足部截肢及其康复

为了足部截肢取得更好的康复效果 ,足趾截肢时应尽可能选择远的水平 ,以保证较好的站立和行走功能 ,防止残足畸形的发生。1足部截肢水平的选择在充分保证良好皮肤愈合的前提下 ,尽量保留足的长度是足部截肢水平选择的总原则。前足杠杆力臂缩短可严重影响快步行走、跑和跳跃。经跖骨截肢时 ,前足的负重点消失 ,经跗骨近端的截肢可破坏足部肌力的平衡 ,常发生残足马蹄内翻畸形 ,影响矫形器的穿戴、站立和行走。2足各部位截肢的特点与技术2 .1足趾截肢　拇趾截肢会影响快速行走、跑步和跳跃 ;第 2趾截肢后 ,大拇趾很容易向第 3趾侧倾斜 ,产生拇…     

足内在肌的解剖学研究

目的研究足内在肌的解剖结构特点,为足部生物力学模型、假肢设计、临床肌皮瓣移植和足部功能分析等外科手术设计提供解剖学基础和依据。方法对12只成人足标本进行系统的解剖,其中左足5只,右足7只,记录各足内在肌的起止点,用游标卡尺和排水量技术分别测量肌肉的长度、周径和容量。结果足内在肌的解剖学特点与足标本的大小存在一定的关系。平均肌肉长度从(3.39±0.75)cm(拇收肌横头)到(13.15±0.84)cm(拇展肌),平均肌肉周径从(1.45±0.14)cm(第四蚓状肌)到(6.20±0.62)cm(拇短屈肌),平均肌肉容量从(0.58±0.13)ml(第四蚓状肌)到(14.00±1.20)ml(拇展肌)。结论拇展肌、趾短屈肌以及拇短屈肌具有解剖学代表性,三者各自肌肉长度、周径、容量均较大。     

足下垂刺激仪对脑卒中足下垂患者下肢运动功能的影响

目的:观察足下垂刺激仪联合功能锻炼对脑卒中足下垂患者的治疗价值。方法:选取2015年2月~2016年2月于我院住院治疗的脑卒中合并足下垂患者104例,运用数字随机法将患者分为对照组和研究组,每组52例,对照组接受常规功能锻炼;研究组在此基础上,于患者步行过程中使用足下垂刺激仪。观察分析研究组和对照组足跖屈群肌张力治疗效果、胫前肌肌力治疗效果、FMA评分。结果:研究组足跖屈群肌张力、胫前肌肌力治疗效果显著优于对照组(P0.05);治疗后研究组的FMA评分显著高于对照组(P0.05)。结论:足下垂刺激仪联合功能锻炼能够显著地改善脑卒中合并足下垂功能障碍患者的肌张力,促进下肢运动功能改善,从而改善患者预后。     

足下垂刺激仪对脑卒中足下垂患者下肢运动功能的影响

目的 观察足下垂刺激仪联合功能锻炼对脑卒中足下垂患者的治疗价值。方法　选取2015年2月～2016年2月于我院住院治疗的脑卒中合并足下垂患者104例,运用数字随机法将患者分为对照组（52例）和研究组（52例）,对照组接受常规功能锻炼;研究组在此基础上,于患者步行过程中使用足下垂刺激仪。观察分析研究组和对照组足跖屈群肌张力治疗效果、胫前肌肌力治疗效果、FMA评分。结果　研究组足跖屈群肌张力、胫前肌肌力治疗效果显著优于对照组(P<0.05);治疗后研究组的FMA评分显著高于对照组(P<0.05)。结论　足下垂刺激仪联合功能锻炼能够显著地改善脑卒中合并足下垂功能障碍患者的肌张力,促进下肢运动功能改善,从而改善患者预后。     

内侧楔形鞋垫矫治成人扁平足的研究进展

成人扁平足导致的足部过度旋前可造成下肢力线改变并影响下肢关节运动功能, 从而引起疼痛并增加运动损伤风险。矫形鞋垫是一种以恢复人体下肢异常力线结构为目的的辅助功能矫形器, 也兼具缓冲减震、增加本体感觉等作用。内侧楔形鞋垫(MWO)能矫正扁平足患者的下肢力线, 改善踝、膝、髋关节运动学参数并缓解下背部疼痛, 因此被广泛应用于矫治扁平足。本研究通过总结分析近年来关于MWO矫治成人扁平足的文献报道, 发现合理应用MWO可改善扁平足患者足部过度旋前, 从而影响下肢各关节运动及下肢肌肉活动, 对缓解扁平足人群在特定运动时疼痛及预防运动损伤具有积极作用。     

