後足楔型內側墊片對慢性腳踝不穩定運動員之影響

研究背景：慢性腳踝不穩定是由重覆性的外側韌帶扭傷所造成的。此問題常會影響到患者的日常生活，在有腳踝部動作時感受到疼痛，有時會有無力感，並且足壓的改變會衍生出其他足部的併發症。而對於運動員會影響他們的運動表現。臨床上經由徒手治療介入來改善此問題，但因效果持續時間較短，所以許多專家開始探討足部輔具對慢性腳踝不穩定患者的療效。研究目的：本研究的目的在於探討後足楔型內側墊片對於患者慢性腳踝不穩定的症狀改善，如足底壓力中心的位移、動態平衡表現、步態的改變狀況。研究方法：本研究採用單盲的臨床實驗的方式。研究徵召二十五位慢性腳踝不穩定患者及二十四位健康人，分成受傷組與健康組。受傷組除了馬上檢測其立即效應也會利用電話訪查的方式追蹤其八週的穿著情形。在介入前與介入後、及介入八週後，分別進行動態、靜態平衡測試及步態評估。統計方法以皮爾森相關係數分析健康組前測及立即測試的資料作為所有測試的再測信度。並用單因子受試者內多重比較針對受傷組三個時間點作分析並採用LSD事後分析比較差異(P<.05)。結果：受傷組靜態平衡部分，八週後在開眼狀況下，壓力中心位移面積有顯著下降；閉眼狀況下，壓力中心位移路徑有顯著下降。動態平衡部分，八週後失誤分數有顯著下降。步態部分則皆未達顯著差異。結論：穿著後足內側四度墊片在於靜態平衡與動態平衡皆有改善效果，八週後效應尤其明顯，因此可搭配物理治療訓練，對於需要長時間活動的運動員能有效解決慢性腳踝不穩定的問題。

Background: Chronic ankle instability (CAI) is caused by recurrent lateral ankle sprain. This problem often affects the daily lives of patients, such as they would feel pain and weakness when they participated physical activities. Furthermore, change of foot pressure would lead to other foot complications and may affect the athelete’s exercise performance. Clinical intervention using manual therapy could improve this problem, but the effect from manual therapy only lasts for show short-term duration, so many experts begin to search foot orthotic in CAI efficacy. The purpose of this study is to explore the benefit of rearfoot medial wedge, such as changes of center of pressure, dynamic balance test and gait pattern. Methods: The study will use a clinical trial design. Twenty-four patients with CAI and twenty-four healthy people will be divided into two group. Outcome measures include: (1) center of pressure (area, path length); (2) dynamic balance test; (3) gait pattern. All measurements will be tested at the initial assessment and eight-week after intervention. Statistical Analysis: Pearson’s correlation coefficient , Repeated measured one way-ANOVA and LSD post hoc test(P<.05). Results: In CAI group, the static balance and dynamic balance improved between pretest and after 8 weeks. Conclusion: Rearfoot medial wedge with 4 degrees could improve static and dynamic balance especially after 8 weeks. It could combine the physical training for athletes.