Palmanovich Ezequiel, Ayalon Moshe, Sira David Ben, Nyska Meir, Hetsroni Iftach
Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
The Academic College at Wingate Institute, Israel.
Foot (Edinb). 2017 Dec;33:39-43. doi: 10.1016/j.foot.2017.10.003. Epub 2017 Oct 24.
Elevated heel construction offloads the forefoot after surgery. However, side-to-side height difference alters limb kinetics, whereas leg-length equalizing-sole at non-operated side may have beneficial effects on foot loading. The purpose of this study was to characterize leg-length equalizing sole effect on bilateral plantar pressures when using heel-lift forefoot-offloading shoe.
Twenty men were tested walking. Plantar peak pressures (PP) and pressure-time integrals (PTI) in the forefoot-offloading shoe and in contralateral running shoe were compared between two conditions: one with- and the other without leg-length equalizing sole elevation at the running shoe.
Adding leg-length equalizing sole to the running shoe resulted in the following changes in the forefoot-offloading shoe: increased lateral midfoot PP (8.7%, p=0.03), increased lateral midfoot (11.3%, p=0.05) and lateral metatarsals PTI (10.3%, p=0.04), and decreased medial and lateral heel PTI (>5%, p=0.02). These changes were non-significant when applying a Bonferroni correction. Changes in the running shoe were: increased medial midfoot (20.5%, p=0.03) and decreased 2nd and lateral metatarsals PP (23%, p<0.01). PTI increased in medial and lateral heel (>25%, p<0.01), medial midfoot (63.2%, p<0.01) and lateral midfoot (9.2%, p=0.04) and decreased in 2nd and lateral metatarsals (>24.5%, p<0.01).
Leg-length equalizing sole at contralateral running shoe in subjects wearing forefoot-offloading shoe results in lateral load shift alongside heel pressure attenuation within the forefoot-offloading shoe, which is beneficial during first month after medial forefoot surgery. Reciprocal medial load-shift in the elevated running shoe itself should yet be considered when bilateral medial forefoot pathology is present.
术后采用高后跟结构可减轻前足负荷。然而，双侧高度差异会改变肢体动力学，而在非手术侧使用腿长均衡鞋垫可能对足部负重有益。本研究的目的是在使用足跟抬高、前足减负鞋时，描述腿长均衡鞋垫对双侧足底压力的影响。
对20名男性进行步行测试。比较两种情况下在前足减负鞋和对侧跑鞋中测得的足底峰值压力（PP）和压力时间积分（PTI）：一种情况是跑鞋带有腿长均衡鞋垫抬高，另一种情况是跑鞋没有腿长均衡鞋垫抬高。
在跑鞋上添加腿长均衡鞋垫后，前足减负鞋出现以下变化：足中外侧PP增加（8.7%，p = 0.03），足中外侧PTI增加（11.3%，p = 0.05）以及第5跖骨外侧PTI增加（10.3%，p = 0.04），足跟内外侧PTI降低（>5%，p = 0.02）。采用Bonferroni校正后，这些变化无统计学意义。跑鞋的变化为：足中内侧增加（20.5%，p = 0.03），第2跖骨和第5跖骨外侧PP降低（23%，p < 0.01）。足跟内外侧、足中内侧和足中外侧PTI增加（>25%，p < 0.01），第2跖骨和第5跖骨外侧PTI降低（>24.5%，p < 0.01）。
对于穿着前足减负鞋的受试者，在对侧跑鞋上使用腿长均衡鞋垫会导致前足减负鞋内出现侧向负荷转移以及足跟压力衰减，这在内侧前足手术后的第一个月是有益的。当存在双侧内侧前足病变时，仍应考虑抬高的跑鞋本身会出现相应的内侧负荷转移。
