Treatment for Idiopathic Toe-Walking: Results at Skeletal Maturity
Treatment for Idiopathic Toe-Walking: Results at Skeletal Maturity
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特发性踮脚行走的治疗：骨骼成熟时的结果
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
Richard O. Nicol
中科院分区：
文献类型：
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作者：
N. Stott;S. Walt;Glenis Lobb;N. Reynolds;Richard O. Nicol
13名骨骼发育成熟的儿童特发性足趾行走患者在最后一次干预后平均10.8年接受步态分析和小腿肌力测试。其中六个只进行了连续铸造；其中7人接受了经皮跟腱延长术或贝克氏腓肠肌-比目鱼肌延长术。在13名受试者中，12名受试者的踝关节矢状面运动发生了改变，但只有3名受试者在视觉上可以检测到这种变化。一名受试者在初次接触时踝关节跖屈曲增加，但其他12名受试者的第一次摇臂正常。站立时踝关节背屈峰值平均仅为9°，其中11名受试者的站立时踝关节背屈峰值比正常值低2个标准差以上。踝关节背屈也受到被动措施的限制，但非负重踝关节背屈与步态没有相关性。第二摇杆倒置见于两名受试者，在站立时踝关节背屈高峰发生在步态周期的25%之前。在单次脚跟上升测试中，小腿产生的能量在受试者之间是可变的，但与对照组相比在正常值范围内。作者得出结论，尽管进行了治疗，但大多数受试者的踝关节运动学和动力学都出现了持续的变化，但这在大多数受试者中是无法通过视觉检测到的。
Thirteen skeletally mature subjects who had been treated as children for idiopathic toe-walking underwent gait analysis and calf muscle strength testing at an average of 10.8 years from the last intervention. Six had had serial casting only; seven had had either a percutaneous tendo Achilles lengthening or a Baker's gastroc-soleus lengthening. Sagittal plane kinematics at the ankle was altered in 12 of the 13 subjects, but the changes were detectable visually in only 3 subjects. One subject had increased ankle plantarflexion at initial contact, but the other 12 subjects had a normal first rocker. Peak ankle dorsiflexion in stance averaged only 9°, and 11 of the subjects had a peak ankle dorsiflexion in stance greater than 2 standard deviations below normative values. Ankle dorsiflexion was also restricted on passive measures, but there was no correlation between ankle dorsiflexion non-weight-bearing and in gait. Inversion of second rocker was seen in two subjects with peak ankle dorsiflexion in stance occurring before 25% of the gait cycle. Power generation by the calf during a single heel-rise test was variable between subjects but within normative values compared with controls. The authors conclude that most subjects showed persistent changes in ankle kinematics and kinetics despite treatment but that this was not detectable visually in most subjects.