防垂足固定托的制作及应用

足下垂是由于脊髓损伤后引起下肢胫骨前肌群肌力降低,小腿三角肌痉挛引起足跟腱挛缩等原因使踝关节不能背曲。足下垂一旦发生,矫正过晚将会发生足部的内翻、畸形,影响患者下地行走,严重者给患者造成终身残疾。所以采取有效的预防措施至关重要。     

基于聚类分析的足横弓承重类型及足底压力特征

背景：研究表明足横弓的完整和稳定对足部功能的实现至关重要,前足过度承重是导致足横弓变形的主要因素,关于国人足横弓承重类型研究至今少有报道。目的：探讨步行时足部冲量峰值区域,区分足横弓承重类型,为足部损伤的预防和康复提供相关依据。方法：采用Footscan高频足底压力测试系统,对1000名女大学生自然行走时的动态足底压力分布进行测试分析,观察其步态及支撑期冲量、时相、足内外翻等指标。结果与结论：通过聚类分析,第1跖骨承重类型109例、第2、3跖骨承重类型213例、第3跖骨承重类型517例、第3、4跖骨承重类型161例。第1跖骨承重类型离地阶段时间百分比大于其他3类,差异具有显著性意义;第1跖骨承重类型在离地阶段过度足外翻的比例最大,第2,3跖骨,第3跖骨,第3,4跖骨承重类型的足外翻比例依次减小。基于足底压力分析,正常人步行时足横弓负重可分为4类承重类型,为解释足步行时的足部功能提供帮助,其中第1跖骨承重类型易前足发生足部损伤。     

小针刀治疗小儿足内外翻18例疗效分析

近年来,我院共收治足内外翻患儿50例,其中18例采取小针刀,松解胫骨后肌腓骨长肌减轻趾长屈肌腓骨短肌肌力或挛缩,胶布固定等方法。强筋正骨,以达到纠正小儿足内外翻并取得良好疗效,分析如下。1临床资料1.1一般资料本组男11例,女7例,左足内翻4例,右足8例,双足4例。右足外翻2例。年龄1~7岁。临床主要表现患儿行走时,跨步困难,一侧者走路跛行。双侧走路行走摇摆不稳。1.2病因与症状本病由先天形成,可能因胎儿在子宫内位置异常或肌肉发良不良引起肌力不均等导致。患儿出生时可见一足或两足内外翻,用手板正时,有不同程度的阻力。当患儿行走时,跨…     

田径运动员足肌闭合性损伤的成因

足肌力量的大小和柔韧性的优劣,在田径运动中起着至关重要的作用。如果不重视对足肌损伤的预防,足肌的损伤会时常发生,并将直接影响田径运动员水平的提高。     

缓解足底压力与有效防治糖尿病足溃疡发生体会

糖尿病足溃疡是糖尿病患者下肢截肢致残的主要原因,糖尿病患者中,约有10%的人将在发病过程中,由于足底压力异常增高,最终导致足部溃疡。对缓解足底压力与有效防治糖尿病足溃疡发生体会如下。1糖尿病患者足底压力增高的主要原因1.1神经病变糖尿病神经病变在糖尿病足发病机制中起主要作用,如人体的外周感觉、运动、自主神经调节等,均是支配人体足部肌肉的神经,当人体发生糖尿病时,则代谢紊乱,引起神经纤维减少,从而引起足部小肌群萎缩,足部肌肉的萎缩直接引起足部屈伸功能失衡,运动神经病损害的同时也累及自主神经,从而患糖尿病的人感觉足部皮…     

足姿指数评价足部位置的信效度研究

目的 探究足姿指数(FPI)评分系统对我国足部姿势评价的信度和效度。 方法 2019年9月至10月,2名评定者(评定者1、评定者2)学习FPI-6评分系统,熟练后对15例20~40岁成年人双下肢的足部姿势进行评估,2名评定者同一天先后对所有受试者进行第1次测试;2周内,再由评定者1对受试者进行第2次测试。计算组内相关系数(ICC)进行重测信度和测试者间信度评价,采用MedCalc进行Bland-Altman绘图。采用Spearman相关系数评价量表的内容效度,采用因子分析评价量表的结构效度。 结果 FPI各项及总分的重测信度和测试者间信度的ICC均> 0.75。测试者间FPI评分的平均差值为-0.133,一致性限度为(-1.82, 1.55)。FPI各条目与总分均相关(P < 0.05);提取到3个公因子,累计贡献率达80%以上。 结论 FPI-6评分系统具有较好的信度和效度,可应用于中国人的足姿评估,对减少运动损伤、疾病预防及康复治疗有重要的指导意义。     

