【踮起腳尖痛,腳踝也會有夾擠問題?】
(這次文章內容稍長,若懶得看文字內容可直接觀看影片)
大家應該對於肩夾擠、髖夾擠這兩個名詞不陌生,但你有聽過腳踝夾擠嗎?夾擠指的是我們的骨頭過度擠壓到周遭的軟組織,可能是肌腱、韌帶或是滑液膜等等,造成疼痛或角度受限。夾擠是一個症候群,並非一個特定的病症,夾擠症候群底這個名詞底下,可能夾到的組織不同,造成的原因歧異度也非常大,造成評估上其實並不是那麼容易。腳踝夾擠雖然沒有像肩夾擠一樣有被正式分類成不同的夾擠類型,但仍能根據症狀呈現的方式跟解剖構造簡單分為前夾擠跟後夾擠,若還要再細分還會分前內側、前外側夾擠,以及後內側、後外側夾擠。
前側夾擠的症狀主要出現在腳踝背屈末端角度的時候,脛距關節 (Tibiotalar joint) 前側的組織受到擠壓。腳踝前側的有不少脂肪、滑囊組織,正常情況,這些組織會在腳踝背屈15度過後受到擠壓,但如果在遠端脛骨前側或是距骨頸有增生的骨頭的話,便可能限縮前側的空間,讓組織提早受到壓迫。如果長期在這角度下活動,就可能進一步造成慢性的發炎,或是造成關節囊韌帶的增生。除此之外,如果腳踝曾經扭過傷,造成韌帶或皺襞增厚的話,也是可能造成前側夾擠的原因之一。
雖然這些解剖構造上的變化已有多篇文章有所描述。但造成這些組織增生的原因卻仍不是很清楚。因為運動員有比較高的比例有這樣的問題,有些學者認為前側夾擠可能是因為頻繁地做出大角度的背屈,或是因為運動過程中受到的外力,讓前側軟骨邊緣反覆受到衝擊所造成。也有些學者認為,踝關節的不穩定,造成關節有不正常的微小滑動,也是一個可能造成骨質增生、或是軟組織受到夾擠的的原因。另外在比較早期的文章,一開始學者認為前側的骨質增生可能是來自於頻繁地蹠屈,牽拉到關節囊,進而造成關節處的增生,只是這樣的假設被後來的研究給推翻了。
因為前側夾擠症狀大多是在腳踝背屈的末端角度下出現,上樓梯、跑步、走上坡、爬梯還有深蹲是幾個比較容易會加劇前側疼痛的活動。若未接受妥善治療,在症狀後期可能會因為組織的增生或疼痛,造成更進一步的活動度受限、夾擠和周圍組織的傷害,再回頭限制關節活動度與功能,形成惡性循環。
後側夾擠的症狀主要出現在腳踝蹠屈到末端角度的時候,脛距關節與距跟關節後側的組織受到擠壓。後側夾擠常出現在需要頻繁把腳踝往下壓的人身上,像是芭蕾舞者、需要頻繁跳躍的運動員等等。與前側夾擠雷同,後側夾擠可能是骨質或是軟組織的夾擠,或是兩者同時存在。距骨後外側 (trigonal process) 的骨質增生是比較常被認為導致後側夾擠的原因。除此之外,頻繁的將腳板大幅度的往下踩,可能會導致後側關節囊、後下脛腓韌帶、三角韌帶的後側韌帶發炎,產生疤痕組織,進而造成組織增厚。另外我們的屈足拇長肌的肌腱經過距骨後側的內、外骨突中間的凹槽,也很容易因為過度使用,或是周遭骨質的增生,造成肌腱病變,像是肌腱或腱鞘炎的問題。
與前側夾擠的疼痛大多較為淺層、可觸摸的到相反,後側夾擠的症狀通常較為模糊,比較難有一個特定的單點疼痛,而且位置較深,通常落在阿基里斯腱底下。這也讓後側夾擠不容易和阿基里斯腱或是腓骨長肌的問題做區分。因為症狀出現在腳踝往下踩的時候,走下坡、下樓梯或是穿鞋跟較高的鞋子是幾個容易誘發症狀出現的活動。芭蕾舞者之所以比較容易出現這樣的症狀,被認為是因為需要頻繁的做出踮腳站,承重在前足的關係。
雖然影像檢查出來的骨質、軟組織的病變被認為是可能導致腳踝夾擠的原因之一,但實際上研究還是有提到,我們仍然不能光靠這些影像結果證據就判斷踝關節是否夾擠。影像檢查與我們的症狀表現之間的相關程度有限,仍需要結合其他理學檢查做綜合判斷才行。針對踝關節夾擠的介入,目前比較常見的作法仍是先採取保守治療,若在急性疼痛期,需要先避免會造成疼痛的動作,有必要的話也會使用消炎藥來控制疼痛。在非急性期,甚至是已經是慢性問題的個案,我們則需要著重在踝關節穩定、本體感覺的訓練上,畢竟前面有提到,踝關節不穩、扭傷都是可能造成夾擠的原因之一。與其他肌肉骨骼問題一樣,即使解剖構造上的異常也會被認為是造成踝關節夾擠的原因,但大多數的個案都能在不開刀的情況下有很好的進步。若有類似的狀況,一樣記得先找醫療人員的協助,避免症狀隨著時間越變越嚴重。底下的影片 (6:52) 將跟大家分享幾個簡單的踝關節穩定與本體感覺的訓練。
Impingement syndrome is a common musculoskeletal problem in shoulder and hip joints. But have you ever heard of ankle impingement? Impingement syndrome refers to abnormal contact of bony structures or soft tissue, e.g., tendon, ligament, synovial tissue, resulting in pain and restriction. Through different causes of impingement syndrome, it includes different medical signs or symptoms. Therefore, causes of impingement syndrome differ from person to person, making it more difficult to make a right diagnosis. Although ankle impingement is not officially classified into different types like shoulder impingement, researchers still sort it into anterior and posterior impingement according to anatomical structures are involved. More specifically, it can be classified into anteriomedial, anteriolateral, posteriomedial and posteriolateral impingement.
