歩行の左立脚期に膝関節外反が増大し安定性低下を認めた左脛骨・腓骨近位部骨折後患者の理学療法

抄録

Here we report the physical therapy administered to a patient with fracture of the proximal left tibia and fibula and instability during the left stance phase of walking. In postural standing, i.e., at the start position of walking, there was flexion of the upper thoracic vertebrae, mild flexion and adduction of the left hip, slight flexion of both knees in the valgus position, external rotation of the left lower leg to the thigh, inclination of the inside lower leg, and supination of the left rear foot. During the left stance phase of walking, at the initial ground contact of the left knee joint in the valgus position, partial supination of the left rear foot together with left lateral pelvic migration due to left hip adduction in the left-loading response, increased the left knee joint valgus position with poor outer inclination of the left lower leg and insufficient shifting of weight to the left. The valgus positioning of the left knee increased during the left mid-stance phase of walking, with inadequate left foot dorsiflexion in the terminal stance phase, left knee flexion, and inadequate rapid grounding of the bottom of the right foot due to the increase in the left knee valgus position and outer positioning of the lower leg, causing instability during walking. Therefore, impairments of the left knee and left foot were considered to be the cause of the instability in the left stance phase of walking as well as being responsible for increasing the left knee valgus position, which required improvement. The braking action of the left knee valgus position was chosen for physical therapy, which resulted in reduction of the left knee valgus position in the left loading response period, improvement in rapid grounding of the bottom of the right foot in the left terminal stance phase, and improvement in walking stability. In this case, detailed evaluation of the relationship between the knee joint and foot at the time of lateral weight transfer to the affected lower limb during walking highlighted the importance of physical therapy.