Jandacka Daniel, Plesek Jan, Skypala Jiri, Uchytil Jaroslav, Silvernail Julia Freedman, Hamill Joseph
Human Motion Diagnostic Centre, Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic.
Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, Nevada, USA.
Orthop J Sports Med. 2018 Jun 22;6(6):2325967118779862. doi: 10.1177/2325967118779862. eCollection 2018 Jun.
Despite the increasing incidence of Achilles tendon (AT) ruptures, there is a lack of information on the possible risks associated with regular running and walking for exercise after an injury. There are some known kinematic gait changes after an AT rupture, especially at the knee. However, it is not clear whether runners with AT ruptures may be at risk for secondary knee injuries during shod or barefoot running/walking.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare the kinematics and kinetics of barefoot walking and barefoot and shod running between athletes with a history of AT ruptures and a healthy control group. We hypothesized that there would be increased knee joint loads in the affected limb of the AT rupture group, especially during shod running.
Controlled laboratory study.
Ten patients who had undergone surgical treatment of a unilateral acute AT rupture (6.1 ± 3.7 years postoperatively ) and 10 control participants were matched according to age, sex, physical activity, weight, height, and footfall type. The kinematics and kinetics of barefoot walking and barefoot and shod running were recorded using a high-speed motion capture system synchronized with force platforms.
The main outcome measures were lower extremity joint angles and moments during the stance phase of walking and running. After AT repair, athletes had increased internal knee abduction moments during shod and barefoot running compared with the healthy control group ( < .05, η > 0.14). There were no significant differences in kinematics and kinetics during walking between the AT rupture and healthy control groups ( ≥ .05).
After an AT rupture, athletes had increased internal knee abduction moments during running compared with the healthy control group.
The increased abduction loads on the knee in patients with an AT rupture could lead to further running-related injuries. However, barefoot walking may be used as a proprioceptive exercise without an increased risk of overuse injuries in these patients.
尽管跟腱断裂的发病率不断上升，但对于受伤后定期跑步和步行锻炼可能存在的风险，相关信息却很匮乏。跟腱断裂后存在一些已知的运动步态变化，尤其是在膝关节处。然而，尚不清楚跟腱断裂的跑步者在穿鞋或赤脚跑步/行走时是否有继发膝关节损伤的风险。
目的/假设：本研究的目的是比较有跟腱断裂病史的运动员与健康对照组在赤脚行走以及赤脚和穿鞋跑步时的运动学和动力学。我们假设跟腱断裂组患侧肢体的膝关节负荷会增加，尤其是在穿鞋跑步时。
对照实验室研究。
选取10例接受单侧急性跟腱断裂手术治疗的患者（术后6.1±3.7年）和10名对照参与者，根据年龄、性别、体力活动、体重、身高和步型进行匹配。使用与测力平台同步的高速运动捕捉系统记录赤脚行走以及赤脚和穿鞋跑步时的运动学和动力学数据。
主要观察指标为步行和跑步支撑期下肢关节角度和力矩。与健康对照组相比，跟腱修复后的运动员在穿鞋和赤脚跑步时患侧膝关节内收力矩增加（P<0.05，η>0.14）。跟腱断裂组与健康对照组在步行时的运动学和动力学方面无显著差异（P≥0.05）。
跟腱断裂后，与健康对照组相比，运动员在跑步时患侧膝关节内收力矩增加。
跟腱断裂患者膝关节外展负荷增加可能导致更多与跑步相关的损伤。然而，赤脚行走可作为一种本体感觉训练方式，且不会增加这些患者过度使用损伤的风险。