红外温度检测足部皮肤温度预防糖尿病足并发症效果的Meta分析

目的评价红外温度检测足部皮肤温度对预防糖尿病足并发症的效果。方法计算机检索Cochrane Library、PubMed(1990-2010)、EMBase(1990-2010)、EBSCO、中国期刊全文数据库(1999-2010)、维普中文科技期刊全文数据库(1989-2010)中关于红外温度检测仪的使用对预防糖尿病足溃疡的效果的随机对照试验(randomized controlled trial,RCT),同时筛检纳入文献的参考文献。按照Cochrane协作网等推荐的方法评价纳入研究的方法学质量和提取有效数据后,采用RevMan 5.0统计软件进行Meta分析。结果共纳入3篇RCT文献。分析结果显示,以红外温度测量为干预措施的观察组糖尿病足溃疡的发病率低于对照组。结论对于糖尿病足高危患者,足部皮肤温度监测作为一种预防措施能及时发现足部并发症的发生。     

Compartment Syndrome of the Foot After Calcaneal Fracture

Background: Compartment syndrome of the foot as a result of a calcaneal fracture has received only occasional consideration in the recent Emergency Medicine literature, yet it remains a challenging diagnosis to make. The devastating consequences of untreated compartment syndrome of the foot include clawing of the lesser toes, stiffness, chronic pain, motor weakness, neurovascular dysfunction, and fixed deformities of the foot. In addition to decreased quality of life, this also leads to lost time at work and lost wages. Calcaneal fractures can lead to devastating long-term disability that is often permanent and life-altering for patients suffering from this injury. Approximately 10% of patients with these fractures develop compartment syndrome of the foot. The pathogenesis of calcaneal fractures is well recognized, and the surgical treatment techniques continue to evolve. Objectives: The objectives of this case report are to increase understanding of the pathophysiology of compartment syndrome and its short- and long-term consequences, to improve the ability to diagnose compartment syndrome, and to emphasize the need for emergent surgical treatment. Case Report: A 37-year-old man sustained an isolated comminuted, extra-articular calcaneus fracture that resulted in compartment syndrome of the foot. The diagnosis required measurement of several compartments in the foot. He subsequently received emergent operative decompression and experienced a positive outcome. Conclusion: Diagnosis of compartment syndrome of the foot is a clinical one, and diagnostic tools such as radiographic imaging and compartment pressure monitoring can help confirm the diagnosis. It is also important to understand the long-term sequelae of this injury and to involve a specialist early in the decision-making and treatment process.     

Strength Training for the Intrinsic Flexor Muscles of the Foot: Effects on Muscle Strength,the Foot Arch,and Dynamic Parameters Before and After the Training

[Purpose] The purpose of the present study was to verify the effects of intrinsic foot flexor strength training. [Subjects] The subjects were 12 healthy males without motor system disease. [Methods] A training method that involved flexion of all toe interphalangeal and metatarsophalangeal joints against a 3-kg load was implemented and was performed for 200 repetitions once per day, three times per week, for a period of eight weeks. [Results] Significant changes were observed for intrinsic foot flexor strength scores, foot arches, vertical jumping, 1-legged long jumping, and 50-m dash time. [Conclusion] This muscle strength training method significantly improved muscle strength scores, foot arch shape, and movement performance.Key words: Intrinsic flexor muscles of the foot, Muscle training, Muscle strength     

利用足部护理箱开展老年糖尿病患者糖尿病足的健康教育

目的：提高老年糖尿病患者足部护理能力。方法对80例住院老年糖尿病患者,应用足部护理箱,开展有关糖尿病足相关知识的健康教育。内容包括对糖尿病足的早期筛查,糖尿病足日常护理,足部的检查,选择合适的鞋袜,促进肢体血液循环的锻炼和糖尿病足部常见问题等。结果干预2周采用自制“糖尿病足部自护能力评估表”评价80例患者的足部自护能力。结果显示：教育后,患者对足部糖尿病各项相关知识知晓率达到91%～96%,患者都建立了自己的足部护理箱。结论采用图、文及教育工具相结合的教育方式,符合老年人的特点,能激发患者学习兴趣,有效提高健康教育效果和患者的足部护理能力。     

