| Summary: | 碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 96 === Background: Flexible flatfoot is commonly observed in children. Although the condition gradually resolves over the years, a small percentage keeps the foot type into the adult life. It is widely believed that excessive pronation of the foot will result in lower extremity problems due to abnormal kinematic changes during walking or running. Clinically, foot inserts or orthosis are frequently prescribed to children with flexible flatfoot to prevent problems in later lives. Several researchers reported that insole application could reduce abnormal lower extremity kinematics through supporting the foot in a more neutral position. Although customized fabrication has been the gold standard for producing the foot orthosis, numerous studies have shown that even simple-designed orthosis such as medial-wedge inserts could have similar effects on lower extremity kinematic changes just like the customized ones. However, there has been no study to compare the lower extremity kinematic differences in children with and without flexible flatfoot, and insufficient evidence to show the effect of foot insole on the lower extremity kinematic behaviors in children to support the treatment rationale. The purpose of our study was to investigate the differences of lower extremity kinematics in children with and without flexible flatfoot, and the effect of insole with medial wedge application on lower extremity kinematics during gait in children with flexible flatfoot. Methods: Twenty children with flexible flatfoot were recruited. They walked 10 trials on a wooden platform at a comfortable speed with and without a wedged-insole, respectively in the laboratory soft-insole shoes. Another 10 children without flatfoot served as the comparison group. Electromagnetic sensors were placed on the pelvis, thigh, lower leg and calcaneus. Three-dimensional kinematic data were collected using the Liberty Electromagnetic Tracking System, We retrieved data of maximum angle of the calcaneal eversion and internal rotation of the tibia, knee and hip, as well as excursion and maximum velocity of calcaneal inversion/eversion and rotation of the tibial, knee and hip during the stance phase. The data were averaged over three gait cycles for comparison. The static foot alignment variables of the calcaneal eversion angle and navicular height were also measured in the standing position to compare the effects before and after application of the wedged-insole. Results: Children with flexible flatfoot demonstrated less excursion in internal rotation of the hip during gait. The maximum calcaneal eversion velocity and the maximum internal tibial rotation angle reduced significantly after application of the wedged-insole. No other statistical differences were found in the remaining kinematic parameters. The static foot alignment also demonstrated significantly reduced calcaneal eversion angle and increased navicular height in the static standing position. Conclusion: The results of this study showed the maximum calcaneal eversion velocity and internal tibial rotation angle reduced significantly after application of the wedged-insole in children with flexible flatfoot. These changes might provide preventive effects for some of the lower extremity injuries that might result from flexible flatfoot condition.
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