不同鞋具設計對於步態站立期間足底筋膜之生物力學效應

足底筋膜在靜態站立與動態活動時，扮演承載人體體重的重要角色。足底筋膜承受過度與重複性的負載被視為造成足底筋膜發炎可能的危險因子。以治療策略而言，減少造成步態站立期後期足底筋膜承載過度應變與應力的危險因子，將可能有助於足底筋膜炎患者的復原。足部輔具及鞋具的修飾常用來治療足底筋膜炎，然而針對步態站立期間其背後的機轉尚未充分的探究。因此，本研究目的為探討步態站立期間，不同鞋墊設計與鞋具修飾對於足底筋膜的生物力學響應。本研究完成十位正常健康受試者於步行時之足部運動學分析，試驗條件分別為受試者裸足步行、穿著常規鞋具加上平板鞋墊或碳纖維強化鞋墊步行，以及穿著船型鞋底鞋具加上平板鞋墊或碳纖維強化鞋墊步行。鞋具的鞋面則由透明的聚氯乙烯高分子材料構成，以便於能夠輕易去除鞋面特定的區域而利於反光球直接黏貼於皮膚表面，進而完成精確的量測。此外，本研究也完成建構一組強調足底筋膜限定承受張力特性之特定受試者三維足部有限元素模型，以模擬足部步行之運動行為。足部運動之運動學參數則擷取作為動態有限元素分析之輸入參數。分析之條件包含裸足步行、穿著常規鞋具加上平板鞋墊或全觸式鞋墊步行，以及穿著船型鞋底鞋具加上平板鞋墊或全觸式鞋墊步行。實驗量測的結果指出，在裸足步行的條件下，第一趾蹠關節的最大背屈角度平均值為48.0°±7.3°。當穿著常規鞋具及平板鞋墊或碳纖維強化鞋墊時，則分別顯著降低為28.2°±5.7°及24.1°±5.7°。而當穿著船型鞋底鞋具及平板鞋墊或碳纖維強化鞋墊時，第一趾蹠關節的最大背屈角度平均值則進一步降低至大約13°。相對於裸足步行的條件下，受試者僅穿著鞋具時能夠增加最小足部內側縱弓角度，同時減少蹠骨相對於跟骨之最大蹠屈角度，形成較為平緩之內側足弓。因此，無論選用何種鞋墊，船型鞋底鞋具最有助於降低足部之絞盤效應。模擬分析的結果則顯示，相較於平板鞋墊而言，全觸式鞋墊能夠有助於減少步態站立中期足底筋膜之張力及內側應力。然而，對於發生在步態站立期後半段之絞盤效應，全觸式鞋墊則沒有顯著之抑制效果。但相較於常規鞋具而言，船型鞋底鞋具能夠更進一步減少足底筋膜之最大張力。因此，除了選用全觸式鞋墊來防止內側足弓的塌陷，船型鞋底鞋具應被考量作為足部抑制絞盤效應之用。本研究提供科學量化依據來協助臨床醫師尋找合適之鞋具，藉由有效抑制足部之絞盤效應加以治療如足底筋膜炎之足部病症。未來應進行臨床試驗以進一步驗證本研究所提出之建議。

關鍵字

足底筋膜炎；全觸式鞋墊；船型鞋底鞋具；有限元素分析；步態分析；足底筋膜

並列摘要

The plantar aponeurosis (PA) has long been considered to play an important role in weight-bearing, both in static stance and in dynamic ambulation. Excessive and repeated loading imposed on the PA is believed to be the most likely risk factor for developing plantar fasciitis. Treatment strategies that can diminish factors leading to excessive strain or stress on the PA during the terminal stage of the gait cycle may facilitate a patient's recovery from plantar fasciitis. Foot orthoses and shoe modifications are commonly used in treating the plantar fasciitis. However, the mechanism has not been thoroughly investigated during the entire gait cycle. Therefore, the purpose of this study was to investigate the biomechanical responses of the PA to different insole designs and shoe modifications throughout the stance phase of the gait. Foot kinematic analyses of 10 normal volunteers were performed during gait under the conditions of barefoot, regular shoe (RGS) with flat insole (FI) or carbon fiber insole (CFI), and rocker sole shoe (RSS) with FI or CFI. The shoe cover consisted of transparent polymer, PolyVinyl Chloride, which allowed for accurate measurement of kinematic data since it meant specific areas on the cover could be cut away for direct placement of reflective markers onto the skin. Furthermore, a subject-specific three-dimensional finite element foot model with emphasis on the "tension-only" feature of the PA was constructed to simulate the foot motion. The kinematic data of foot bone motions were collected to serve as the input conditions for the dynamic finite element analysis. The analyses were performed under barefoot, RGS with FI or total contact insole (TCI), and RSS with FI or TCI conditions. The experimental results revealed that the mean of maximum dorsiflexion angle of the 1st MTP joint was measured to be 48.0°±7.3° under the barefoot condition, and decreased significantly to 28.2°±5.7° when wearing RGS with FI, and to 24.1°±5.7° when wearing RGS with CFI. This angle was further decreased to around 13° when wearing RSS with FI or CFI. Subjects wearing footwear alone can increase the minimum medial longitudinal angle and decrease the maximum plantarflexion angle of the metatarsus in relation to the calcaneus, as compared with the barefoot condition, resulting in a flatter medial foot arch. It is suggested that RSS is the most effective footwear for reducing the windlass effect, regardless of the type of insole inserted. The predicted results showed that the TCI provides more benefit in terms of reducing the PA force and the medial PA von Mises stress than the FI during the mid-stance phase. However, no obvious inhibition was found on the windlass effect occurring in the late stance phase. As compared to the RGS, the RSS can provide more reduction in peak PA force. Therefore, in addition to prescribing TCIs to prevent the collapse of the medial longitudinal arch, the RSS should be taken into consideration as a means of inhibiting the windlass effect. The findings in this study provided us with evidence to assist clinicians in finding the appropriate footwear for treating foot disorders such as plantar fasciitis by effectively reducing the windlass effect. Clinical trials should be carried out in the future to validate the suggestions from this study.

並列關鍵字

plantar aponeurosis ； plantar fasciitis ； total contact insole ； finite element analysis ； rocker sole shoe ； gait analysis

參考文獻

Cailliet, R., (1997). Foot and Ankle Pain. F. A. Davis Company, Philadelphia.

Hsu, C. C., Pai-Chu, C. C., Lin, S. C., Tsai, W. C., Liu, H. T., Lin, Y. C.,

Pfeffer, G., Bacchetti, P., Deland, J., Lewis, A., Anderson, R., Davis, W.,

Li, K. W., Chen, C. Y., Chen, C. C., Liu, L., (2012). Assessment of slip resistance under footwear materials, tread designs, floor contamination, and floor inclination conditions. Work 41 Suppl 1, 3349-3351.

Aquino, A., Payne, C., (1999). Function of the plantar fascia. The Foot 9, 73-78.

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不同鞋具設計對於步態站立期間足底筋膜之生物力學效應

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