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		<h1 class="catchCopy">ベテラン理学療法士による，臨床での創意工夫！その技術の集大成!!</h1>
		

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					編集：橋本雅至（大阪河﨑リハビリテーション大学教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">好評シリーズの第2弾．前作「臨床実践 変形性膝関節症の理学療法」と同様，足部・足関節に対する敏腕理学療法士の技術とコツを12テーマに分けて解説．前半では，触察技術が有効である足部・足関節の機能解剖，力学的な負荷による障害のメカニズム，機能評価の工夫とそこから導き出される結果に繋がる運動療法，テープやインソール療法などを紹介．後半では，日常臨床でよく診る，あるいは問題になりやすい扁平足障害・痛みを有する外反母趾・後脛骨筋腱，腓骨筋腱の障害・アキレス腱炎，足底腱膜炎・足関節捻挫を取り上げ，臨床で実際に行われている機能的特徴を踏まえた理学療法手技をレクチャー．さらには循環障害や糖尿病による足病変への対応も掲載．本書にはこれまで紹介されていない敏腕PTならではの技術のコツも要所に紹介されており，長年の創意工夫により臨床現場で行われ結果を出している技術の集大成となる一冊．</section><section class="preface">［臨床実践　足部・足関節の理学療法］　序文<br><br>　本書は「教科書にはない敏腕PTのテクニック」シリーズの第2弾として，実際に臨床現場で行われ，結果を出している足部・足関節に対する理学療法テクニックを解説するという編集方針にて企画いたしました．特に臨床上頻繁に経験する足部・足関節という部位に着目し，臨床上工夫された評価方法や運動療法に限らず，テープやインソールなどのアイテムを使用したアプローチを多く掲載しました．<br>　本書の前半は，理学療法士が知っておくべき触察技術が有効である足部・足関節の機能解剖の評価をはじめ，身体質量が常に加わる部位であり，この力学的な負荷が引き起こす組織病変について解説しています．さらに固定性と可動性の両面を特徴とする滑膜関節を多く有する足部・足関節の機能評価では多様な工夫が必要であり，そこから導き出される結果につながる運動療法は有益なものとなるでしょう．理学療法アプローチでは運動療法以外に有効なテープやインソール療法について具体的に解説しています．<br>　後半の各論では実際に足部・足関節傷害の評価のポイントや工夫，臨床で実際に行っているアプローチについて紹介しています．年齢を問わず，見受けられる扁平足障害は運動連鎖の観点から足部・足関節よりも上行性に連鎖し，他部位の障害要因になることも少なくありません．痛みを有する外反母趾は必ず歩行機能に悪影響を及ぼし，身体質量が加わる足関節周辺の筋・筋腱の障害や炎症は，日常的に立位・歩行を継続する上で避けることのできない力学的ストレスが誘因となり，発症します．さらに外傷の典型例としての足関節捻挫（靱帯損傷）は組織の修復後にも継続する機能障害や痛みなどが社会復帰やスポーツ復帰の阻害因子になります．著者の臨床での工夫を是非とも参考にしていただきたいと思います．また近年，内部障害から引き起こされる足部・足関節周囲の病変に対して理学療法士も含めた他職種のスタッフがまとまってアプローチしていることが多く報告されています．特に循環障害や糖尿病による足病変は高齢者に多くかかわる職種として知っておくべき事項を多く含んでいます．<br>　理論的背景を優先した理学療法実践に加えて，本書で執筆いただいた先生方は臨床で患者に向き合い，日頃の発想や感性を大事にされつつ現場で創意工夫し，成果を上げている理学療法評価や治療のテクニックが大変重要であるという考えを読者と共有したいと考えられています．これまで紹介されていない敏腕PT ならではの技術のコツも要所に盛り込まれています．本書が足部・足関節に対する理学療法へ積極的に挑戦し，対象者の満足を得るための結果にこだわった理学療法の臨床実践に貢献し得ることを心より願っています．