Choosing among 3 ankle-foot orthoses for a patient with stage II posterior tibial tendon dysfunction.
Choosing among 3 ankle-foot orthoses for a patient with stage II posterior tibial tendon dysfunction.
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DOI：
10.2519/jospt.2009.3107
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发表时间：
2009-11
期刊：
影响因子：
--
通讯作者：
Houck JR
中科院分区：
文献类型：
--
作者：
Neville CG;Houck JR
病例报告。迄今为止，还没有对II期胫骨后肌腱功能障碍（PTTD）患者的不同矫形器进行头部对头部的比较。此外，矫形器的成本差异很大，因此选择一个有效的矫形器，病人负担得起很大程度上是一个反复试验的过程。患者为77岁女性，主诉足部姿势异常（“我的脚外翻了”），足内侧和踝关节疼痛轻微，有3年保守治疗的II期PTTD病史。患者受累侧不能完成1次单肢足跟上升，而未受累侧可以完成3次。踝关节力量测试显示轻度至中度的足底屈肌力量损失（受累侧20%-31%的损失），同时踝关节内翻和前足内收力量22%的损失。为了帮助该患者控制她的平足姿势和PTTD，我们考虑了3种矫形器：现成的踝足矫形器（AFO），定制的固体AFO和定制的关节式AFO。病人的主诉部分是为了美容（“我的脚伸出来了”）。由于平足运动的减少可以减轻胫骨后肌的负担，从而防止足部畸形的发展，因此矫形干预的主要目标是改善平足运动。考虑到评估平足运动学的临床方法的困难，使用多段足模型进行定量步态分析。在额平面，所有3种矫形器均伴有后足内翻的微小变化。在矢状面，在2.7°到6.1°之间，发生较大的前足足底屈曲（抬高内侧纵弓）。不同矫形器对后脚内翻和前脚足底屈曲的影响无显著差异。在横切面，现成的设计与前足外展相关，定制实体矫形器与无变化相关，定制关节矫形器与前足内收相关。基于步态分析，选择成本较高的定制关节矫形器作为患者的最佳选择。这种定制的关节矫形器与平足畸形的最大变化相关，通过步态分析进行评估。患者认为它对足部畸形的矫正效果最好。在允许踝关节活动的同时减少平足畸形可能会限制II期PTTD的进展。
Case report. No head-to-head comparisons of different orthoses for patients with stage II posterior tibial tendon dysfunction (PTTD) have been performed to date. Additionally, the cost of orthoses varies considerably, thus choosing an effective orthosis that is affordable to the patient is largely a trial-and-error process. A 77-year-old woman was seen with complaints of abnormal foot posture (“my foot is out”), minimal medial foot and ankle pain, and a 3-year history of conservatively managed stage II PTTD. The patient was not able to complete 1 single-limb heel rise on the involved side, while she could complete 3 on the uninvolved side. Ankle strength testing revealed a mild to moderate loss of plantar flexor strength (20%–31% deficit on the involved side), combined with a 22% deficit in isometric ankle inversion and forefoot adduction strength. To assist this patient in managing her flatfoot posture and PTTD, 3 orthoses were considered: an off-the-shelf ankle-foot orthosis (AFO), a custom solid AFO, and a custom articulated AFO. The patient’s chief complaint was partly cosmetic (“my foot is out”). As decreasing flatfoot kinematics may unload the tibialis posterior muscle, thus prevent the progression of foot deformity, the primary goal of orthotic intervention was to improve flatfoot kinematics. Given the difficulties in clinical approaches to evaluating flatfoot kinematics, a quantitative gait analysis, using a multisegment foot model, was used. In the frontal plane, all 3 orthoses were associated with small changes toward hindfoot inversion. In the sagittal plane, between 2.7° and 6.1°, greater forefoot plantar flexion (raising the medial longitudinal arch) occurred. There were no differences among the orthoses on hindfoot inversion and forefoot plantar flexion. In the transverse plane, the off-the-shelf design was associated with forefoot abduction, the custom solid orthosis was associated with no change, and the custom articulated orthosis was associated with forefoot adduction. Based on gait analysis, the higher-cost custom articulated orthosis was chosen as optimal for the patient. This custom articulated orthosis was associated with the greatest change in flatfoot deformity, assessed using gait analysis. The patient felt it produced the greatest correction in foot deformity. Reducing flatfoot deformity while allowing ankle movement may limit progression of stage II PTTD.
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影响因子：
2.7
作者：
Imhauser, CW;Abidi, NA;Siegler, S
通讯作者：
Siegler, S
影响因子：
2.7
作者：
Flemister, Adolph S.;Neville, Christopher G.;Houck, Jeff
通讯作者：
Houck, Jeff
DOI：
10.1249/01.mss.0000126385.12402.2e
发表时间：
2004-05-01
期刊：
MEDICINE AND SCIENCE IN SPORTS AND EXERCISE
影响因子：
--
作者：
Kulig, K;Burnfield, JM;Terk, M
通讯作者：
Terk, M
影响因子：
1.5
作者：
Augustin, Jeffrey F;Lin, Sheldon S;Johnson, Jeffrey E
通讯作者：
Johnson, Jeffrey E
影响因子：
3.2
作者：
Kulig, Kornelia;Reischl, Stephen F.;Smith, Ronald W.
通讯作者：
Smith, Ronald W.