Anatomy 結構
Foot is a very complicated structure that serves two functions, rigid enough to allow transmitting significant force during running and jumping, and supple enough to allow shock absorption for impact taken on heel strike and walking on uneven terrain.
Each foot is made up of 26 bones, 30 joints and more than 100 muscles, tendons and ligaments, all of which work together to provide support, balance and mobility. But there are lots of congenital variation. Bones can be fused as one, or there are additional bones.
We conceptualise the foot into forefoot, midfoot and hindfoot.
Pathologies affecting the forefoot include hallux valgus and hallux rigidius. Midfoot problems include flatfoot and Lisfranc injury. Hindfoot pathologies are valgus heel and plantar fasciitis.
足部是一個非常複雜的結構，它同時具有兩個功能。其剛度足以在跑步和跳躍過程中傳遞巨大的力量，可超越300公斤，但又能夠瞬間提供足夠的柔軟性以吸收衝擊力，以應對跑步是腳後落地的撞擊並能在崎嶇不平的地面上行走如履平地。
每隻腳由26塊骨頭，30個關節和100多個肌肉，肌腱和韌帶組成。它們結合起來，可以提供足夠的支撐力，平衡力和活動性。但是足部先天性畸變亦很多。有些人會有兩塊骨頭但卻融合為一塊，但亦有人會比正常生多數塊骨頭。
我們將腳概念化分為前足，中足和後足。
影響前足的病變包括𧿹趾外翻和𧿹趾僵直。中足問題包括扁平足和Lisfranc傷。後足病變是足跟外翻和足底筋膜炎。
Pathology 毛病
Disease 病變
The followings are common pathologies in foot
以下是常見足部病變
- Hallux valgus
- Bunion
- Gouty arthritis
- Buniette
- Ingrown toenail
- Accessory navicula
- Flatfoot
- Lisfranc injury
- Hallux rigidus
- Calcaneum fracture
- Plantar fasciitis
- 𧿹趾外翻
- 𧿹趾滑液囊炎
- 痛風性關節炎牛
- 小趾滑液囊炎
- 趾甲內生（嵌甲）
- 副舟狀骨
- 扁平足
- Lisfranc受傷
- 𧿹趾僵直
- 跟骨骨折
- 足底筋膜炎
Investigation 評估
MRI is required to review soft tissue status. X-ray would be needed for bony pathology. Nerve conduction study might be indicated for possible nerve palsy.
磁力共震片能夠提供軟組織情況。骨頭問題，例如骨折，就會需要照X光。神經線問題可以電神經測試得知情況。
Management 治療
Conservative treatments are indicated for majority of cases. They included,
- Physiotherapy
- Chiropractor
- TCM practitioner
- Prescribed Exercise
- Medication
For cases failed conservative treatments, or when the injury is unstable, then surgical intervention would be indicated.
For patients with witnessed deterioration, surgical intervention might be advocated.
絕大多數病人只需採取保守治療。他們包括
- 物理治療
- 脊醫
- 中醫
- 處方運動
- 藥物（口服及外敷）
對於保守治療無效的病例，或受傷位置不穩定，醫生會改為介入治療，例如打針甚至手術。
對於持續惡化的患者，醫生往往會建議手術，以保肢體功能。
Reference
- Torkki M, Malmivaara A, Seitsalo S, Hoikka V, Laippala P, Paavolainen P. Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial JAMA. 2001 May 16;285(19):2474-80.https://pubmed.ncbi.nlm.nih.gov/11368700/