{"id":1113,"date":"2019-05-13T06:00:58","date_gmt":"2019-05-13T06:00:58","guid":{"rendered":"http:\/\/www.mojemedunka.cz\/?p=1113"},"modified":"2020-10-16T10:18:22","modified_gmt":"2020-10-16T10:18:22","slug":"zdrave-a-pekne-nohy","status":"publish","type":"post","link":"https:\/\/www.mojemedunka.cz\/index.php\/2019\/05\/13\/zdrave-a-pekne-nohy\/","title":{"rendered":"ZDRAV\u00c9 A P\u011aKN\u00c9 NOHY"},"content":{"rendered":"

\"\"Bl\u00ed\u017e\u00ed se l\u00e9to – \u010das, kdy odkl\u00e1d\u00e1me nejen svetry a dlouh\u00e9 ruk\u00e1vy, ale tak\u00e9 uzav\u0159enou obuv.<\/strong> D\u00edky lehk\u00fdm sand\u00e1lk\u016fm \u010di \u017eabk\u00e1m vystavujeme sv\u00e9 nohy slunci i pohled\u016fm ostatn\u00edch lid\u00ed – proto je d\u016fle\u017eit\u00e9 o nohy pe\u010dovat, db\u00e1t o jejich zdrav\u00ed i vzhled. Pokud\u00a0 na sv\u00e9 nohy zat\u00edm tak trochu „zapom\u00edn\u00e1te“, je mo\u017en\u00e1 na\u010dase jim za\u010d\u00edt v\u011bnovat pozornost. \u0158adu rad a tip\u016f najdete v knize Pavla Klouda Nohy, no\u017eky, no\u017ei\u010dky, kter\u00e1 p\u0159ed \u010dasem vy\u0161la v medu\u0148kov\u00e9 edici. Koukn\u011bte na www.knihovnickamedunky.cz
\n<\/strong><\/p>\n

Nohy, no\u017eky, no\u017ei\u010dky…<\/strong><\/h3>\n

V\u00a0\u010cesk\u00e9 republice se odborn\u00edkovi, kter\u00fd je znal\u00fd komplexn\u00ed p\u00e9\u010de o nohy, \u0159\u00edk\u00e1 zkr\u00e1cen\u011b podiatr, co\u017e je v\u00fdraz p\u0159ejat\u00fd z\u00a0angli\u010dtiny. Setkat se m\u016f\u017eeme tak\u00e9 s\u00a0ozna\u010den\u00edm podolog \u2013 to je v\u00fdraz pou\u017e\u00edvan\u00fd v\u00a0p\u0159ev\u00e1\u017en\u011b n\u011bmecky mluv\u00edc\u00edch zem\u00edch. Oba v\u00fdrazy znamenaj\u00ed tot\u00e9\u017e.
\n<\/strong>Podiatrie (podologie) je obor, kter\u00fd sdru\u017euje odborn\u00edky z mnoha oblast\u00ed zab\u00fdvaj\u00edc\u00edch se p\u00e9\u010d\u00ed o nohy. Je to mlad\u00e1, mnohostrann\u00e1 discipl\u00edna, kter\u00e1 se zab\u00fdv\u00e1 bolest\u00ed nohou, hygienou a vyu\u017e\u00edv\u00e1 p\u0159i tom nejnov\u011bj\u0161\u00ed poznatky z t\u011bchto medic\u00ednsk\u00fdch obor\u016f: dermatologie, ortopedie, neurologie, diabetologie, rehabilitace, pediatrie, flebologie, traumatologie. S\u00a0p\u00e9\u010d\u00ed o nohy ov\u0161em souvis\u00ed i dal\u0161\u00ed obory \u2013 pedik\u00fara, v\u00fdroba obuvi a individu\u00e1ln\u00edch ortopedick\u00fdch pom\u016fcek, v\u0161eobecn\u00e1 anatomie, hygiena, prvn\u00ed pomoc, reflexologie a fyzioterapie. Podiatr (podolog) m\u00e1 z\u00e1kladn\u00ed v\u011bdomosti ze v\u0161ech zm\u00edn\u011bn\u00fdch obor\u016f a mus\u00ed m\u00edt dovednosti, mezi kter\u00e9 pat\u0159\u00ed dob\u0159e proveden\u00e1 pedik\u00fara (mokr\u00e1 i p\u0159\u00edstrojov\u00e1), rovn\u00e1n\u00ed neht\u016f, nehtov\u00e1 protetika, vy\u0161et\u0159ov\u00e1n\u00ed chodidel, zhotovov\u00e1n\u00ed drobn\u00fdch korek\u010dn\u00edch pom\u016fcek a jin\u00e9.<\/p>\n

