第五章 結論與建議
第二節 建議
外側楔型鞋墊的構想雖已提出十餘年，但仍只保持在實驗室階段，
未被廣泛應用於臨床實務上。外側楔型鞋墊的開發及應用除了硬體的研發 製作：外側楔型鞋墊材質的選擇，角度及高度的選擇等；還需要軟體的配 套措施：例如臨床上適用患者的選擇和教育，另外更重要的是一套有效可 信的評估標準。
在未來外側楔型鞋墊足部輔具的臨床研究中，提出幾個建議：
一. 針對不同膝關節退化程度的患者，設計不同的外側楔型鞋墊(如不同角 度或高度,有無足弓,全足或非全足)，並從事多次重複的研究測試，進 一步了解外側楔型鞋墊對於臨床患者的適用性。
二. 穿鞋墊的方式，雖然過去的文獻認為將外側楔型片綁在腳下所造成的 X- 光下的角度變化最大，但在臨床上並不符合台灣本國人的使用方 式，發展完全本土化的外側楔型鞋墊並廣泛應用是最重要的。
三. 本研究中確實發現外側楔型鞋墊的立即和長期（十二週）效果，造成 些許運動學和動力學的變化，但是更長期的影響更需要密切的追蹤，
以避免出現代償性的不良步態變化，或反而加速內側退化性膝關節炎 的惡化。
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附錄一
退化性膝關節炎患者關節破壞程度之評估 — X 光之分級
（Radiography Grading of Osteroarthritis：Kellgren – Lawrence Classification）
* Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494-502, 1957
Grade 1 Subtle narrowing of the joint space and osteophytic lipping Grade 2 Joint space narrowing with definite osteophyte formation Grade 3 Narrowing of joint space, sclerosis, osteophytes and joint
deformity
Grade 4 Marked narrowing of the joint space, severe sclerosis, large osteophytes and definite deformity of bone ends