新型動態性矯正副木對少年型腳拇趾外翻的效用－個案報告

The Effect of a New Style Dynamic Corrective Splint for Juvenile Hallux Valgus: A Case Report

余鴻文(Hung-Wen Yu) ； 邱滿艷(Man-Yen Chiu)

《臺灣職能治療研究與實務雜誌》 8卷1期 (2012/06) Pp. 54-66

https://doi.org/10.6534/jtotrp.2012.8(1).54

摘要

腳拇趾外翻為腳拇趾發生趾骨向外側且第一蹠骨向內側偏移的現象，可能伴隨第一蹠骨頭內側的腫脹問題。造成腳拇趾外翻的原因，包括：穿著尖頭、高跟鞋等外在因素，及足部構造變化、風溼性關節炎及遺傳等內在因素。腳拇趾外翻造成承重時的疼痛和外觀的變形是病人尋求治療的主要原因。而對腳拇趾外翻的處理方法有保守式治療與手術治療兩種，對於少年型腳拇趾外翻問題，由於手術後復發率非常顯著，除非嚴重影響行動能力或日常生活，係以保守式治療為主。副木是常見的保守式治療方法，本研究透過個案研究，探討新型動態性矯正副木對少年型腳拇趾外翻的效用與臨床上的適用性。研究結果發現從外觀攝影、足底拓印、X光攝影等均可看到腳拇趾外翻角度明確的改變，整體外翻角度改善為9 ~11，此外，副木穿於寬圓頭的鞋子內，可支持正常關節的排列，個案穿戴時使用方便、舒適且可維持正常的蹠趾關節彎曲／伸直活動，不會對腳趾的關節活動度產生不良影響。整體而言，個案及其家長覺得非常滿意。惟本研究屬個案研究，運用在其他個案的成效及在療效評估的標準上仍有發展與研究的空間。

關鍵字

腳拇趾外翻 ； 新型動態性矯正副木 ； 關節角度

並列摘要

Hallux valgus (HV) is defined as a lateral deviation of the great toe and medial deviation of the first metatarsal bone and might accompany with medial soft-tissue enlargement of the first metatarsal head (bunion). The causes of hallux valgus includes extrinsic and intrinsic factors. The extrinsic factors include wearing pointed and high-heeled shoes. And the intrinsic factors include structure change of foot, rheumatoid arthritis and gene et al.Pain and deformity are two major reasons that force patients with HV to visit doctors for medical intervention. Management of HV contains conservative and surgical interventions. The patients with juvenile hallux valgus seldom choose surgical intervention due to high recurrence unless the syndromes of HV seriously affect moving ability and the performance of activities of daily life. Although utilizing splint is often mentioned in conservative intervention of HV, there are few studies concerning with the benefits of the dynamic corrective splint. The purpose of this case report is to explore the clinical benefits of the new style dynamic corrective splint on reducing the deformity of moderate HV and its appropriateness.The precise findings of this study could be acquired from appearance picture, foot print and radiographic imaging of both feet. In this juvenile HV study, the improvement of HV is 9 to 11 degrees. The result indicates that the new style dynamic corrective splint can keep normal flexion and extension of the first metartasophalangeal joint and can provide continuing medial traction to prevent aggravation of HV. Also, the case and her parents are satisfied with this improvement. Our findings suggest that further studies have to be conducted such as the effects of the new style dynamic corrective splint and the clarification of the assessment criteria.

並列關鍵字

Hallux valgus ； Dynamic corrective splint ； Joint angle