Noha versus doln\u00ed kon\u010detina
\n<\/strong>Sta\u010d\u00ed mal\u00fd zku\u0161ebn\u00ed test\u00edk mezi nejbli\u017e\u0161\u00edmi, abychom zjistili, \u017ee v\u011bt\u0161ina z\u00a0n\u00e1s (nem\u00e1me-li medic\u00ednsk\u00e9 vzd\u011bl\u00e1n\u00ed) nem\u00e1 v\u00a0t\u00e9to terminologii \u00fapln\u011b jasno.
\nTak tedy: Mluv\u00edme-li o NOZE, mysl\u00edme t\u00edm \u010d\u00e1st doln\u00ed kon\u010detiny od kotn\u00edku dol\u016f.
\nZm\u00edn\u00edme-li DOLN\u00cd KON\u010cETINU, je \u0159e\u010d o CEL\u00c9 doln\u00ed kon\u010detin\u011b, kter\u00e1 za\u010d\u00edn\u00e1 stehnem a kon\u010d\u00ed chodidlem.
\nZdrav\u00e1 noha vytv\u00e1\u0159\u00ed na vnit\u0159n\u00ed stran\u011b pod\u00e9lnou klenbu, kter\u00e1 je na zevn\u00ed hran\u011b minim\u00e1ln\u00ed, a p\u0159\u00ed\u010dnou klenbu v m\u00edst\u011b kost\u00ed z\u00e1n\u00e1rtn\u00edch \u2013 p\u0159edev\u0161\u00edm jejich hlavi\u010dek. Prsty jsou voln\u011b pohybliv\u00e9 a rovn\u00e9, pod\u00e9ln\u00e1 osa palce je v pod\u00e9ln\u00e9 ose chodidla. Pata je u\u017e\u0161\u00ed ne\u017e pr\u016fm\u011br kotn\u00edk\u016f p\u0159i pohledu zezadu a stoj\u00ed kolmo k podlo\u017ece v pokra\u010dov\u00e1n\u00ed pod\u00e9ln\u00e9 osy b\u00e9rce p\u0159i pln\u00e9m zat\u00ed\u017een\u00ed ve stoje. Prsty i chodidla jsou bez otlak\u016f, puch\u00fd\u0159\u016f, bradavic.
\nD\u011btsk\u00e1 noha m\u00e1 v m\u00edst\u011b pod\u00e9ln\u00e9 klenby tukov\u00fd pol\u0161t\u00e1\u0159, kter\u00fd ji vypl\u0148uje a vyvol\u00e1v\u00e1 dojem ploch\u00e9 nohy, kter\u00fd ve v\u011bku dvou a\u017e t\u0159\u00ed let miz\u00ed. Probl\u00e9m je, kdy\u017e je patn\u00ed kost ve stoji uch\u00fdlena od osy b\u00e9rce, nebo kdy\u017e je chodidlo vylo\u017een\u011b prohnut\u00e9. Noha d\u011btsk\u00e1 a dosp\u011bl\u00e1 se li\u0161\u00ed, a pokud nen\u00ed chodidlo deformov\u00e1no n\u011bkterou z vrozen\u00fdch vad, z\u00e1vis\u00ed dal\u0161\u00ed v\u00fdvoj d\u011btsk\u00e9 nohy na spr\u00e1vn\u00e9m celkov\u00e9m r\u016fstu a rozvoji hybnosti, mo\u017enostech chozen\u00ed naboso, spr\u00e1vn\u00e9 v\u00fd\u017eiv\u011b, odpov\u00eddaj\u00edc\u00ed v\u00e1ze t\u011bla a na spr\u00e1vn\u00e9m obouv\u00e1n\u00ed.<\/p>\n

