鞋墊介入對於具內旋足之女性髕股骨症候群患者之療效

髕股骨疼痛症候群是造成膝關節失能、疼痛及疾病問題之最普遍的原因。此症候群包含了多種病因，治療方式需要對於病因有一定了解才能真正改善病人的問題。目前認為造成髕股骨疼痛症候群的最大原因在於髕骨的外移，導致髕骨與股骨間的壓力過大而有疼痛產生，髕骨外移的原因除了為髕骨本身的不正常位移外，還包括了其他下肢骨頭的相對錯位，例如：股骨過度內轉，以及足部的旋內動作等，都是可能的原因。近年來研究顯示，足部排列不正常，尤其是內旋足，是影響髕骨位置的原因之一，然而，以鞋墊介入的方式針對一般髕股骨疼痛症候群患者，在過去幾篇研究文獻中並沒有顯現好的療效，可能的原因即是對受試族群的足部篩選不足所致。若能精準篩選適當個案，鞋墊介入療效或許能更加彰顯。本研究目的為探討加上鞋墊介入，對於具有內旋足之髕股骨疼痛症候群患者之療效，包含在疼痛、身體功能與活動量上的影響。本研究設計為前瞻性隨機分配的臨床試驗，實驗組將會進行鞋墊介入加上一般物理治療訓練，控制組則接受未具療效的鞋墊加上一般物理治療運動訓練，分別在介入前與介入 6 周後接受成果評量，包括基本資料、疼痛、身體功能與活動量之評估，而基本資料將會在受試者接受治療前收集完畢。本研究共招募 27 位受試者，控制組 13 位，實驗組 14 位。所有分析使用 SPSS 17.0 套裝軟體作為統計分析之工具，除了以獨立 t 檢定(independent t test)分析受試者的基本資料，另以無母數分析方式: Mann-Whitney U test 比較控制組與對照組之間的差異，以及使用 Wilcoxon signed-rank test 比較組內的評量成果在介入前後的差異。顯著水準訂在 0.05，而檢定力則訂在 0.8。本研究結果為客製化鞋墊相比控制組之不具治療效果的鞋墊，於六週後，不論在膝蓋一般疼痛(p=0.005)、最痛時(P=0.001)與症狀改善上(P=0.029)，病人自覺評估結果都是明顯進步的，顯示針對活動度較高，且具內旋足之女性髕股骨疼痛症候群患者，除傳統物理治療運動與貼紮外，加上客製化鞋墊的介入也是一有效的治療方式。對於髕股骨疼痛症候群患者之療效，除一般物理治療運動與貼紮介入以外，在臨床治療中，觀察足部內旋的不正常排列與受試者活動度及運動習慣，給予客製化鞋墊的介入可提升對此族群之療效。然而，本研究療效評估為六週，未來針對鞋墊介入的長期療效還需要驗正。

關鍵字

髕股骨疼痛症候群；扁平足；鞋墊介入；物理治療運動；肌內效貼紮

並列摘要

Patellofemoral pain syndromes (PFPS) are multifactorial conditions. A successful treatment requires the understanding of the predisposing factors. Lateral tracking of the patella has been hypothesized to be the major contribution to the development of patellofemoral pain. The increases in patellofemoral joint stress from mal-alignment have been identified in these patients. The underlying mechanisms which cause maltracking of patella include factors related to the lower limb such as excessive internal femoral rotation or rear foot movements. Lately, the evidences showed that PFPS patients may exhibit more pronated foot type. However, there was limited evidence of the intervention with insoles and the results showed no significant difference. One of the possible reasons may be lack of subgroup analysis for the subject characteristics to find those subjects who will respond better to insoles. As a result, the purpose of the study was to investigate the effects of insoles in PFPS patients with pronated foot on pain reduction, functional improvement and activity level. This study was a prospective randomized control study. The experimental group received intervention with customized insoles plus general physical therapy; in contrast, the control group received sham insoles plus general physical therapy. The statistical analysis was performed using SPSS v.17.0 software. The demographic data was collected before receiving treatment, including basic data, pain level, functional status and activity level. There were totally 27 subjects recruited in this study with 13 subjects in control group and 14 subjects in experimental group. The basic dada was analyzed by independent t test. The outcome assessment was conducted and compared between groups with Mann-Whitney U test and within group at baseline and after 6 week with Wilcoxon signed-rank test. The significant level was set at 0.05 while the power was 0.8. The result showed that customized insoles are superior to flat inserts in both usual pain and worst pain reduction(p=0.005; P=0.001) and symptom relief (P=0.029), which may be an effective intervention in addition to PT exercise and kinesio-taping in female PFPS individuals with pronated foot and high activity level in 6 weeks. Foot pronation and high activity level of the subjects may be key characteristics to enhance the effects of insoles intervention in individuals with PFPS in clinical industry in addition to general physical therapeutic exercise and kinesio-taping. However, prospective studies are required to determine whether the effects can maintain in the long term.

並列關鍵字

patellofemoral pain syndrome ； pronated foot ； insoles intervention ； physical therapeutic exercises ； McConnell approach of kinesio-taping

參考文獻

1. Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. Br J Sports Med 2009;43:163-8.

2. Munuera PV, Mazoteras-Pardo R. Benefits of custom-made foot orthoses in treating patellofemoral pain. Prosthet Orthot Int 2011;35:342-9.

3. Barton CJ, Menz HB, Crossley KM. The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome. Br J Sports Med 2011;45:193-7.

5. Thijs Y, Van Tiggelen D, Roosen P, De Clercq D, Witvrouw E. A prospective study on gait-related intrinsic risk factors for patellofemoral pain. Clin J Sport Med 2007;17:437-45.

6. Devereaux M, Lachman S. Patellofemoral arthralgia in athletes attending a sports injury clinic. Br J Sport Med 1984;18:18-21.

國際替代計量

鞋墊介入對於具內旋足之女性髕股骨症候群患者之療效

全文下載

主題瀏覽