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  • 學位論文

不同蹠骨墊設計與擺放位置對於足底壓力分佈之影響

Effects of Different Metatarsal Pad Designs and Placements on Plantar Pressure Distribution

指導教授 : 陳文斌

摘要


人類於步行時,由於力量傳遞機制導致推進期間力量集中於第一與第二蹠骨頭下方區域,所產生之不適與疼痛感稱為蹠骨痛,而蹠骨墊為臨床上常用於緩解該症狀之輔具。過去文獻已藉由足底壓力量測系統證實蹠骨墊具有減壓效益,然而此一實驗過程繁複且往往無法排除足部與蹠骨墊之間的相對位移且無法確切定義擺位。因此,如何擺放以及使用何種幾何外型之蹠骨墊具有較佳減壓效益仍未有定論。本研究藉由動態有限元素分析中對位準確及參數調整快速等優勢排除過去文獻中之實驗限制,探討不同蹠骨墊設計與擺放位置對於足底壓力分佈之影響。 研究過程中沿用本研究室過往已建構完整足部模型,配合以樑元素取代實體足底筋膜以及鞋具、鞋面、鞋內墊與蹠骨墊之有限元素模型建構,並以步態實驗獲得之運動學與力動學結果作為有限元素分析邊界條件與模型驗證。完成模型驗證後,探討蹠骨墊五種擺放位置、兩種高度與三種面積尺寸變化對於蹠骨下方以及第二蹠骨頭下方區域之壓力變化影響。 有限元素分析結果顯示,當蹠骨墊置於第二蹠骨頭近心端10mm時,相較於其他擺放位置具有較佳之減壓效果。當蹠骨墊置於適當擺放位置,高度由5mm增加至10mm後,能有效的增加蹠骨墊減壓效果,卻相對產生高壓力峰值集中之現象。而蹠骨墊面積尺寸由原尺寸增加10%後,能達到分散高壓力峰值集中之功效。因此,當蹠骨墊置於合宜的位置下,適當的增加蹠骨墊高度與面積尺寸,能增加蹠骨墊之減壓效果並避免高壓力峰值集中現象發生。本研究有限元素分析結果僅針對單一受測試者進行探討,受測試者之足部尺寸與型態則尚未考量。未來可藉由招募具有不同足部大小及型態之受測試者進行探討,以提供更為完整之參考建議。

並列摘要


Due to the load transfer mechanism, the propulsive ground reaction force is often concentrated on the area beneath the first and second metatarsal heads during human ambulation. The pain and discomfort resulted at this area are known as metatarsalgia. In order to relieve this symptom, metatarsal pad is commonly prescribed for patients with metatarsalgia in clinical practice. Although the effectiveness of metatarsal pad on the plantar pressure reduction had been investigated in previous studies using plantar pressure measurement system, the experiment itself is very difficult to eliminate the relative motion between the foot sole and insole, and to define the location precisely. For this reason, no clear conclusion on the metatarsal pad design and placement that can achieve best effectiveness in plantar pressure reduction so far. Due to the finite element analysis has the advantages in modifying the model and adjusting the parameters easily, this study aimed to investigate the effects of different placements and geometrical designs of metatarsal pad on the plantar pressure distribution through dynamic finite element analysis. A three-dimensional finite element model of the foot-shoe complex, including the foot bony and ligamentous structure, soft tissue, metatarsal pad, insole, outsole and shoe cover, was adopted in this study. The trajectory of the reflective markers and the kinematic data of the foot obtained from gait analysis were used to define the boundary condition in the finite element analysis. After validation of the model, the effects of metatarsal pad on the plantar pressure distribution beneath the metatarsus and the second metatarsal head were investigated by changing five different placements, two different heights, and three different sizes of the metatarsal pad. According to the results from the dynamic finite element analysis, when the pad was placed 10 mm proximal to the second metatarsal head, better efficacy of pressure reduction than other placements was found. Under the appropriate placement, the efficacy would be further improved by raising the height of the pad from 5 mm to 10 mm, but causing high pressure concentration beneath the metatarsus. However, increasing the pad size by 10% would relieve the concentrated high pressure. As a result, increasing the height as well as area of metatarsal pad properly may enhance the efficacy of plantar pressure reduction beneath the second metatarsal head, and relieve high pressure concentration beneath the metatarsus. The current results from the dynamic finite element analysis were focused on one single subject. Different foot dimension and structural classification were not considered in this study. More subjects with different size and structure of foot should be recruited in the future in order to provide a more comprehensive recommendation on the prescription of metatarsal pad.

參考文獻


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