NEJ\u010cAST\u011aJ\u0160\u00cd PORUCHY NOHOU<\/strong><\/p>\n

Deformity nohou a jejich l\u00e9\u010den\u00ed
\n<\/strong>Nohy n\u00e1s nos\u00ed cel\u00fd \u017eivot, a pokud dob\u0159e slou\u017e\u00ed, v\u011bt\u0161ina z\u00a0n\u00e1s to s\u00a0p\u00e9\u010d\u00ed o n\u011b p\u0159\u00edli\u0161 nep\u0159eh\u00e1n\u00ed. Jsou za norm\u00e1ln\u00edch okolnost\u00ed dob\u0159e p\u0159izp\u016fsobeny b\u011b\u017en\u00e9 z\u00e1t\u011b\u017ei a funguj\u00ed jako dokonal\u00fd anatomick\u00fd syst\u00e9m. Vlivem cel\u00e9 \u0159ady r\u016fzn\u00fdch faktor\u016f se v\u00a0pr\u016fb\u011bhu \u017eivota m\u011bn\u00ed odolnost nohou k\u00a0zat\u00ed\u017een\u00ed a vznikaj\u00ed typick\u00e9 deformity. Nej\u010dast\u011bji vznikaj\u00ed r\u016fzn\u00e9 odli\u0161nosti v d\u016fsledku chybn\u00e9ho a z\u00e1rove\u0148 dlouhodob\u00e9ho zat\u00ed\u017een\u00ed nohy a nedostatku tr\u00e9ninku. Po pl\u00eds\u0148ov\u00fdch infekc\u00edch tvo\u0159\u00ed statick\u00e9 deformity nej\u010detn\u011bj\u0161\u00ed skupinu onemocn\u011bn\u00ed nohou. Trp\u00ed jimi a\u017e pades\u00e1t procent dosp\u011bl\u00e9 populace a ka\u017ed\u00fd dvac\u00e1t\u00fd je v\u00a0oblasti nohou operovan\u00fd. Probl\u00e9my vznikaj\u00ed ji\u017e v\u00a0d\u011btsk\u00e9m v\u011bku, v\u017edy\u0165 nejm\u00e9n\u011b t\u0159etina dne\u0161n\u00edch d\u011bt\u00ed nikdy neb\u011bhala naboso a nav\u00edc nos\u00ed obuv, kter\u00e1 po\u0161kozuje zdrav\u00ed jejich nohou. Teprve kdy\u017e se nohy ozvou bolest\u00ed, za\u010dnou se jejich majitel\u00e9 sh\u00e1n\u011bt po odborn\u00e9 p\u00e9\u010di. Na za\u010d\u00e1tku takov\u00e9 pomoci by m\u011bla v\u017edy b\u00fdt jasn\u00e1 diagn\u00f3za. Ta je zalo\u017eena na\u00a0vy\u0161et\u0159en\u00ed nejen bolav\u00fdch nohou, ale tak\u00e9 anal\u00fdzy stoje, ch\u016fze a p\u0159\u00edpadn\u011b b\u011bhu. O\u0161et\u0159uj\u00edc\u00ed by m\u011bl v\u017edy srozumiteln\u011b vysv\u011btlit po\u017eadovan\u00e1 vy\u0161et\u0159en\u00ed, jejich o\u010dek\u00e1van\u00fd efekt a terapeutick\u00e9 postupy, kter\u00e9 z\u00a0p\u0159edchoz\u00edho vypl\u00fdvaj\u00ed.<\/p>\n

