Mazur F, Swoboda B, Carl H D, Lutter C, Engelhardt M, Hoppe M W, Hotfiel T, Grim C
Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Rathsberger Str. 57, D-91054, Erlangen, Germany.
Department of Orthopaedic and Trauma Surgery, Martha-Maria Hospital, Nuremberg, Germany.
J Exp Orthop. 2019 Feb 7;6(1):7. doi: 10.1186/s40634-019-0173-9.
It is frequently observed that overloading the foot can impair bone and soft tissue healing and can lead to harmful sequelae (i.e. ulcers, stress reactions) in context of pre-existing tissue disabilities. In terms of offloading, hindfoot relief devices are commonly applied as a non-operative treatment as well as after various surgical procedures for hindfoot disorders. Despite their common use, there is a paucity of data comparing different orthotic devices with respect to changes in plantar pressure distributions. The aim of this study was to investigate plantar loadings in hindfoot relief devices of different designs.
Twenty-five healthy participants (13 women, 12 men; (mean ± SD) age 37 ± 14 years; BMI 23 ± 4 kg/m) were recruited. Plantar pressure distributions were collected using i.) a neutral shoe, ii.) a hindfoot relief shoe (HRS) and iii.) a hindfoot relief orthosis (HRO). Peak pressure values were measured via dynamic pedobarography during walking and were analysed from four different plantar regions: the hindfoot, midfoot, metatarsal I-V and forefoot. As a reference standard, the normal walk using neutral shoes served as the condition for full weight-bearing.
Concerning the hindfoot, using the HRS as well as the HRO resulted in significant decreases in plantar pressures compared to baseline values that were obtained with the neutral shoe (- 52% for the HRS and - 52% for the HRO, p < 0.001). Significant increases in peak pressures were found in the midfoot region for both devices (HRS: 32%, p = 0.002; HRO: 47%, p < 0.001). For the metatarsal region, peak pressures were found to decrease significantly (HRS: - 52%, p < 0.001; HRO: -17%, p = 0.034). With respect to the forefoot, a significant reduction in peak pressures using the HRS (- 41%, p < 0.001) was detected, whereas the HRO did not lead to significant changes (- 4%, p = 0.691).
Both the HRO and HRS significantly reduced plantar hindfoot pressure, corresponding to a relative decrease of nearly 50% of the baseline. Nevertheless, the adjacent midfoot zone displayed a significant increase in plantar pressure values for both devices. Supported by these findings, physicians should cautiously consider a substantial increase in midfoot loading, especially in patients affected by additional midfoot injuries or accompanying impairments of tissue healing.
IV, Case series.
人们经常观察到，足部负荷过重会损害骨骼和软组织愈合，并在已有组织功能障碍的情况下导致有害的后遗症（如溃疡、应力反应）。在减轻负荷方面，后足减压装置通常作为非手术治疗方法应用，也用于各种后足疾病的手术后。尽管它们被广泛使用，但关于不同矫形装置对足底压力分布变化影响的数据却很少。本研究的目的是调查不同设计的后足减压装置的足底负荷情况。
招募了25名健康参与者（13名女性，12名男性；平均年龄±标准差为37±14岁；体重指数为23±4kg/m）。使用以下三种方式收集足底压力分布：i. 中性鞋；ii. 后足减压鞋（HRS）；iii. 后足减压矫形器（HRO）。在行走过程中通过动态足底压力测量法测量峰值压力值，并从四个不同的足底区域进行分析：后足、中足、第一至第五跖骨和前足。作为参考标准，穿着中性鞋的正常行走作为完全负重的条件。
在后足方面，与穿着中性鞋获得的基线值相比，使用HRS和HRO均导致足底压力显著降低（HRS降低52%，HRO降低52%，p<0.001）。两种装置在中足区域的峰值压力均显著增加（HRS：32%，p=0.002；HRO：47%，p<0.001）。在跖骨区域，峰值压力显著降低（HRS：-52%，p<0.001；HRO：-17%，p=0.034）。在前足方面，使用HRS时峰值压力显著降低（-41%，p<0.001），而HRO未导致显著变化（-4%，p=0.691）。
HRO和HRS均显著降低了后足足底压力，相当于基线值相对降低了近50%。然而，两种装置相邻的中足区域的足底压力值均显著增加。基于这些发现，医生应谨慎考虑中足负荷的大幅增加，尤其是在患有额外中足损伤或伴有组织愈合障碍的患者中。
IV，病例系列。
