen, M.K., Cuddeford, T.J., Glasoe, W.M., DeKam, L.M., & Lee, P.J. ( 2004 ). Relationship between static mobility of the first ray and first ray, midfoot, and hindfoot motion during gait. Foot and Ankle International, 25(6), 391-396.

Birke , J.A., Franks , B.K., & Foto, J.G. (1995). First ray joint limitation, pressure, and ulceration of the first metatarsal head in diabetes mellitus. Foot and Ankle International, 16(5), 277-284.

Buell, T., Green, D.R., & Risser, J. (1988). Measurement of the first metatarsophalangeal joint range of motion. Journal of the American Podiatric Medical Association, 78(9), 439-448.

Cornwall, M.W., Fishco, W.D., McPoil, T.G., Lane , C.R., & O'Donnell, D. (2004). Reliability and validity of clinically assessing first-ray mobility of the foot. Journal of the American Podiatric Medical Association, 94(5), 470-476.

Dye, R.W. (2007). A strapping: The Journal of the National Association of Chiropodists-Podiatrists and Pedic Items, November 1939. Journal of the American Podiatric Medical Association, 97(4), 282-284.