不常見位置之足底筋膜病變：兩病例報告

Plantar Fasciopathy at Unusual Location: A Report of Two Cases

李珈樺(Chia-Hua Lee) ； 湯豐誠(Feng-Cheng Tang) ； 陳耀仁(Yao-Jen Chen) ； 戴龍偉(Long-Wei Dai) ； 蔡素如(Su-Ju Tsai) ； 何啟中(Chi-Chung Ho)

《台灣復健醫學雜誌》 48卷2期 (2020/12) Pp. 153-162

https://doi.org/10.6315/TJPMR.202012_48(2).0010

摘要

足底筋膜病變是很常見的疾病，通常是臨床診斷且最常影響到的區域是足底筋膜的跟骨近端處，很少人在探討跟骨遠端的足底筋膜病變，據文獻回顧發生在跟骨遠端的的病灶只佔足底筋膜病變的12％，而本文的兩病例報告是上述遠端病灶之中發生在足底筋膜中段的筋膜病變，此類病灶發生比例顯然會更低。這兩案例位於足弓之足底筋膜病變，是屬於非典型部位的病灶，經過增生治療，均未見明顯效果，接著改為類固醇注射，只經一次注射，病患疼痛症狀都有明顯改善。另外扁平足是其危險因子，所以建議使應該用雙腳足弓支撐墊，以改善足底的生物力學缺陷，預防疾病的再度發生。回顧文獻後發現典型跟骨近端的足底筋膜病變相關的文獻很多，但這類非典型足底筋膜病變及其治療文獻討論則極為少見，本報告完整呈現兩病例報告之臨床療程，以提供臨床醫師參考。

關鍵字

足底筋膜炎（plantar fasciitis） ； 超音波（ultrasound） ； 足底纖維瘤（plantar fibromatosis） ； 增生治療（prolotherapy） ； 扁平足（pes planus）

並列摘要

Plantar fasciopathy is a common problem in the general population involving the proximal area of the central cord of the plantar aponeurosis. Few studies have discussed plantar fasciopathy distal to the calcaneus. In article reviews, plantar fasciopathy distal to the calcaneus occurred in only 12% of the cases. In the case report, including two cases in which fasciopathy were involved in the central part of the plantar fascia, the incidence was obviously less than that mentioned above. These two cases were atypical diseases of plantar fasciopathy over the plantar arch. They both received one to several sessions of prolotherapy, but no significant effect was observed. After changing to steroid injection on just one occasion, the symptoms subsided quickly. Furthermore, flatfoot was noted as a risk factor, so arch support to correct biomechanical deficits is a reasonable suggestion to prevent the recurrence of plantar fasciopathy. A brief literature review found many studies discussing typical plantar fasciopathy over the proximal calcaneus; however, few studies have discussed the atypical disease of plantar fasciopathy. We present the clinical course of these two cases and provide some practical examples for clinicians.

並列關鍵字

plantar fasciitis ； ultrasound ； plantar fibromatosis ； prolotherapy ； pes planus

參考文獻

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Hoffman D, Bianchi S. Sonographic Evaluation of Plantar Hindfoot and Midfoot Pain. J Ultrasound Med 2013; 32:1271–1284.

Griffith JF, Wong TY, Wong SM, et al. Sonography of Plantar Fibromatosis. Am J Roentgenol 2002;179:1167–1172.

Kane D, Greaney T, Bresnihan B, et al. Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis 1998;57:383-384.

B Mansiz-Kaplan, B Nacir, S Pervane-Vural,et al. Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis. Am J Phys Med Rehabil 2020;99:318–324.