足部輔具與運動治療改善功能性長短腳以減輕下背痛之個案報告

The Effects of Foot Orthoses Combined with Therapeutic Exercise in Functional Leg Length Discrepancy to Relief Low Back Pain

黃玟菱(Wen-Ling Huang) ； 許世賓(Shih-Pin Hsu) ； 林瀛洲(Yin-Chou Lin) ； 陳智光(Chih-Kuang Chen)

《臺灣職能治療研究與實務雜誌》 18卷1期 (2022/06) Pp. 85-96

https://doi.org/10.6534/jtotrp.202206_18(1).0006

摘要

目的：功能性長短腳（functional leg length discrepancy, fLLD）是指由肚臍測量至雙側內踝之兩下肢長度不同，fLLD可能會造成下肢關節疼痛、下背痛等骨骼肌肉的症狀。常見的原因是肌肉較緊或無力、下肢關節緊繃、髖關節外展或內收肌群較緊等因素。方法：本報告敘述一名22歲長期右側下背痛以及功能性長短腳的個案，個案接受4週客製化鞋墊輔以居家運動治療。本報告共有4次評估，包含：前測、期中測驗、後測以及一個月後追蹤。評估內容包括：仰躺姿勢下，雙側下肢長度（皮尺測量）、坐姿體前彎、6種髖關節被動關節活動度、疼痛視覺模擬評分（visual analog scale, VAS）、諾丁漢健康量表以及行走時雙側下肢個別的站立時間。結果：經過4週治療後，個案的評估結果如下：（1）fLLD由0.87cm減少至0.07cm；（2）6種髖關節被動關節活動的兩側活動度差異由2-31度減少至1-9度；（3）增加柔軟度，坐姿體前彎由33公分增進至36公分；（4）疼痛感消除，疼痛視覺模擬評分由7分降至0分，且疼痛不再影響個案的生活品質，諾丁漢健康量表疼痛項目由100降至0；（5）行走時雙側下肢個別的站立時間差由170毫秒降至30毫秒。結論：本報告的初步證據顯示，混合客製化鞋墊和居家運動的治療策略，對於受試者的身體結構排列，雙側下肢的柔軟度，疼痛感受以及生活品質，有正面的影響，未來研究將增加受試者以及納入適當控制組進行進一步探討。

關鍵字

鞋墊 ； 運動治療 ； 功能性長短腳 ； 下背痛 ； 居家復健

並列摘要

Objective: Functional leg length discrepancy (fLLD) is defined as the condition when both legs are markedly different in length from the umbilicus to the medial malleolus. fLLD may inducemusculoskeletal painin the lower trunk and extremity due to weakness or tightness of muscle groups among aforementioned body structures. Methods: A 22-year-old man with chronic right low back pain and fLLD was recruited for this study. The participant received a daily home-based intervention across 4 week, which included the use of custom-made foot orthoses combined with therapeutic exercise. Data were collected 4 times: baseline, midterm and end of intervention, and follow-up after 1 month. Outcome measures included: leg length,sit-and-reach flexibility, 6passive range of motion (PROM) of hips, visual analog scale (VAS) in pain, Nottingham Health Profile (NHP), and single-limb support time between bilateral lower extremities. Results: The following changeswere observed after 4-week treatment: (1) improved fLLD from 0.87cm to 0.07cm; (2) reduced the difference of PROM between bilateral hips from 2-31° to 1-9°; (3) increased flexibility from 33cm to 36cm; (4) ameliorated self-reported VAS and pain-related NHP from 7 to 0 and 100 to 0, respectively; (5) decreased the difference of single-limb support timebetween bilateral lower extremitiesfrom 170ms to 30ms. Conclusion: Data from this study indicate that foot orthoses combined with therapeutic exercisemay improveleg length asymmetry, pain and flexibility forindividual withfLLD and chronic low back pain. Future plans for validating current findings include:recruitment of more individuals with a measurable leg-length discrepancy and inclusion of a matched control group.

並列關鍵字

foot orthoses ； therapeutic exercise ； functional leg length discrepancy ； low back pain ； home rehabilitation