Kothari A, Dixon P C, Stebbins J, Zavatsky A B, Theologis T
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK.
Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK.
Gait Posture. 2016 Mar;45:204-10. doi: 10.1016/j.gaitpost.2016.02.008. Epub 2016 Feb 11.
The role of flexible flat feet (FF) in the development of musculoskeletal symptoms at joints proximal to the ankle is unclear. We undertook an observational study to investigate the relationship between foot posture and the proximal joints in children. It was hypothesised that reduced arch height would be associated with proximal joint symptoms and altered gait kinematics and kinetics particularly in the transverse plane at the hip and knee. Ninety-five children between the ages of 8-15 were recruited into this ethically approved study. Foot posture was classified using the arch height index (AHI). The frequency of knee and hip/back pain was documented, and each child underwent three dimensional gait analysis. Reduced arch height was associated with increased odds of knee symptoms (p<0.01) and hip/back symptoms (p=0.01). A flat foot posture was also significantly associated with a reduction in the second peak of the vertical ground reaction force (p=0.03), which concomitantly affected late stance hip and knee moments. A reduced AHI was also associated with increased pelvic retraction and increased knee valgus in midstance. No kinematic and kinetic parameter associated with a flat foot posture related to increased proximal joint symptoms in the FF group. Children with a flatter foot posture are more likely to have pain or discomfort at the knee, hip and back; however, the mechanisms by which this occurs remain unclear. Treating FF without explicit understanding of how it relates to symptoms is difficult, and further work in this area is required.
柔性扁平足（FF）在踝关节近端关节肌肉骨骼症状发展中的作用尚不清楚。我们进行了一项观察性研究，以调查儿童足部姿势与近端关节之间的关系。研究假设足弓高度降低与近端关节症状以及步态运动学和动力学改变有关，特别是在髋关节和膝关节的横断面。95名8至15岁的儿童被纳入这项经伦理批准的研究。使用足弓高度指数（AHI）对足部姿势进行分类。记录膝关节和髋部/背部疼痛的频率，每个儿童都接受三维步态分析。足弓高度降低与膝关节症状（p<0.01）和髋部/背部症状（p=0.01）的几率增加有关。扁平足姿势还与垂直地面反作用力的第二个峰值降低显著相关（p=0.03），这同时影响了站立后期的髋关节和膝关节力矩。AHI降低还与站立中期骨盆后缩增加和膝关节外翻增加有关。在FF组中，与扁平足姿势相关的运动学和动力学参数均与近端关节症状增加无关。足部姿势较扁平的儿童在膝盖、臀部和背部更有可能出现疼痛或不适；然而，这种情况发生的机制仍不清楚。在没有明确了解FF与症状之间关系的情况下治疗FF是困难的，该领域需要进一步开展工作。
