理学療法ジャーナル53巻11号

2019年11月発行

講座 運動器の理学療法—その常識は正しいか？・3

足関節内反捻挫はトレーニングによって再発予防が可能か？

著者： 廣幡健二¹ 相澤純也¹

所属機関： ¹東京医科歯科大学スポーツ医歯学診療センター

ページ範囲：P.1115 - P.1125

緒言

　足関節捻挫は，スポーツ活動に参加する人々において最も頻発するスポーツ外傷である^1〜3）．足関節内反捻挫の再発率は3〜42％であり^3〜7），すべての下肢スポーツ外傷・障害のなかで最も高い．受傷の繰り返しは慢性足関節不安定症（chronic ankle instability：CAI）の要因となる^2,6,7）．CAIとは，The Executive Committee of the International Ankle Consortiumによれば，① 足関節内反捻挫の受傷歴があること，② 自覚的なgiving wayエピソードや妥当な患者報告型アウトカムツールでの評価をもとにした足関節内反捻挫由来の機能制限があること，と定義され，この主症状は継続的な痛み，giving way，不安定感などの異常感覚である^8,9）．CAIが重傷化すると，日常生活で痛みや症状に悩まされ，将来的に変形性足関節症へ進展するリスクが高まる．罹患期間や症状の程度によっては，足関節固定術など除痛を目的とした観血的治療が適応となる．

　初回足関節捻挫をCAIへ進展させないためには，“足関節捻挫を再発しないこと”が非常に重要である．本稿では，足関節捻挫の病態と，再発を含む発生リスクファクターに関する最近の研究を整理し，トレーニングによる再発予防効果について述べる．

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