迈向更健康:克服拇极限症

迈向更健康—克服半勒克斯极限

Orig­i­nal­ly Pub­lished in Race Play Michi­ana August-Sep­tem­ber 2016

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 and 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, and 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 and 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 and ​“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 and 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, and inflam­ma­tion in the joint. Treat­ment would tar­get regain­ing flex­i­bil­i­ty in the great toe, 脚底:脚底, 阿喀琉斯的跟腱. This would be done in con­junc­tion with an eval­u­a­tion of shoes and treat­ment of any bio­me­chan­i­cal abnor­mal­i­ties (with orthotics if necessary).

第二阶段 –Struc­tur­al change begins in the joint as it fur­ther los­es motion. 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 and the pos­si­ble use of pre­scrip­tion anti-inflam­ma­to­ries and 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 and 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 and 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, and 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, and 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 and 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 and flexibility.

In my case, I under­went surgery in 1997 in which my bone was decom­pressed and 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.