迈向更健康—克服半勒克斯极限
原创发表于Race Play Michi-ana 2016年8月- 9月
Distance running has a way of revealing biomechanical abnormalities — many times in ways we would never expect. 在我医学院的第一年, I began to see the advant年龄s of improving my cardiovascular fitness 和 took up running to this end. 没过多久,我就意识到需要一双合适的私人鞋, 更好的饮食, 和 knowing how to dress for the weather in the varying climate of central Iowa. 离我的第一次半程马拉松只有几周了, how-ev-er, 我开始听到咔哒一声从我的大脚趾底部传来, 伴随的 “关节周围充满感觉. Remarkably, my foot looked quite ordinary from the outside, with no 肿胀 or redness. I purchased some over-the-counter inserts 和 ran the half marathon with no difficulty. 不久之后, how-ev-er, 整个感觉变得隐隐作痛,起初断断续续, 然后一直.
什么是半光极限?
Hallux (great toe) limitus (diminished motion) is a condition in which the great toe cannot move through a normal range of motion during normal ambulation. Normal gait requires 65 to 75 degrees of dorsiflexion (ability to bend upward) at the base of the great toe. Any impairment in the fluid motion of this joint can be considered arthritis (“arthro” meaning joint 和 “它的意思是炎症。. 这种部分u型关节的名字叫做hallux lim-i-tus. This progressive condition can eventually lead to losing all motion (Hallux rigidus) at the base of the great toe. The x‑ray image below compares a normal great toe joint with the full progression of the arthritis-associated Hallux rigidus.
临床体征和症状
在早期阶段,患者可能会感到肿胀或 “大脚趾底部的“丰满”, which can progress to pain in the joint as the toe bends to its upper limit. Pain will be aggravated by ambulation that will advance to a burning sensation or dull ache even at rest. 在某一时刻, the selling in the joint will be 伴随的n underlying bony prominence that may be visible through the skin as the joint begins to lose mobility. Even-tu-al-ly, 如果不及时治疗, the joint will auto-fuse as it advances from hallux limitus to hallux rigidus.
为什么会发生这种情况??
有几种生物成因,包括:扁平足, 第一跖骨长, 一种伸展的大脚趾或一种功能完全发达的第一趾. A tight Achilles tendon can also contribute to the flattening of your feet, 增加前脚的压力. This joint destructive process can also be be the outcome of an injury or other inflammatory condition such as gout or rheumatoid arthritis.
你能做什么??
The key to treating Hallux limitus is early intervention prior to the destruction of the joint.
1. 非处方的足弓支撑是一个好的开始. Com-mer-cial-ly可用 “rocker bottom” shoes can also help relieve a painful great toe joint when walking, 但我不建议你穿这种鞋跑步.
2. NSAIDs such as ibuprofen or Naproxen can relieve inflammation but will not treat the cause. Prolonged use can also cause many drug interactions 和 potential kidney overload, 因此,即使需要超过几天,也应谨慎行事.
你的pod - a - trist可以做什么:
Hallux limitus is a progressive, destructive process classified into four st年龄s. 治疗取决于病情发展的阶段:
阶段1 -Pain at the end range of motion, minimal joint changes, 和 inflammation in the joint. 治疗的目标是恢复大脚趾的柔韧性, 脚底:脚底, 阿喀琉斯的跟腱. This would be done in conjunction with an evaluation of shoes 和 treatment of any biomechanical abnormalities (with orthotics if necessary).
第二阶段 当关节进一步失去运动时,结构-转向变化开始于关节. It becomes common for people to walk with their foot pointed outward to compensate for the inability to bend the great toe upward. 这可能会导致筋膜炎,甚至膝盖疼痛. 此时此刻, physical therapy 和 the possible use of prescription anti-inflammatories 和 custom orthotics may be necessary to address the biomechanical cause functionally. Surgical intervention may be required to restore motion along with conservative treatment. Such an early surgical intervention may preserve the joint 和 prevent the need for fusion of the joint later.
Pictured are comparison x‑rays of Hallux Limitus st年龄s 1 – 4, from left to right. Notice the narrowing of the joint 和 the destruction of the underlying sesamoid bones, 作为全油推进.
S天3 -关节几乎没有剩余的运动, 和 there is significant structural loss marked by bony build-up around it. 磨床与任何尝试的关节运动是常见的, 伴随着疼痛的增加, 肿胀, 以及步态的补偿性改变. 手术干预在这一点上是必要的. Orthotics, physical therapy, 和 rehabilitation will likely be done after surgery.
第四阶段(半强直)-已发生关节自动融合. The joint may not be painful at this point, but the function is completely lost. 此时此刻, 适应性矫形器可能是有益的, 或者手术干预可能是必要的.
告诉我手术的情况.
Several procedures are available depending on the severity of the condition. The ultimate goal is to reduce the pain 和 allow you to return to normal activity. 如果手术干预是必要的, 你的恢复情况会因手术过程而异, 年龄, 整体健康, 等. How-ev-er, 在gen-er-al, you can expect three to six weeks of non-weight bearing (with crutches or a knee scooter), followed by several weeks of rehabilitation to restore your strength 和 flexibility.
In my case, I underwent surgery in 1997 in which my bone was decompressed 和 the joint remodeled. This, combined with orthotics, allowed me to continue running with no recurrence.
祝你在接下来的一年里身体健康.
健康的话题: