SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Foot Ankle Int. 2012 May;33(5):406-14. doi: 10.3113/FAI.2012.0406.
Data are limited on the various orthotic devices available for patients with Stage II posterior tibial tendon dysfunction (PTTD). Foot kinematics observed while walking with an orthotic device are hypothesized to be associated with clinical outcomes and could be used to refine future device designs.
Fifteen subjects (age, 63.6 ± 6.8 years) with Stage II PTTD walked in the lab under four conditions: (1) shoe only (control condition), (2) shoe with a custom solid AFO (Arizona Co, Mesa, AZ), (3) shoe with a custom articulated AFO (Arizona Co, Mesa, AZ), and (4) shoe with an off-the-shelf AFO (AirLift, DJ Orthopedics). Kinematic data were collected to determine the degree of hindfoot inversion, forefoot plantarflexion (reflective of raising the MLA), and forefoot adduction associated with each condition.
The custom articulated device was associated with greater hindfoot inversion compared to the shoe only condition at loading response (p = 0.002), mid-stance (p < 0.001), and terminal stance (p = 0.02). The custom articulated device, custom solid device, and off-the-shelf device were associated with greater forefoot plantarflexion compared to the shoe only condition across all four phases of stance. There were no differences between any of the devices and the shoe condition associated with forefoot adduction.
The custom devices were associated with greater hindfoot inversion and forefoot plantarflexion compared to walking with only a shoe, while the off-the-shelf device was associated with forefoot plantarflexion but no change in hindfoot motion. None of the devices corrected forefoot abduction compared to the shoe only condition.
The current biomechanical data may aid in understanding the clinical outcomes seen using these devices as well as provide data to support new designs.
对于患有 II 期胫骨后肌腱功能障碍 (PTTD) 的患者，可提供的各种矫形器数据有限。 当使用矫形器行走时，观察到的足部运动学被假设与临床结果相关，并可用于改进未来的设备设计。
15 名年龄为 63.6 ± 6.8 岁的 II 期 PTTD 患者在实验室中在四种情况下行走：（1）仅穿鞋（对照条件），（2）鞋加定制实心 AFO（Arizona Co， Mesa，AZ），（3）鞋加定制铰接式 AFO（Arizona Co，Mesa，AZ）和（4）带现成 AFO（AirLift，DJ Orthopedics）的鞋。 收集运动学数据以确定与每种情况相关的后足内翻，前足跖屈（反映抬高 MLA）和前足内收的程度。
与仅穿鞋的情况相比，定制铰接式装置在负荷反应（p = 0.002），中步（p <0.001）和终步（p = 0.02）时与更大的后足内翻相关。 与仅穿鞋的情况相比，定制铰接式装置，定制实心装置和现成装置在整个四个站立阶段都与更大的前足跖屈相关。 任何设备与鞋子条件之间都没有与前脚内收相关的差异。
与仅穿鞋相比，定制设备与更大的后足内翻和前足跖屈相关，而现成设备与前足跖屈相关，但后足运动没有变化。 与仅穿鞋的情况相比，没有任何设备纠正前脚外展。
当前的生物力学数据可能有助于理解使用这些设备获得的临床结果，并提供支持新设计的数据。
