负重徒步致足部水疱的发病机制研究

摘要

Objective To analyze the related factors of foot blisters caused by long-distance weight-bearing march and to explore the pathogenesis of foot blisters to provide a useful way for the prevention and treatment.Methods After the 300 km march,counted the number who had accomplished the march,and then recorded the number of foot blisters,location of blisters,and abrasion of sole.Collected the data of gender,age,body mass index (BMI),hand dominance,and whether had bliters before the march through questionnaire.And the data were coded for analysis with SPSS 13.0 statistical package.Results The 7 cases who complete the whole march and 17 cases who already had foot blisters before the march were ruled out of the final statistics.Among the remaining 590 cases,there were 554 cases (93.9%)suffered from foot blisters.And there were 1 282 blisters in total,among which the plantar blisters occupied 98% (1 257 cases).The analysis showed that the incidence of foot blisters had no significant correlation with gender,left/right foot,hand dominance,BMI and age.The predilection sites of blisters were the second and third metatarsals (28.2%),the hallux (21.3%),the fifth metatarsal (18.1%),and the calcaneus (15.8%)of the left foot.The predilection sites of blisters were the second and third metatarsals (33.3%),the hallux (22.4%),the fifth metatarsal (18.6%),and the calcaneus (14.5%)of the right foot.In terms of the abrasion of sole,the lateral heel was worn out the most (34.6% on the left and 34.2% on the right).Conclusion The study confirmed that the incidence of foot blisters had no significant correla-tion with gender,left/right foot,hand dominance,BMI and age,which may be affected by the particularity of this march.Most of the foot blisters occurred in the planta,and the predilection sites of blisters were in accord with sites of of the abrasion of sole and the distribution of plantar shear force,which demonstrated the shear force is the most critical factor on the pathogenesis of foot blisters.%目的：分析远距离负重徒步过程中产生足部水疱的相关因素，探讨足部水疱的发病机制，为足部水疱的防治提供参考。方法300 km 负重徒步结束后，统计完成全程徒步人数；记录足部水疱发生的数量、部位及其鞋底磨损情况；发放调查问卷，获悉一般情况，包括性别、年龄、体重指数、是否左利手、徒步前是否存在足部水疱等，采用 SPSS 13．0进行统计学分析。结果排除未能完成全程徒步者（7人）及在徒步前已出现足部水疱者（17人），剩余590人纳入本研究，有554人出现足部水疱（发病率93．9％），共计有1282个水疱，其中1257个发生在足底（占98％）。性别、左右足、左右利手、体重指数、年龄与足部水疱间无显著相关性。足部水疱好发部位依次为：左足，第2、3跖骨头区（28．2％）、拇趾区（21．3％）、第5足趾区（18．1％）、跟骨区（15．8％）；右足，第2、3跖骨头区（33．3％）、拇趾区（22．4％）、第5足趾区（18．6％）、跟骨区（14．5％）。鞋底共1312处出现磨损，磨损率最高的部位为左鞋底，足跟外侧区（34．6％）；右鞋底，足跟外侧区（34．2％）。结论性别、左右足、左右利手、年龄、体重指数与足部水疱无显著相关性，这可能与本徒步过程的特殊性有关。足部水疱几乎都发生在足底，且其好发部位与鞋底磨损部位及足底剪切力强度分布基本拟合，验证了剪切力是足部水疱发病机制中最为关键的因素。