Symptoms of anterior ankle impingement are generally induced by compression of anterior margin of tibiotalar joint in terminal dorsiflexion. There are adipose and synovial tissues in the anterior joint space. Normally, these tissues are compressed after 15 degree of dorsiflexion in healthy individuals. However, if there is osteophyte at anterior distal tibia or talus neck, it will take up the space and limit ankle movement, causing early compression. This will result in chronic inflammation, synovitis, and capsuloligamentous hypertrophy. Apart from this, ankle sprain, thickened anterior tibiofibular ligament and synovial plica are also possible causative factors.
Even though structural pathologies are well described in much research, their exact etiologies are still less understood. Research showed that athletes are tend to affected by anterior impingement, and it led to hypothesis that pathologies are caused by repetitive impact injury to anterior chondral margin from hyper-dorsiflexion or direct impact during sports. Chronic ankle instability has also been hypothesized to be the causative factor of anterior impingement, because abnormal repetitive micromotion may develop bony and soft tissue lesions. In addition, early research hypothesized anterior osteophyte is caused by traction to the anterior capsule during repetitive plantar flexion, but this theory was disproved by later anatomic studies.
Anterior impingement symptom typically presents as anterior ankle pain during terminal dorsiflexion. Climbing stairs, running, walking up hills, ascending ladders and deep squat are common aggravating activities. If anterior impingement doesn’t get treated well, in the later stage, joint mobility may be further restricted due to mechanical block or pain, resulting in vicious circle.
Posterior ankle impingement symptom typically occurs in terminal plantarflexion, due to compression of tissues posterior to the tibiotalar and talocalcaneal joint. Posterior impingement tend to occur in athletes who need to plantarflex frequently, like ballet dancers, etc. Similarly, posterior impingement can result from compression of bony or soft tissue in isolation or in combination. Trigonal process of posterior talus is the most common cause of posterior impingement. Besides this, repetitive hyper-plantarflexion may cause posterior capsule, inferior tibiofibular ligament, and posterior fiber of deltoid ligament inflammation, scarring, and thickening. Lastly, tendinitis and tenosynovitis are easily found in flexor hallucis longus tendon, running between the medial and lateral posterior process of the talus. This probably results from overuse or irritation from surrounding abnormal bony tissue. The tissues mentioned above are all possible causative factors to the posterior ankle impingement.