<br><br>2017年5月<br>大阪河﨑リハビリテーション大学　橋本雅至</section><section class="indexes">病態・評価・治療方針の理解<br>　足部・足関節の機能解剖を理解する<br>　　Ⅰ　下腿部から足部・足趾に至る筋の解剖と機能 <br>　　　1　外在筋の解剖と機能<br>　　　2　内在筋の解剖と機能<br>　　Ⅱ　下腿部から足部・足趾に至る靱帯の解剖と機能<br>　　　1　脛腓関節の靱帯<br>　　　2　距腿関節および距骨下関節に関する靱帯<br>　　　3　ショパール関節に関する靱帯<br>　　Ⅲ　圧痛点から機能不全の原因を探る<br>　　　1　下腿部<br>　　　2　足関節部<br>　　　3　足　部<br>　足部に加わる力学的特性と腱や靱帯の病態について理解する<br>　　Ⅰ　足部に加わる力学的特性 <br>　　　1　力学的特性をテコから考える<br>　　Ⅱ　腱・靱帯付着部症 <br>　　　1　エンテーシス<br>　　　2　繰り返し刺激による損傷と修復過程<br>　足部・足関節機能と身体運動との関係をとらえる<br>　　Ⅰ　関節の可動性と固定性<br>　　　1　関節機能に影響する関節弛緩性<br>　　Ⅱ　足部・足関節の機能 <br>　　　1　距骨下関節とショパール関節の機能<br>　　　2　トラス機構とウィンドラス機構<br>　　　3　身体運動の土台としての役割<br>　　Ⅲ　動作観察におけるポイント<br>　　　1　動作に介入して運動の機能（役割，目的）を知る<br>　　　2　身体重心位置を予測する<br>　　Ⅳ　下肢荷重位での身体運動と足部機能との関係 <br>　　　1　片脚立位での姿勢保持運動と足部機能<br>　　　2　歩行動作における体重移動と足部機能<br>　足部・足関節の機能評価と機能的な運動療法を理解する<br>　　Ⅰ　アライメントからみたトップダウン評価の考え方 <br>　　　1　ボトムアップとトップダウン<br>　　　2　アライメントからみたトップダウン評価<br>　　Ⅱ　足部・足関節の機能評価 <br>　　　1　アライメント評価<br>　　　2　ROM と不安定性<br>　　　3　筋力・筋機能<br>　　　4　歩行機能<br>　　Ⅲ　機能的な運動療法<br>　　　1　距骨の滑動性改善<br>　　　2　距骨下関節・ショパール関節のモビライゼーション<br>　　　3　立方骨のモビライゼーション<br>　　　4　脛骨内果後下方〜載距突起部の滑動性改善<br>　　　5　圧迫刺激を用いた腓骨筋腱の滑走性改善<br>　　　6　アーチ機能の向上　<br>　テーピング・インソールを用いて足部・足関節の機能障害に挑む<br>　　Ⅰ　テーピングによる関節機能評価<br>　　　1　足部・足関節の機能評価とテーピング<br>　　　2　テーピングによる機能評価の実際<br>　　　3　テーピングの貼付方法<br>　　Ⅱ　インソールによる関節アライメント調整アプローチ <br>　　　1　関節アライメント調製とインソール<br>　　　2　インソールパッドによる関節アライメント調整のポイント<br>　　　3　インソールパッドによる関節アライメント調整の実際<br><br>実践と結果に基づく理学療法手技<br>　扁平足障害─足部・足関節の機能的特徴を踏まえ介入する<br>　　Ⅰ　扁平足障害のアーチ構造と病態を理解する<br>　　　1　扁平足障害の機能的問題と歩行での特徴をとらえる<br>　　　2　足部の形態評価<br>　　　3　扁平足障害に対する動的評価<br>　　Ⅱ　理学療法プログラムの実際<br>　　　1　効果的なアプローチを想起する<br>　　　［CT］足部へのテーピング<br>　　2　スポーツ障害の扁平足による問題<br>　有痛性外反母趾─足部・足関節の機能的特徴を踏まえ介入する<br>　　Ⅰ　外反母趾を伴う足部全体の変形<br>　　　1　外反母趾とは<br>　　　2　外反母趾とアーチとの関係<br>　　　［CT］外反母趾による母趾外転筋の機能変更<br>　　Ⅱ　外反母趾を有する対象者の動作の特徴を理解する <br>　　　1　立ち上がりの特徴<br>　　　2　歩容の特徴<br>　　Ⅲ　理学療法プログラムの実際 <br>　後脛骨筋腱，腓骨筋腱の障害─足部・足関節の機能的特徴を踏まえ介入する<br>　　Ⅰ　筋の機能解剖と障害発生メカニズムについて理解する <br>　　　1　筋機能と障害発生メカニズムの概要<br>　　　