Roberts Andrew, Hulse David, Bennett Alexander N, Dixon Sharon
Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey KT18 6JW, England; Sport and Health Sciences, College of Life and Environmental Sciences, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, England.
Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey KT18 6JW, England.
Clin Biomech (Bristol). 2017 Dec;50:27-31. doi: 10.1016/j.clinbiomech.2017.10.002. Epub 2017 Oct 2.
Anterior chronic exertional compartment syndrome of the leg has been hypothesised to develop due to excessive muscle activity and foot pronation. Plantar pressure variables related to lower limb muscle activity and foot type may therefore provide insight into this condition.
70 male cases and 70 asymptomatic controls participated. A clinical diagnosis was established from typical symptoms, with clinical examination excluding other pathologies. Plantar pressure variables during walking, hypothesised to be related to foot type, toe extensor activity or had shown predictive validity for general exercise-related lower leg pain, were extracted.
Cases were shorter in height (mean difference 2.4cm), had greater body mass (mean difference 4.4kg) and had reduced ankle dorsiflexion range of motion than controls (mean difference 1.5cm). Plantar pressure variables indicative of foot-type and toe extensor activity did not differ between groups (P>0.05). The magnitude of medial forefoot loading was the strongest plantar pressure predictor of the presence of chronic exertional compartment syndrome (Odds ratio:0.87, P=0.005). There was also some evidence of greater lateral heel loading at 5% of stance time (P=0.049-0.054).
The lack of association with foottype-related and toe extensor activity-related plantar pressure variables suggest that these are not risk factors for the development of chronic exertional compartment syndrome, contrary to earlier hypotheses. The greater lateral to medial loading could theoretically represent increased Tibialis anterior muscle activity at heel strike but a subsequent loss of control as the ankle is lowered. Future studies directly investigating muscle activity and function are now required.
小腿前侧慢性运动性骨筋膜室综合征被推测是由于过度的肌肉活动和足内翻所致。因此，与下肢肌肉活动和足型相关的足底压力变量可能有助于深入了解这种病症。
70名男性病例和70名无症状对照者参与研究。根据典型症状进行临床诊断，临床检查排除其他病理情况。提取步行过程中被认为与足型、趾伸肌活动相关或已显示出对一般运动相关小腿疼痛具有预测效度的足底压力变量。
病例组身高较矮（平均差异2.4厘米），体重更大（平均差异4.4千克），踝关节背屈活动范围小于对照组（平均差异1.5厘米）。两组之间表明足型和趾伸肌活动的足底压力变量无差异（P>0.05）。前足内侧负荷大小是慢性运动性骨筋膜室综合征存在的最强足底压力预测指标（优势比：0.87，P=0.005）。在站立时间的5%时，外侧足跟负荷也有增加的迹象（P=0.049 - 0.054）。
与足型相关和趾伸肌活动相关的足底压力变量缺乏关联表明，与早期假设相反，这些并非慢性运动性骨筋膜室综合征发生的危险因素。理论上，外侧到内侧负荷增加可能代表足跟触地时胫骨前肌活动增加，但随着踝关节下降随后失去控制。现在需要直接研究肌肉活动和功能的未来研究。