Vbo\u010den\u00e1 pata
\n<\/strong>Vbo\u010den\u00e9 postaven\u00ed patn\u00ed \u010d\u00e1sti nohy stoj\u00ed v\u011bt\u0161inou na za\u010d\u00e1tku cel\u00e9 \u0159ady probl\u00e9m\u016f. Sledujeme je v pom\u011brn\u011b vysok\u00e9m zastoupen\u00ed. P\u0159i b\u011bhu se vych\u00fdlen\u00ed zv\u011bt\u0161uje a je p\u0159\u00ed\u010dinou chronick\u00e9ho p\u0159et\u00ed\u017een\u00ed kloub\u016f, sval\u016f a \u0161lach s\u00a0n\u00e1sledn\u00fdm poran\u011bn\u00edm p\u0159edev\u0161\u00edm hlezenn\u00e9ho kloubu. U d\u011bt\u00ed je tento jev v podstat\u011b fyziologickou z\u00e1le\u017eitost\u00ed. Ukazuje se (a nov\u00e9 studie to prokazuj\u00ed), \u017ee ne v\u017edy se tato vada sama s p\u0159ib\u00fdvaj\u00edc\u00edm v\u011bkem uprav\u00ed a \u017ee vybo\u010den\u00ed z\u00e1kladu se ve v\u00fdvoji d\u00edt\u011bte v\u00a0dosp\u011bl\u00e9ho automaticky v\u017edy neztr\u00e1c\u00ed.
\nP\u0159i pohledu zezadu stoj\u00ed ob\u011b patn\u00ed kosti rovn\u011b a Achillova \u0161lacha prob\u00edh\u00e1 tak\u00e9 rovn\u011b ve svislici. Rovnom\u011brn\u00e9 zat\u00ed\u017een\u00ed pat je p\u0159edpokladem pro neporu\u0161enou no\u017en\u00ed klenbu s\u00a0dobrou funkc\u00ed prst\u016f. Svaly l\u00fdtek a Achillova \u0161lacha tak mohou rovnom\u011brn\u011b zat\u011b\u017eovat chodidla. N\u00e1prava nespr\u00e1vn\u00e9 z\u00e1t\u011b\u017ee stoj\u00ed na po\u010d\u00e1tku \u0159e\u0161en\u00ed probl\u00e9m\u016f s\u00a0velk\u00fdmi klouby i p\u00e1te\u0159\u00ed.
\nJsou-li paty v\u00fdrazn\u011b vbo\u010den\u00e9 dovnit\u0159, prob\u00edh\u00e1 Achillova \u0161lacha obloukovit\u011b. Mluv\u00edme o vbo\u010den\u00e9 noze, cel\u00e1 noha je nato\u010den\u00e1 dovnit\u0159. Vbo\u010den\u00e9 nohy maj\u00ed za n\u00e1sledek nohy s pokleslou pod\u00e9lnou i p\u0159\u00ed\u010dnou klenbou. Vbo\u010den\u00ed pat ovliv\u0148uje vznik vbo\u010den\u00e9ho palce a r\u016fzn\u00fdch deformit prst\u016f.
\nU d\u011bt\u00ed je tvar chodidla ovliv\u0148ov\u00e1n v\u00fdvojem osy kon\u010detin, kter\u00fd u zdrav\u00fdch d\u011bt\u00ed prob\u00edh\u00e1 tak, \u017ee novorozenec m\u00e1 nejd\u0159\u00edve doln\u00ed kon\u010detiny fyziologicky vyoseny do tvaru p\u00edsmene O. Ve dvou letech p\u0159ech\u00e1zej\u00ed do tvaru p\u00edsmene X, a v dosp\u011blosti jsou prakticky rovn\u00e9. \u017deny m\u00edvaj\u00ed doln\u00ed kon\u010detiny m\u00edrn\u011b ve tvaru X, u mu\u017e\u016f b\u00fdvaj\u00ed rovn\u00e9 nebo podle druhu zat\u011b\u017eov\u00e1n\u00ed m\u00edrn\u011b do O. U d\u011bt\u00ed do dvou let jsou paty, a t\u00edm cel\u00e1 chodidla, rovn\u011b\u017e tla\u010dena do O, s p\u0159et\u00ed\u017een\u00edm zevn\u00edho chodidla. U kon\u010detin do X je p\u0159et\u011b\u017eov\u00e1na vnit\u0159n\u00ed \u010d\u00e1st, co\u017e m\u016f\u017ee b\u00fdt po\u010d\u00e1tkem rozvoje statick\u00e9 ploch\u00e9 nohy, kter\u00e1 je p\u0159i nadv\u00e1ze nebo jin\u00e9m p\u0159et\u011b\u017eov\u00e1n\u00ed u d\u011bt\u00ed st\u00e1le \u010dast\u011bj\u0161\u00ed. Jak\u00e9koliv p\u0159etrv\u00e1v\u00e1n\u00ed deformity kon\u010detin do O p\u0159es dva roky v\u011bku d\u00edt\u011bte nebo nadm\u011brn\u00e9 vybo\u010den\u00ed osy kolen do X vy\u017eaduj\u00ed posouzen\u00ed odborn\u00edkem a l\u00e9\u010den\u00ed, kter\u00e9 za\u010d\u00edn\u00e1 p\u0159edev\u0161\u00edm cvi\u010den\u00edm, vytvo\u0159en\u00edm p\u0159irozen\u00e9ho prost\u0159ed\u00ed pro ch\u016fzi naboso a teprve potom n\u00e1sleduje korekce obuvi ortopedick\u00fdmi vlo\u017ekami. Rovn\u00e9 plochy, po kter\u00fdch se dnes v\u011bt\u0161inou pohybujeme, jsou bez dr\u00e1\u017ediv\u00fdch podn\u011bt\u016f pro plochu nohy, a t\u00edm se tak\u00e9 pod\u00edlej\u00ed na nep\u0159irozen\u00e9m v\u00fdvoji doln\u00edch kon\u010detin.<\/p>\n