In contrast to patients with anterior impingement pain that are accessible to palpation, posterior impingement pain is less specific, deep to the Achilles tendon. This makes it difficult to differentiate from Achilles tendon or peroneal tendon pathology. Since posterior impingement symptom is usually irritated by repetitive plantarflexion, walking downstairs, downhill running, and wearing high-heeled shoes are some common exacerbated activities to posterior impingement syndrome. Ballet dancers are commonly affected by posterior impingement syndrome due to weight bearing on forefoot in plantarflexion position over and over again.
Though osseous or soft tissues abnormality in radiography is seen to be one of the causes of ankle impingement, it doesn’t mean that we can simply blame patient’s symptom on these structural pathology. In fact, there is a limited correlation between medical image findings and our symptom. We should integrate patient’s history, physical examination, imaging studies, etc., for accurate diagnosis. Conservative treatment remains first option to manage ankle impingement. In acute stage, patient should avoid from doing provocative activities. If it is necessary, NSAIDs can be used for pain management. In chronic stage, clinicians should focus on ankle stability and proprioception training because ankle instability and sprain are both causative factors of ankle impingement. Just like other musculoskeletal disease, even though structural abnormality is thought to be a possible cause of ankle impingement, most ankle impingement cases still respond well to conservative treatment. If you have any similar medical problem, please find medical professions for help. The video below will show you some simple ways to train our ankle stability and proprioception.
參考資料:
https://pubmed.ncbi.nlm.nih.gov/27608626/
https://link.springer.com/article/10.1007/s00247-019-04459-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065672/
#腳踝夾擠 #踝關節不穩 #腳踝扭傷 #本體感覺訓練 #物理治療 #ankleimingement #ankleinstability #anklesprain #proprioception #physiotherapy #hunterptworkout
同時也有1部Youtube影片,追蹤數超過4萬的網紅大鹿寶基Poke,也在其Youtube影片中提到,偽娘,是一個中文ACG名詞,也稱「偽女」,指的是有女性化的外表特質、但生理上完全是男性的人物,亦即是虛擬世界的易裝者。 在cosplay中也指穿著女裝的男性。 偽娘的得名是因為其容貌,而不完全因為男扮女裝。但大多數偽娘都是靠化妝打扮來達到女裝效果,有多少人是天生就長得像女生啊!!這些可是讓女生都妒忌...
avoid名詞 在 浩爾譯世界 Facebook 的最佳解答
看到紐約時報這標題,精神都來了
#作息破壞者 浩爾 解析大仁哥專文
Taiwan’s Weapon Against Coronavirus: An Epidemiologist as Vice President
台灣對抗武漢肺炎的武器:流行病學家副總統
這句話,帥:
 “Evidence is more important than playing politics,” he said in a recent interview in Taiwan’s capital, Taipei.
「實證比玩政治來得重要。」他近期在台灣的首都台北受訪表示。
——
人物側寫這樣寫

Mr. Chen, 68, with his frizzy gray hair and a toothy smile, is known affectionately in Taiwan as “elder brother,” and many people credit him with helping the island avoid the large-scale infections and deaths from the coronavirus that have overwhelmed many countries.
好可惜竟然沒有寫他是聖墓騎士
大家都認識大仁哥,這段我就不翻譯
選幾個有意思的表達方式:
frizzy gray hair 捲捲灰髮
toothy smile 露多齒的微笑
credit him with 歸功他
He has embraced his rare dual role, using his political authority to criticize China for initially trying to conceal the virus even as the scientist in him hunkers down to analyze trends in transmission.