足底压力分布测量系统及临床应用

目的 :研制一套足底压力分布测量系统并评价其临床应用价值。方法 :足底压力分布测量系统由硬件和软件 2个部分组成。系统硬件包括一个由 2 0 0个国产微型压力传感器组成的 30 0mm× 15 0mm的压力传感器矩阵、接口电路、信号采集及计算机系统 ;系统软件主要由实时数据采集模块、数据存贮模块、数据计算分析和显示模块、病历管理与资料查询模块、诊断模块等组成。应用本系统对 5 8例正常人 (正常组 )、75例无明显周围神经病变的糖尿病患者 (DM组 )及 30例合并周围神经病变的糖尿病患者 (DN组 )进行足底压力测试。结果 :DN组足底最大压力比正常组明显增高 ,而DM组足底最大压力与正常组相似。结论 :本系统稳定 ,灵敏度和分辨率高 ,结果可靠 ,操作简便 ,具有良好的临床应用前景。     

Foot Compartment Syndrome: A Rare Presentation to the Emergency Department

Background

Compartment syndrome of the foot is a rare but life- and limb-threatening condition that is often difficult to diagnose. The common signs and symptoms of compartment syndrome are pain out of proportion to the injury, pain with passive stretch of the compartment, paresis, paresthesias, and often, intact pulses. Foot compartment syndrome is often caused by traumatic injuries, and the clinical presentation may be confusing in this setting. The foot contains nine compartments, which should all be assessed for elevated compartment pressures. Definitive management is fasciotomy. Prompt recognition, diagnosis, and treatment are essential to prevent devastating complications.

Objectives

This article discusses the key components of presentation, diagnosis, and management of foot compartment syndrome.

Case Report

A patient presented to the Emergency Department (ED) with a crush injury of his foot. He had significant swelling and pain in his foot, but no fractures were identified on X-ray study. Given the severity of his injury and pain, foot compartment pressures were measured to accurately diagnose foot compartment syndrome. The patient underwent fasciotomies of the foot within 3 h of presentation to the ED and suffered no sequelae at the time of follow-up in clinic.

Conclusion

Foot compartment syndrome is a surgical emergency that can be difficult to diagnose. Early diagnosis with compartment pressure measurements is crucial, as definitive management with fasciotomies can prevent long-term sequelae.     

Implementing Diabetic Foot Care in the Primary Care Setting

Patients with diabetes mellitus are at risk for foot ulcers and subsequent amputations. The outpatient diabetic population could benefit from services to prevent factors that lead to the development of foot ulcers and further complications. The purpose of this project was to evaluate the effectiveness and feasibility of implementing a foot care program in the primary care setting. An evaluation of the outcomes supported these foot care services. Future studies showing the effectiveness of foot care services in the primary care setting would further substantiate the benefits of providing diabetic foot care in primary care practice.     

Causes and Prevention of Diabetic Foot Skin Breakdown

As the number of persons with diabetes increases, there is an increased incidence of foot skin breakdown and lower extremity amputations. Approximately 44%–85% of those amputations can be prevented. Prevention requires an understanding of the causes of diabetic foot skin breakdown and the measures necessary for prevention. As rehabilitation nurses, we care for patients with strokes, hip fractures, spinal cord injuries, or joint replacements, who are diabetic and are at risk for foot skin breakdown. We also care for patients with amputations who are at risk for skin breakdown of the remaining foot. This article identifies the causes of foot skin breakdown, such as neuropathy, peripheral vascular disease, trauma, and infection. Discussion includes patients who are at risk, the foot areas at risk, preventive measures, and patient and family education for the prevention of foot skin breakdown in the diabetic patient.     

糖尿病足患者足部自护能力及健康需求的调查

目的探讨糖尿病足患者足部自护能力及健康需求情况。方法采用自行设计的问卷调查表,对80例糖尿病足患者进行足部自护能力及健康需求调查。结果患者对糖尿病基本知识、对糖尿病足的认识、足部保健知识、正确的穿鞋袜知识、正确的修剪指甲知识等了解甚少,93.8%的患者希望接受糖尿病足知识教育。结论医护人员应加强对糖尿病患者糖尿病足知识的健康教育,提高患者的自护能力。