運動員的拇趾外翻與保守治療

Conservative Treatments for Hallux Valgus in Athletes

10.6162/SRR.2014.130.07

王乾勇(Chien-Yung Wang)；黃啟煌(Chi-Huang Huang)

輔具 ； 貼匝 ； 徒手治療 ； 運動治療 ； orthoses ； taping ； manual therapy ； exercise therapy

大專體育

130期（2014 / 09 / 30）

47 - 53

繁體中文

拇趾外翻是運動員常見的足部問題之一，它除會造成外觀上的影響外，也有可能造成疼痛並影響功能表現。文獻指出拇趾外翻是多重原因造成，包括外在不正常鞋具的壓迫與內在因素如遺傳，後足外翻、扁平足等結構問題，以及關節鬆弛與疾病等因素。處理的方式包含外科手術與保守治療二大類，手術治療的效果明顯，但有併發症與高復發率的風險，保守治療則是在手術前的一種選擇，目前保守治療的種類繁多，分為：一、改善鞋具，減輕腳趾壓迫；二、利用外力矯正受力方式，如鞋墊、副木或貼紮；三、徒手治療與運動治療調整關節與軟組織，改善肌肉的不平衡等。保守治療原理各有不同，治療也可交互並用可達到更多效果。文獻回顧發現保守治療對拇趾外翻患者的疼痛與功能表現是有幫助的，但是否能矯正拇趾外翻仍缺乏證據，且即使可以矯正，其改善的幅度也有限，並需要較長時間的治療追蹤。治療選擇要考慮病人的特性、喜好與生活形態、運動形式等，最後決定患者可以接受的方式以達到最好的效果。

Hallus valgus is one of the common foot problems in athletes. It posts not only the cosmetic problems, but also induce their physiological dysfunction. External compression from inappropriate shoes wearing, and internal inheritance, rearfoot valgus, pronated foot, joint laxity and neurological disease are factors found to cause hallus valgus. Conservative and surgical treatments are two main approaches to manage the hallus valgus deformity. The cosmetic outcomes of surgery are significant, but the recurrent rate is high and may have other complications. Patients whose symptoms are not relieved after conservative treatment may need to be referred to surgical intervention. The conservative treatments include: 1. Shoes box modification to relief foot pressure, 2. Add insole, splint and realignment foot structure, 3. Manual and exercise therapies to adjust soft tissue and correct muscle imbalance. Clinicians can combine different approaches for better results. Current researches indicated that conservative approaches may relieve the symptoms and improve function; however, it is still lack of evidence to support that this approach can prevent the worsening or correct the valgus deformation. The conservative treatment took more time to see improvement than surgical intervention. The patients' personal needs, preferred lifestyle, and types of sports also need to be considered when managing a hallux valgus problem.

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