2　後脛骨筋の機能<br>　　　3　後脛骨筋に関連する障害と発生メカニズム<br>　　　4　腓骨筋の機能<br>　　　5　腓骨筋に関連する障害と発生メカニズム<br>　　Ⅱ　筋による姿勢制御とメカニカルストレスの関連を探る<br>　　　1　後脛骨筋へのメカニカルストレスの要因<br>　　　2　腓骨筋群へのメカニカルストレスの要因<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　消炎鎮痛処置<br>　　　2　筋力・筋機能トレーニングおよび再教育<br>　　　［CT］姿勢制御に必要な足部以外のトレーニング<br>　　　3　テーピング<br>　　　4　インソール処方<br>　アキレス腱炎・足底腱膜炎─足部・足関節の機能的特徴を踏まえ介入する<br>　　Ⅰ　アキレス腱炎・足底腱膜炎のメカニズム<br>　　　1　アキレス腱と足底腱膜の構造<br>　　　2　アキレス腱炎と足底腱膜炎<br>　　　［CT］歩行分析ポイント<br>　　　3　アキレス腱炎と足底腱膜炎の評価<br>　　　4　動作分析<br>　　　5　荷重位の各種ストレステスト<br>　　Ⅱ　理学療法プログラムの実際<br>　　　1　徒手的介入<br>　　　2　運動療法<br>　　　3　テーピング<br>　　　4　インソール<br>　　　5　その他<br>　足関節捻挫─足部・足関節の機能的特徴を踏まえ介入する<br>　　Ⅰ　足関節の構造と足関節捻挫の基礎知識<br>　　Ⅱ　急性期におけるスポーツ現場での対応<br>　　　1　受傷直後の損傷部位の判断<br>　　　2　受傷後の応急処置<br>　　　3　アイシングと圧迫の併用<br>　　Ⅲ　損傷靱帯別にみた機能回復のための対応<br>　　　1　外側の靱帯損傷に対する対応<br>　　　2　内側の靱帯損傷に対する対応<br>　　　［CT］ROM改善の方法<br>　　Ⅳ　再発予防に向けた身体動作改善のための対応 <br>　　　1　バランス機能の改善<br>　　　2　神経筋コントロールの改善<br>　　Ⅴ　理学療法プログラムの実際<br>　　　1　走動作<br>　　　2　ジャンプ着地動作<br>　　　3　ストップ方向転換動作<br>　　Ⅵ　受傷状況を考慮した再発予防の取り組み<br>　　　1　足関節捻挫発生の特徴<br>　　　2　サッカー関連動作時の受傷動作の特徴<br>　　　3　競技復帰に向けての対応<br>　リスクを見極め循環障害を有する足部と向き合う<br>　　Ⅰ　循環障害の病態・重症度の評価<br>　　　1　下肢の血管の解剖<br>　　　2　末梢動脈疾患<br>　　　3　臨床症状<br>　　　4　治　療<br>　　　5　予　後<br>　　　6　リスクの層別化<br>　　Ⅱ　足部・足関節の機能と足底圧の評価<br>　　　1　感覚検査<br>　　　2　関節可動域<br>　　　3　下肢筋力<br>　　　4　歩　行<br>　　　5　足底圧<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　FontaineII<br>　　　［CT］トレッドミル歩行<br>　　　2　FontaineIII，IV（CLI）<br>　　　［CT］炎症軽快期の免荷管理・免荷歩行<br>　糖尿病足病変の病態を理解しフットケアを実践する<br>　　Ⅰ　糖尿病足病変の病態を理解する <br>　　　1　理学療法士がフットケアにかかわる理由とは<br>　　　2　糖尿病足病変の発症メカニズムを理解する<br>　　　3　足底負荷量に関節機能，歩行機能がどのように影響するかを理解する<br>　　Ⅱ　足のリスクを評価し層別化する<br>　　　1　理学療法評価<br>　　　2　リスクを層別化し理学療法を決定する<br>　　　［CT］糖尿病神経障害の評価<br>　　Ⅲ　理学療法プログラムの実際 <br>　　　1　靴のフィッティング指導<br>　　　2　足部の観察<br>　　　3　関節可動域練習<br>　　　4　装具療法（フットウエア）<br>　　　5　身体活動量への介入<br>　　　6　人工炭酸泉温浴<br><br>索　引<br><br>［CT］＝クリニカル・テクニック</section></article>
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