成年柔性扁平足动静态足弓功能探究

Study on dynamic and static arch function of adult flexible flat feet

目的:通过对比正常足和柔性扁平足患者静态和动态足弓功能差异,探究柔性扁平足患者足弓功能特征,为不同足型足弓功能性区分提供理论参考。方法:招募30例成年男性受试者,采用足印法初步区分正常足和扁平足,采用提踵测试和被动足趾抬高测试筛查,柔性扁平足筛选出正常足16例,柔性扁平足患者14例。通过自然站立和正坐不同负重位足弓高度差计算静态足弓刚度,通过三维动作捕捉和足底压力测评支撑中期开始时刻足弓相对高度、足弓相对高度变化值、足弓相对高度变化率和行走时中足冲量占比,采用偏相关(控制步速)分析静态足弓刚度和动态足弓功能指标的相关性。结果:静态足弓功能测试结果表明,柔性扁平足患者静态足弓刚度低于正常足(P<0.05);动态足弓功能测试结果表明,正常足和柔性扁平足行走支撑中期足弓相对高度和高度变化率均逐渐降低,柔性扁平足患者行走支撑中期开始时刻足弓相对高度、支撑中期足弓相对高度变化值和变化率均低于正常足(P<0.05),柔性扁平足行走支撑期中足冲量占比高于正常足(P<0.05);偏相关分析表明,步速校正后,支撑中期开始时刻足弓相对高度、相对高度变化值和相对高度变化率与静态足弓刚度呈中等显著正相关(r=0.580—0.679,P<0.05),中足冲量占比与静态足弓刚度呈低度显著负相关(r=﹣0.478,P<0.05)。结论:行走过程中,足弓在支撑中期持续下降,且下降速率逐渐减小;柔性扁平足患者静态和动态足弓对负重的适应能力均低于正常足,提高柔性扁平足患者足弓的负重适应性是足踝康复的关键;足弓刚度与动态足弓功能存在相关性,对不同足型足弓功能性划分具有重要参考价值。

Objective:To explore the characteristics of arch function in patients with flexible flat foot by comparing the differences of static and dynamic arch function between normal and flexible flat foot patients,provide theoretical reference for the functional distinction of different types of foot arch.Method:Thirty adult male subjects were recruited.Normal and flat feet were distinguished by foot printing method,and flexible flat feet were screened by heel raising test and passive toe raising test.Sixteen normal feet and fourteen patients with flexible flat feet were screened.Static arch stiffness was calculated by the difference of arch height between natural standing and sitting at different loading positions,and the relative arch height at the beginning of the middle support period,change value of relative arch height,change rate of relative arch height and proportion of middle foot impulse during walking were evaluated by 3D motion capture and plantar pressure.The correlation between static arch stiffness and dynamic arch function was analyzed by partial correlation(controlling step speed).Result:The static arch stiffness of flexible flat feet was lower than that of normal feet(P<0.05).The results of dynamic arch function test showed that the relative height and change rate of arch height in the middle of walking support decreased gradually in both normal and flexible flat feet,the change value and change rate of arch height in flexible flat feet at the beginning of the middle of walking support period were lower than those in normal feet(P<0.05).The proportion of impulse of flexible flat feet in walking support was higher than that of normal feet(P<0.05).Partial correlation analysis showed that the relative height,relative height change value and relative height change rate at the beginning of middle support were positively correlated with static arch stiffness(r=0.580—0.679,P<0.05),the proportion of middle foot impulse was negatively correlated with static arch stiffness(r=﹣0.478,P<0.05).Conclusion:During walking,the arch of the foot continued to decline in the middle of support,and the rate of decline gradually decreased.The adaptability of static and dynamic arches to loading in patients with flexible flat feet was lower than that of normal feet.It is the key of ankle rehabilitation to improve the weight bearing adaptability of arch in patients with flexible flat foot.Arch stiffness is correlated with dynamic arch function,which is an important reference value for the functional division of different types of foot arch.