特发性足尖行走儿童与同龄人相比下肢关节活动范围和力量存在差异：病例对照研究。
Children with idiopathic toe walking display differences in lower limb joint ranges and strength compared to peers: a case control study.
机构信息
Monash Health Community, 140-155 Sladen Street, Cranbourne, VIC, Australia.
Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.
出版信息
J Foot Ankle Res. 2022 Sep 12;15(1):70. doi: 10.1186/s13047-022-00576-x.
BACKGROUND
Idiopathic toe walking (ITW) is an exclusionary diagnosis. There has been limited exploration of lower limb active range of motion and strength measures in children with ITW. This researched aimed to determine any differences in lower limb muscle active range of motion and strength in children who have ITW, compared to normative data collected from children who displayed typical gait.
METHODS
Children were recruited with had a diagnosis of ITW, aged between 4 and 10 years, and no recent treatment. Data collected included parent reported data such as time spent toe walking, percentage of time spent toe walking, and clinician collected data such as age, height and weight. Joint ranges of motion and strength measures were collected by an experience clinician. Active and weight bearing joint ranges of motion were evaluated with a goniometer or digital inclinometer. Lower limb muscle strength measures were evaluated with a hand-held dynamometer. Published normative data sets were used for comparison. Measures were analysed with regression analyses to determine differences between groups in different measures, considering measures known to impact range and strength. Odds ratios (OR), 95% confidence intervals (CI) and p values were reported.
RESULTS
Twenty-six children with ITW participated. Reduced weight bearing ankle range of motion, when measured with the knee bent, was associated with being in the ITW group (p = 0.009), being older (p < 0.001) and weighing less (p < 0.001). Reduced ankle plantar flexion range was only associated with being in the ITW group (p = 0.015). For all lower limb strength measures, excluding hip external rotation, children who displayed greater strength, did not toe walk (p < 0.002), were older (p < 0.001) and weighed more (p < 0.014). with ITW.
CONCLUSION
Children with ITW displayed reduced overall plantar and dorsiflexion at the ankle, compared to non-toe walking children. Reduced plantarflexion is children with ITW has not been described before, however reduced dorsiflexion is commonly reported. Children with ITW were weaker in many lower limb measures, even when age and weight were considered. This should lead clinicians and researchers to pay greater attention to lower limb strength measures in this population.
背景
特发性趾行（idiopathic toe walking，ITW）是一种排他性诊断。对于 ITW 患儿，下肢主动活动范围和力量测量的研究有限。本研究旨在确定与表现出典型步态的儿童的正常数据相比，ITW 患儿的下肢肌肉主动活动范围和力量是否存在差异。
方法
招募患有 ITW 的儿童，年龄在 4 至 10 岁之间，且最近未接受治疗。收集的数据包括父母报告的数据，例如趾行时间、趾行时间百分比，以及临床医生收集的数据，例如年龄、身高和体重。由经验丰富的临床医生收集关节活动范围和力量测量值。使用量角器或数字测斜仪评估主动和负重关节活动范围。使用手持式测力计评估下肢肌肉力量测量值。使用已发表的正常数据进行比较。使用回归分析来分析不同措施之间的差异，考虑到影响范围和力量的已知措施。报告比值比（odds ratio，OR）、95%置信区间（95% confidence interval，CI）和 p 值。
结果
共有 26 名 ITW 患儿参与。当膝关节弯曲时，负重踝关节活动范围减小与 ITW 组相关（p=0.009），与年龄较大（p<0.001）和体重较轻（p<0.001）相关。仅踝关节跖屈活动范围与 ITW 组相关（p=0.015）。对于所有下肢力量测量值（髋关节外旋除外），显示出更强力量的儿童不趾行（p<0.002），年龄较大（p<0.001），体重较重（p<0.014）。
结论
与非趾行儿童相比，ITW 患儿的踝关节整体跖屈和背屈均减小。以前没有描述过 ITW 患儿的跖屈减小，但通常会报告背屈减小。即使考虑到年龄和体重，ITW 患儿的许多下肢测量值也较弱。这应该促使临床医生和研究人员更加关注该人群的下肢力量测量值。
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