他擁抱自己罕見的雙重角色,一面是運用政治權威(官員身份)抨擊中國初期試圖隱匿病毒,一面則是科學家身份投身分析病毒傳播趨勢
dual 雙重的
conceal 隱藏
hunker down 蹲下,在此我引伸翻譯為投身
——
大仁哥の期許
Now Mr. Chen hopes Taiwan can play a leading role in helping the world recover from the virus and restart economic growth. He is overseeing efforts to develop a vaccine and produce tools like rapid coronavirus testing kits.
他期望台灣能扮演全球領導角色,幫助世界抗疫、康復,重振經濟成長。他監督著疫苗的研發,製造快篩組等工具。
recover from 康復
develop a vaccine 研發疫苗
rapid testing 快篩
——
面對猛烈批評,他的風度如何?
“He wears the clothing of professionalism but deviates from the rigorous precision of science and blatantly speaks nonsense and fabricates rumors,” said a recent commentary by Xinhua, China’s official news agency. “The nature of it is particularly vicious.”
中國官媒新華社近期評論:「披著專業外衣,背離科學嚴謹,公然胡說造謠,性質尤為惡劣。」
Mr. Chen laughs at the criticism.
他笑了。
“China has to be focused more on Covid-19 control rather than politics,” he said.
回應:「中國務必專注控制疫情,勝於關注政治。」
讀到這,我笑了。
——
很喜歡結尾
On May 20, Mr. Chen will step down as vice president. He plans to return to academia and says the coronavirus will be a focus of his research.
520,他即將卸任副總統。規劃將重返學界,且表示武漢肺炎將成他研究焦點。
academia 學術界
📝 補充:中研院的英文 Academia Sinica 是拉丁文,字面意思是中華學術院。拉丁文是後位修飾(形容詞放在名詞後面的意思,法文就有沿襲這項特色)
這段話很有智慧
“I pray to have the courage to change what we can change,” he said, noting the effort to produce better tests, drugs and vaccines. “We have to accept what we cannot change.”
「我祈禱能擁有勇氣改變我們能改變的事情」他說,意指努力產出更好的檢測、藥物以及疫苗。「我們必須接受我們無法改變的事情。」
——
喜歡這樣的分析嗎?
訂閱就有每日語音導讀
不過不是導讀紐時
而是跟華爾街日報合作
留言 +1 就送你優惠訊息和試聽
原文在留言區
歡迎分享
#作息破壞者
avoid名詞 在 EZ Talk Facebook 的最佳解答
#EZTALK #你不知道的美國大小事
Spring Breakers
美國大學生春假潮vs武漢肺炎
「如果狂歡會讓我得武漢肺炎,那就讓我得吧!」
武漢肺炎疫情持續升溫之際,卻時逢一年一度的美國大學生春假潮(spring break),大家開始擔心,這一波疫情是否會因為這次春假而變得更嚴重?
--
Colleges and universities in the U.S. have always given students a short vacation in March or April, but the tradition of spring break as a time to party at the beach started in the Florida city of Ft. Lauderdale in 1938. An event for college swimmers was held there, and it ended up turning into a party.
美國的大專院校在3月或4月會給學生放個短期假期,不過,這個春假去海邊玩的傳統,始於佛羅里達州羅德岱堡。1938年,一群大學游泳隊選手在這裡舉辦活動,結果變成派對。
The party got bigger every year, and soon the event was more about drinking than swimming. People even began calling the city “Ft. Liquordale.” In 1959, Time magazine published an article about the phenomenon titled, “Beer and the Beach.” By 1985, over 370,000 students were traveling to Ft. Lauderdale for spring break, and things started to get out of control. After 2,500 students were arrested for rowdy behavior that year, the local authorities banned drinking at the beach, and the mayor went on Good Morning America to announce that spring breakers weren’t welcome anymore.
