- 期刊
從局部到整體的拇趾外翻針灸介入病例報告
Holistic view of Acupuncture for Hallux valgus : A case report
摘要
本案例為37歲女性，平常工作需要大量步行、久站，自述在學時期就有容易足底抽筋的問題；於2021年1月開始大量爬山、健走後發覺雙足大趾關節內側疼痛越來越嚴重，特別是右側疼痛加重明顯，VAS由2分進展至9分。於2022/11/28右足大趾接受韌帶切除手術，右足VAS降至2分，但後續左足大趾內側疼痛也開始疼痛加重，VAS自2增至9分。於2023/1/10針對足部做檢查，發現於平躺下患者足部除了有拇趾外翻以外，還有不自然的蹠屈、前足不自然的外翻、第一趾骨、蹠（腳掌）骨不自然蹠屈、骨盆前傾、膝過伸、髖內收肌過緊、股骨頸前傾、股四頭肌過緊，於站姿足部有內八的傾向，X光檢查顯示足弓正常。患者經過詳細問診、理學檢查後，發現其拇趾外翻的原因為內收拇趾肌與外展拇趾肌間力矩不平衡，深究其原因乃來自下肢與足部的不正常生物力學表現；此外，依據中醫的整體觀，本案例不單只有足部問題，髖部、骨盆、腰部皆有需要治療及調整的空間。
並列摘要
This case is a 37-year-old female who needs a lot of walking and standing for a long time in her usual work. She reported that she had suffered plantar cramps when she was in school. The medial side of metatarsalphalangeal (MTP) joint pain was becoming more and more severe after climbing, especially the right MTP joint, the Visual Analogue Scale (VAS) score progressed from 2 to 8 points. On 2022/11/28, the right MTP joint underwent ligamentectomy, the VAS of the right foot dropped to 2 points, on the other hand, the pain on the medial side of the left big toe also began to aggravate. According to examination of the foot at chinese medicine clinic of Beigang Hospital on 2023/1/10, in addition to hallux valgus, we found that the patient's foot had unnatural plantar flexion, unnatural forefoot valgus, first metatarsal bone unnatural plantarflexion, pelvic forward tilt, knee hyperextension, hip adductor muscle tightness, femoral neck forward tilt, quadriceps muscle tightness, foot tends to turn inward in standing posture, X-RAY exam showed longitudinal arch of foot were normal. After scrupulous interrogation and physical examination, we found that the cause of hallux valgus was the imbalance of torque between the adductor hallucis and abductor hallucis muscles, and the reason for the torque imbalance was the abnormal biomechanical performance of the foot. In addition, according to the holistic view of Chinese medicine, this case not only has problems in foot, but also the hip, pelvis, and lumbar.