柔性扁平足儿童的下肢生物力学变化

Changes in lower-extremity biomechanics in children with flexible flatfoot

摘要

目的 探讨柔性扁平足儿童在步态时空与运动学参数、足底生物力学及下肢肌电活动方面的变化特征,分析足弓结构异常可能的代偿表现,为康复评估和干预提供依据。方法 2024年2月—2025年6月在苏州大学附属儿童医院康复医学科选取柔性扁平足儿童30例为观察组,同期纳入年龄和性别匹配的正常足儿童30例为对照组,采用三维步态动作捕捉与训练系统、足底压力测试系统及表面肌电仪,比较两组步态时空参数、下肢运动学参数、足底生物力学参数及下肢肌群肌电活性。结果 与对照组相比,观察组步幅和步速降低(t=-2.740、-2.347,P<0.05);踝关节最大背屈角度减小(Z=-2.973,P<0.01),最大跖屈角度减小(t=-3.631,P<0.01),膝关节最大屈曲角度增大(t=3.472,P<0.01);内侧负荷比和前足负荷比升高(t=6.155、2.552,P<0.05),压力中心侧向偏移量降低(t=-2.469,P<0.05);胫骨前肌和腓肠肌均方根(RMS)值均升高(Z=5.025、4.582,P<0.01)。结论 儿童柔性扁平足可导致足弓结构异常,引发步态模式改变及下肢肌群代偿性激活,长期可能增加运动损伤风险,需早期进行生物力学干预。

Abstract

Objective To investigate changes in gait spatiotemporal and kinematic parameters, plantar biomechanics, and lower-extremity electromyographic activity in children with flexible flatfoot, and to analyze potential compensatory manifestations associated with abnormal arch structure, so as to provide evidence for rehabilitation assessment and intervention. Methods From February 2024 to June 2025, 30 children with flexible flatfoot were recruited as observation group from the Department of Rehabilitation Medicine, Children's Hospital of Soochow University, meanwhile 30 children with normal feet matched by age and gender were selected as control group. A three-dimensional gait motion-capture and training system, a plantar-pressure testing system, and surface electromyography were used to compare gait spatiotemporal parameters, lower-extremity kinematic parameters, plantar biomechanical parameters, and lower-extremity muscle activity between the two groups. Results Compared with the control group, the observation group had a shorter stride length and lower gait speed (t=-2.740,-2.347, P<0.05), a smaller maximum ankle dorsiflexion angle (Z=-2.973,P<0.01), and maximum plantarflexion angle (t=-3.631, P<0.01); and a larger maximum knee-flexion angle (t=3.472,P<0.01). The medial and forefoot load ratios were higher (t=6.155, 2.552, P<0.05), whereas the lateral displacement of the center of pressure was lower (t=-2.469, P<0.05). The root mean square (RMS) values of the tibialis anterior and gastrocnemius muscles were also significantly higher (Z=5.025,4.582,P<0.01). Conclusions Children with flexible flatfoot exhibit abnormal arch structure, altered gait patterns, and compensatory activation of lower-extremity muscles, which may increase the long-term risk of sports injuries. Early biomechanical assessment and intervention should therefore be considered.

关键词

柔性扁平足 / 下肢生物力学 / 步态分析 / 足底压力 / 儿童

Key words

flexible flatfoot / lower-extremity biomechanics / gait analysis / plantar pressure / children

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基金资助

江苏省卫生健康委面上(青年)项目(MQ2024027)