Rocker Shoes for Natural Immobilization of the Ankle during Single Limb Support

描述(由申请人提供)： 使用行走石膏或靴子固定脚踝是一种常见的缓解疼痛的治疗方法。当穿着步行石膏或靴子行走时，脚踝关节仍然承受着压缩负荷，但其移动能力有限。这一干预措施的使用表明，挤压和运动的相互作用可能会加剧疼痛，其他减少或消除运动的干预措施也可能在减轻疼痛方面有效。不幸的是，行走石膏或靴子的使用减少了踝关节肌肉收缩的需要，导致腿部肌肉萎缩和虚弱。行走石膏和靴子也是非常引人注目的干预措施，可能会对患者的依从性产生负面影响。最近的研究表明，可以制造出在行走的单肢支撑(SLS)阶段导致脚踝很少或没有运动的摇臂鞋，单肢支撑阶段是关节上压缩负荷最大的时期。这些摇臂鞋导致脚踝关节的“自然固定”，因为它们提供了一个摇臂形状，身体健全的人在水平行走时一直自然地试图获得这种形状。摇摆鞋仍然需要肌肉活动才能自然地固定脚踝，这表明长期使用摇摆鞋可能不会导致肌肉萎缩。这项先导性研究包括开发能够在单肢支撑行走时自然固定脚踝的摇摆鞋，以及将这些摇摆鞋与步行靴进行比较。这项研究将包括持续的慢性脚踝疼痛患者的平行分组，对他们来说，步行靴被认为是一种减轻疼痛的方法。其中一组(n=15)将在SLS过程中使用摇杆鞋来“自然固定”脚踝，而第二组(n=15)将使用步行靴来固定脚踝。两组都将在两个月的时间内使用这些干预措施，并将在干预前后获得数据，重点是疼痛缓解、小腿围(以反映肌肉萎缩)、使用时间和患者满意度。 公共卫生相关性： 在美国，关节炎是导致残疾的主要原因。在65岁以上的社区居民中，大约有15%的人患有慢性足部和脚踝疼痛，其中包括许多越战老兵。虽然类风湿性关节炎(RA)和骨关节炎(OA)在很大程度上与年龄和使用有关，但骨关节炎可由任何年龄的伤害引起并产生慢性疼痛，在高度活跃的人群中发病率更高，如退伍军人。尤其是踝关节骨关节炎影响了1-4%的成年人，近年来创伤后踝关节骨关节炎的发病率有所上升。在步行的单肢支撑阶段“自然地固定”脚踝的摇臂鞋可以减轻疼痛，而不会因步行靴完全固定而产生负面影响(例如肌肉萎缩)。这些摇摆鞋的成功开发和测试可能会缓解许多患有足部和脚踝疼痛的退伍军人的疼痛。

DESCRIPTION (provided by applicant): Immobilization of the ankle using a walking cast or boot is a common treatment to relieve pain. When walking with a walking cast or boot, the ankle joint still bears compressive load, but is limited in its ability to move. The use of this intervention suggests that pain may be exacerbated by the interaction of compression and movement and that other interventions that reduce or eliminate movement may also be effective at reducing pain. Unfortunately, the use of walking casts or boots reduce the need for muscular contractions across the ankle joint, leading to atrophy and weakness of the leg muscles. Walking casts and boots are also highly noticeable interventions that may negatively affect patient compliance. Recent work has shown that rocker shoes can be manufactured that lead to little or no motion at the ankle during single limb support (SLS) phase of walking, the period of highest compressive load on the joints. These rocker shoes lead to "natural immobilization" of the ankle joint because they provide a rocker shape that able- bodied persons consistently and naturally try to obtain during level walking. Muscle activity is still needed to "naturally immobilize" the ankle with rocker shoe, suggesting that long term use of the shoes may not lead to muscle atrophy. This pilot study includes development of rocker shoes that can "naturally immobilize" the ankle during single limb support of walking and a comparison of these rocker shoes with a walking boot. The study will contain parallel groups of persons with constant chronic ankle pain for whom walking boots are being considered as an approach to reduce pain. One group (n = 15) will use rocker shoes that "naturally immobilize" the ankle during SLS, while the second group (n = 15) will use a walking boot to immobilize the ankle. Both groups will use the interventions over a two month period of time and data will be acquired before and after the intervention focusing on pain relief, calf circumference (to reflect muscle atrophy), usage times, and patient satisfaction. PUBLIC HEALTH RELEVANCE: Arthritis is the leading cause of disability in the US. Approximately 15% of community-dwelling persons over age 65 have chronic pain in the foot and ankle, including many Vietnam veterans. While rheumatoid arthritis (RA) and osteoarthritis (OA) are largely age and use related, osteoarthritis can result from injury at any age and produce chronic pain, the incidence of which would be greater in populations that have been highly active, such as veterans. Osteoarthritis of the ankle in particular affects between 1-4% of the adult population and the incidence of post traumatic ankle osteoarthritis has risen in recent years. Rocker shoes that "naturally immobilize" the ankle during the single limb support phase of walking may reduce pain without negative effects of complete immobilization in a walking boot (e.g. muscle atrophy). Successful development and testing of these rocker shoes could lead to pain relief in many veterans with foot and ankle pain.