儿童常见的步姿问题.pdf

中華民族福音化 華人教會國度化 中國文化基督化Common Walking Problem in Children兒童常見的步姿問題屯 門 醫 院 物理治療部 （兒童組）新界西醫院聯網 病人啟力基金 Supported by Patient Empowerment Programme New Territories West Cluster致謝/ACKNOWLEDGEMENTCommon Walking Problems in Children兒童常見的步姿問題 Common Walking Problems in ChildrenProblems in Children兒童常見的步姿問題 Common Walking 兒童常見的步姿問題12Introduction 前言Skeletal development of lower limb 下肢骨骼的發展The maturity of lower limb alignment depends on the proper stimulation during growth. The baby is born in a flexed posture. With normal development and stimulation, our bones, joints and muscles matures with time. This pamphlet introduces four common conditions of skeletal development in children including bow leg, flat feet, in-toeing and tip-toeing walk.正常的下肢骨骼發展取決於正確的生長刺激。

初生嬰兒 的肢體是屈曲的， 通過正常的發展，骨骼、關節和肌肉 續漸成長本小冊子介紹了四種常見的小兒骨骼發展問題，包括“O”形腳、扁平足、“入”字腳及腳尖走路Common skeletal problem in children 常見的小兒骨骼問題- Babies are born with physiologic bow legs. This is normal at birth. The knee becomes straight at around the age of 2, then bends out afterwards. Maximum bending out angle occurs at about age 3. It then gradually reduces and becomes stabilized at age 9.- 初出生的嬰兒都是有少許“O”形腳，這現象是正常的， 外觀上嬰兒的膝部好像是向內翻的，此角度約於兩歲時 便會變直，內翻繼而變得相反的向外翻而最明顯外翻的 時間約發生於三歲時，此後，外翻的角度會慢慢減少並 會於九歲時停止I. Bow leg 弓形腿,“O” 形腳 (圖 1)I. Bow leg 弓形腿,“O” 形腳 (圖 1)Figure 圖 112Introduction 前言Skeletal development of lower limb 下肢骨骼的發展The maturity of lower limb alignment depends on the proper stimulation during growth. The baby is born in a flexed posture. With normal development and stimulation, our bones, joints and muscles matures with time. This pamphlet introduces four common conditions of skeletal development in children including bow leg, flat feet, in-toeing and tip-toeing walk.正常的下肢骨骼發展取決於正確的生長刺激。

初生嬰兒 的肢體是屈曲的， 通過正常的發展，骨骼、關節和肌肉 續漸成長本小冊子介紹了四種常見的小兒骨骼發展問題，包括“O”形腳、扁平足、“入”字腳及腳尖走路Common skeletal problem in children 常見的小兒骨骼問題- Babies are born with physiologic bow legs. This is normal at birth. The knee becomes straight at around the age of 2, then bends out afterwards. Maximum bending out angle occurs at about age 3. It then gradually reduces and becomes stabilized at age 9.- 初出生的嬰兒都是有少許“O”形腳，這現象是正常的， 外觀上嬰兒的膝部好像是向內翻的，此角度約於兩歲時 便會變直，內翻繼而變得相反的向外翻而最明顯外翻的 時間約發生於三歲時，此後，外翻的角度會慢慢減少並 會於九歲時停止I. Bow leg 弓形腿,“O” 形腳 (圖 1)I. Bow leg 弓形腿,“O” 形腳 (圖 1)Figure 圖 134Knee alignment 膝部 內翻/ 外翻Figure 2 shows a graph of knee angle changes against age. The knee of a new born baby is in slight varus (bend in, figure 3a), with normal development, the knee gradually straightens (figure 3b) and subsequently becomes valgus (bend out, figure 3c). The maximum valgus angle is achieved at around 3 years of age. The knee valgus slowly reduces and remains at mild valgus at skeletally maturity.圖2 顯示初生嬰兒的膝關節是內翻(圖3a)的，通過正常發展， 膝關節會漸漸變直(圖3b)而會外翻(圖3c)，外翻的情況約在三 歲時會最明顯，此後便會慢慢減少，到發育成熟時，膝關節會 維持少許的外翻。

Figure 圖 3Valgus 外翻varus 內翻3Age 歲數Figure 圖 2Bow legs not only cause cosmetic problem, but may also lead to pain. When the knee is in varus, the inner side of knee joint will be over stressed. In such situation, the ankle will then be forced to varus. The weight bearing point of the sole will shift to the outer side causing development of callosity. Shoe wear is therefore easily broken.“O” 形腳不但影響外觀，患者膝關節內側會受力過大而引 致痛楚，因膝部變形而踝關節和足部會被迫內翻，著地 點會集中在腳底外側而引起皮膚硬化，鞋的外側亦很快 被磨損a)(b)(c)34Knee alignment 膝部 內翻/ 外翻Figure 2 shows a graph of knee angle changes against age. The knee of a new born baby is in slight varus (bend in, figure 3a), with normal development, the knee gradually straightens (figure 3b) and subsequently becomes valgus (bend out, figure 3c). The maximum valgus angle is achieved at around 3 years of age. The knee valgus slowly reduces and remains at mild valgus at skeletally maturity.圖2 顯示初生嬰兒的膝關節是內翻(圖3a)的，通過正常發展， 膝關節會漸漸變直(圖3b)而會外翻(圖3c)，外翻的情況約在三 歲時會最明顯，此後便會慢慢減少，到發育成熟時，膝關節會 維持少許的外翻。

Figure 圖 3Valgus 外翻varus 內翻3Age 歲數Figure 圖 2Bow legs not only cause cosmetic problem, but may also lead to pain. When the knee is in varus, the inner side of knee joint will be over stressed. In such situation, the ankle will then be forced to varus. The weight bearing point of the sole will shift to the outer side causing development of callosity. Shoe wear is therefore easily broken.“O” 形腳不但影響外觀，患者膝關節內側會受力過大而引 致痛楚，因膝部變形而踝關節和足部會被迫內翻，著地 點會集中在腳底外側而引起皮膚硬化，鞋的外側亦很快 被磨損a)(b)(c)56As bow legs improve with growth, there is no urgency for treatment. The doctor will observe the change regularly. Strengthening exercise for the knee such as cycling and stepping up and down can improve the stability of knee and thus provides better support. Physiotherapist will measure the knee alignment at regular intervals. Should there be any deterioration of condition, the patient will be advised to seek medical consultation for further investigation. 由於“O”形腳是會隨着年齡而改變，所以一般沒有治療的迫切 性，醫生一般都會定期觀察骨骼的變化。

一些強化膝關節的 運動如踏單車和踏樓梯可增強膝關節的穩定性，從而提供更 佳的保護物理治療師會定期量度膝關節的角度，如發覺變形惡化，患 者需要見醫生作進一步檢查Physiological flat feet are present in babies and tod。