- 學位論文
杵狀畸形足之踝足矯具合併膠帶黏貼療法
Ankle Foot Orhtosis with Taping for Clubfoot Treatment
摘要
杵狀畸形足（俗稱螃蟹足）是初生兒常見的足部變異，通常男生的罹患率約為女生的兩倍，這種杵狀畸形足主要的特徵就是前足內收、腳後跟內彎、馬蹄足以及內翻足，若更為嚴重的話會伴隨足弓太高以及蜷趾，為了要達到早期發現早期治療的原則，把握新生兒骨骼肌肉系統尚未完全發育的階段，給予外力刺激進而達到治療的目的。本研究中與小兒骨科醫師合作，在治療初期以傳統治療方式進行石膏或手術治療，為了配合病患階段性治療後期所需的矯具固定維持以防止惡化，則以國科會北區輔具中心製作的過度姿勢性固定式踝足矯具合併膠帶黏貼療法為主，在病患穿戴踝足矯具後0.5∼1.5年來觀測治療效果。 雖然目前的治療方式有很多種，但在此項研究中將重點放在傳統的踝足矯具上，一般正規治療杵狀畸形足的踝足矯具是以Dens Browne splint為基礎再加以改良，為了改善現有的保守治療方式，我們將進行杵狀畸形足在穿戴固定是踝足矯具一段時間的癒後評估檢討，針對治療效果、病患對矯具使用的滿意程度以及意見作為研究主軸。 在治療效果方面，透過杵狀畸形足治療後的追蹤以及物理性實驗室的調查，像是關節活動角度、足底壓力分佈以及X光片下的骨骼構造排列等，取得相關的足部資料，希望能夠藉由這些資料的判讀以及生物力學分析，評估病患在近期的治療恢復效果，檢討病患先前使用的矯具設計不足處並建議發展改進日後矯具設計的方向。
並列摘要
Talipes equinovarus also called clubfoot is a common birth deformity of the foot, and boys are affected twice as often as girls. The symptoms of clubfoot are forefoot adductus, heel varus, equines, and eversion; if the worse, it accompanies with cavus and claw toes. In order to achieve the principle, early treat on early stage, we applied forces on infants’ musculoskeletal structure and stimulated its normal growth for correcting clubfoot, as musculoskeletal system had not completely developed. In this research, we cooperated with orthopedists to correct clubfeet. In the early phase, orthopedists traditionally treated by surgery or serial casting. After that by the step, patients’ need orthoses to maintain their normal position to prevent deformities becoming worse, and we applied them solid ankle-foot orthoses (solid AFOs) with over-corrective position made in NRERC and taping technique. And we followed up patients 0.5~1.5 years to observe the effect on solid ankle-foot orthoses (solid AFOs). Although there were many kinds of treatments, such as surgery and conservative treatment, our concern was to consider traditional ankle-foot orthoses in this research. Generally speaking, the basis of the formal ankle-foot orthoses on clubfoot was Dens Browns splint, and we developed it and made new solid ankle-foot orthoses. We assessed patients who accepted daily using solid AFOs after a period of time and self-examined in order to improve existing conservative treatment. In this study the main stress fell on two points, one was the effect of the treatment and the other was the satisfactions and opinions of the patients. In respect of the effect of the treatment, we followed up clubfoot patients by physical examination, such as the range of motion of joints, static plantar pressure distribution, and bony alignment taken by radiographs. According to these foot data, we could analyze the biomechanics of the musculoskeletal structure and evaluate a short-term effect of correcting clubfoot. Thus, we could self-examine and improve the shortages of the previous solid ankle-foot orthoses. It is favorable for orthotic design.