Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea.
Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
NeuroRehabilitation. 2020;47(2):217-226. doi: 10.3233/NRE-203106.
Navicular drop is a common plantar deformity which makes the plantar medial longitudinal arch (MLA) collapse and leads to other deformities in lower extremities. Active structures are from intrinsic and extrinsic foot muscle activities such as abductor hallucis (AbdH), tibialis anterior (TA), tibialis posterior, flexor hallucis brevis, flexor digitorum brevis during dynamic situations. As AbdH plays a role as a dynamic elevator of MLA, the importance of AbdH has been emphasized and the proper recruitment of both intrinsic and extrinsic muscle is crucial for stabilization of MLA during dynamic weight bearing condition. Because the short foot (SF) exercise is difficult to perform and tends to activate the intrinsic muscles concentrically rather than a natural coordination of concentric-isometric-eccentric activation, we have developed the guidance-tubing SF gait (GFG) exercise.
We investigated the effect of GFG exercise on muscle activity, AbdH:TA activity ratio, MLA angle, and foot pressure distribution during walking compared to SF gait (SFG) exercise.
Thirty-two subjects with flexible flat feet were divided into two groups and performed SFG exercise with (GFG) and without guidance-tubing (SFG) for seven serial days.
AbdH muscle activity significantly increased from foot flat to heel rise in the GFG group (p = 0.006). The AbdH:TA activity ratio significantly increased in both the SFG (p = 0.015) group and GFG group (p = 0.006). MLA angles significantly decreased in both the SFG group (p = 0.001) and GFG group (p = 0.000), and the decrement was significantly higher in the GFG group (p = 0.001). The foot pressure distribution did not show any statistically significant change.
The result of this study provides a clinical implication for training MLA supporter muscles in individuals with flat feet. The overactive muscle must be inhibited first, then facilitation and strengthening are followed respectively.
舟状骨下降是一种常见的足底畸形，会导致足底内侧纵弓（MLA）塌陷，并导致下肢其他畸形。在动态情况下，主动结构来自内在和外在足肌的活动，如外展拇肌（AbdH）、胫骨前肌（TA）、胫骨后肌、短屈肌、短屈肌。由于 AbdH 作为 MLA 的动力提升器发挥作用，因此强调了 AbdH 的重要性，并且在动态承重条件下稳定 MLA 时，内在和外在肌肉的适当募集至关重要。由于短足（SF）运动难以进行，并且往往会使内在肌肉同心激活，而不是自然协调同心-等长-离心激活，因此我们开发了导向管 SF 步态（GFG）运动。
我们研究了与 SF 步态（SFG）运动相比，GFG 运动对行走时肌肉活动、AbdH:TA 活动比、MLA 角度和足底压力分布的影响。
将 32 名具有弹性扁平足的受试者分为两组，并在七次连续天内进行 SFG 运动（GFG）和无导向管（SFG）运动。
从足底到跟骨抬起，GFG 组 AbdH 肌肉活动明显增加（p = 0.006）。SFG 组（p = 0.015）和 GFG 组（p = 0.006）的 AbdH:TA 活动比均显著增加。SFG 组（p = 0.001）和 GFG 组（p = 0.000）的 MLA 角度均显著降低，GFG 组的降低幅度明显更高（p = 0.001）。足底压力分布没有显示出任何统计学上的显著变化。
本研究结果为扁平足患者训练 MLA 支撑肌提供了临床意义。必须首先抑制过度活跃的肌肉，然后分别进行促进和加强。