這個派對規模一年比一年大,很快地,與其說大家是來這裡游泳,更多是來喝酒的。人們甚至開始戲稱這個城市為「酒谷堡」。1959年,時代雜誌專文敘述這個現象,標題取做〈啤酒與海灘〉。到了1985年,有超過37萬名學生到羅德岱堡過春假,接著事情就開始失去控制。這一年有多達兩千五百名學生因行為失序被逮捕,自此之後,當地政府便禁止在海灘喝酒,市長更是在早安美國節目上宣佈,不歡迎大學生來這裡過春假。
But when it comes to American college students, there’s no stopping the drinking and debauchery. They just found new beach locations for spring break—like Panama City, Florida, South Padre Island, Texas, and even Cancun, Mexico. In Florida and Texas alone, spring breakers spend over a billion dollars each year, giving a big boost to local economies.
不過對美國大學生來說,根本沒有東西可以阻止他們喝酒開趴。他們大不了找個新海灘過春假就好——像是佛羅里達州巴拿馬市、德州南帕得雷島,甚至是到墨西哥的坎昆。光是在佛羅里達州與德州,每年春假人潮所帶來的消費就超過十億美金,大大振興了當地經濟。
But has the recent coronavirus outbreak put a halt to the festivities this year? Not really. Although President Trump made an announcement urging people to avoid gatherings of more than 10 people, spring breakers still flocked to beaches all over Florida and the Gulf Coast. “If I get corona, I get corona,” said one student. “At the end of the day, I’m not going to let it stop me from partying.”
那最近武漢肺炎疫情爆發,有讓今年的春假潮喊咔嗎?其實也沒有。即使川普公開呼籲,不宜進行10人以上的群聚活動,春假人潮仍然湧進了佛羅里達州與墨西哥灣沿岸的各處海灘。「如果我真的得了武漢肺炎,那就讓我得。」有名學生表示,「無論如何,我不會讓病毒阻止我狂歡。」
【✍關鍵單字】
1. authority「當局」
2. ban「禁止」:後方需接動名詞Ving
3. boost「提高,增強,改善」
4. put a halt to「喊卡,中止」
5. flock「蜂擁,聚集」:在這裡當動時使用,當名詞時指「鳥群、羊群、人群」。
🔔 按下「搶先看」,每週五【美國大小事】,由 Judd 編審分享最即時美國新鮮事!想知道更多美國文化,請看 👉 http://bit.ly/EZTalk嚴選
avoid名詞 在 大鹿寶基Poke Youtube 的最佳解答
偽娘,是一個中文ACG名詞,也稱「偽女」,指的是有女性化的外表特質、但生理上完全是男性的人物,亦即是虛擬世界的易裝者。 在cosplay中也指穿著女裝的男性。 偽娘的得名是因為其容貌,而不完全因為男扮女裝。但大多數偽娘都是靠化妝打扮來達到女裝效果,有多少人是天生就長得像女生啊!!這些可是讓女生都妒忌的身材面貌啊!有些偽娘甚至連胸部都比女生打(咦?)這期就來介紹那些不用特地變裝都讓人不敢相信是男生的角色吧!
1. 阿朱羅丸
2. 白
3. 花瀨薰
4. 木下秀吉
5. 早乙女有人
6. 風鳥院花月
7. 松岡春
8. 阿斯托爾福
9. 漆原琉華
10. 小狐狸
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avoid名詞 在 【avoid 用法】一次搞懂英文「avoid」用法跟意思 - 全民學英文 的相關結果
avoid 的中文意思是指「避免」,英文用法跟語法結構通常是「avoid + 名詞/Ving」,avoid最常讓人誤解的用法,就是avoid後面接to,其實avoid的後面不能 ... ... <看更多>
avoid名詞 在 avoid - Yahoo奇摩字典搜尋結果 的相關結果
避開,躲開;避免[(n./+v-ing)]. Dr.eye 譯典通 · avoid · 查看更多. IPA[əˈvɔɪd]. 美式. 英式. vt. 避免;避開. 牛津中文字典. avoided. avoid的動詞過去式、過去 ... ... <看更多>
avoid名詞 在 多益單字- [ avoid所有相關資訊,by-英文995 ] 的相關結果
avoid [動詞] 避免 ; 形容詞: avoidable ; 副詞: avoidably ; 名詞: avoider ; 動詞過去式: avoided ; 動詞過去分詞: avoided ... ... <看更多>