Cvi\u010den\u00ed u vbo\u010den\u00fdch kotn\u00edk\u016f
\n<\/strong>Vzp\u0159\u00edmen\u00e9 paty jsou prvn\u00edm krokem ke zdrav\u00fdm noh\u00e1m, co\u017e plat\u00ed jak pro nohy d\u011btsk\u00e9, tak pro nohy ve vysok\u00e9m st\u00e1\u0159\u00ed. Pokud jsou paty ji\u017e trochu vybo\u010den\u00e9, je d\u016fle\u017eit\u00e9 za\u010d\u00edt pravideln\u011b cvi\u010dit. C\u00edlem je aktivn\u00ed stabilizace paty, kter\u00e1 podporuje pohyblivost a stabilitu hlezenn\u00edch kloub\u016f, posiluje hlubok\u00e9 svalstvo nohy a natahuje l\u00fdtkov\u00e9 svaly. Cvi\u010d\u00ed se na stup\u00ednku, nech\u00e1v\u00e1me klesat paty a zase je zved\u00e1me. Ne ov\u0161em \u00fapln\u011b na \u0161pi\u010dky, co\u017e by mohlo podporovat sni\u017eov\u00e1n\u00ed p\u0159\u00ed\u010dn\u00e9 klenby. Cvik prov\u00e1d\u00edme alespo\u0148 25x, a to dvakr\u00e1t denn\u011b. Postaven\u00ed pat kontroluje terapeut a u\u010d\u00ed klienta kontrolovat pohyb pomoc\u00ed zrcadla. Po\u0159izujeme kvalitn\u00ed vlo\u017eky do bot, stabilizuj\u00edc\u00ed postaven\u00ed paty v bot\u011b.<\/p>\n

Dal\u0161\u00ed cvi\u010den\u00ed podporuj\u00edc\u00ed spr\u00e1vn\u00e9 vn\u00edm\u00e1n\u00ed postaven\u00ed kotn\u00edk\u016f
\n<\/strong>U\u010d\u00edme se poznat, jak a kdy doch\u00e1z\u00ed ke vbo\u010den\u00ed kotn\u00edku a n\u00e1sledn\u011b toto patologick\u00e9 postaven\u00ed odstranit. Nacvi\u010dujeme stoj s rovn\u00fdmi patami trvaj\u00edc\u00ed nejm\u00e9n\u011b 30 vte\u0159in. Cvi\u010d\u00edme p\u0159ed zrcadlem. M\u016f\u017eeme tak\u00e9 n\u011bkoho po\u017e\u00e1dat, aby pozoroval na\u0161e paty zezadu. Stoj\u00edme, o\u010di nap\u016fl p\u0159iv\u0159en\u00e9, a soust\u0159e\u010fujeme se na paty. St\u0159\u00eddav\u011b p\u0159en\u00e1\u0161\u00edme v\u00e1hu na vn\u011bj\u0161\u00ed okraje pat, pot\u00e9 na vnit\u0159n\u00ed. Pohybujeme se pomalu, dokud nez\u00edsk\u00e1me pocit, \u017ee paty stoj\u00ed pevn\u011b a rovn\u011b. Pak se ji\u017e nepohybujeme a sledujeme postaven\u00ed pat v\u00a0zrcadle. Srovn\u00e1v\u00e1me obraz v\u00a0zrcadle s\u00a0t\u00edm, jak postaven\u00ed vn\u00edm\u00e1me pocitov\u011b. Korigujeme odchylky pomoc\u00ed zrcadla a vyrovn\u00e1v\u00e1me je.
\nDal\u0161\u00ed variantou n\u00e1cviku rovn\u00e9ho postaven\u00ed pat je stoj na jedn\u00e9 noze po dobu asi 30 vte\u0159in s pevn\u011b vzp\u0159\u00edmenou patou, bez opory. Pokud si nejsme jisti rovnov\u00e1hou, cvi\u010d\u00edme v\u00a0dosahu opory v dostupn\u00e9 vzd\u00e1lenosti. Stoj\u00edme uvoln\u011bn\u011b, kolmo nap\u0159\u00edm\u00edme ob\u011b paty, ani\u017e bychom poru\u0161ili pevn\u00fd kontakt z\u00e1kladn\u00edch kloub\u016f palc\u016f s podlo\u017ekou. P\u0159eneseme v\u00e1hu na pravou kon\u010detinu, patu aktivn\u011b stabilizujeme. Opatrn\u011b zved\u00e1me levou kon\u010detinu. Takto setrv\u00e1me po dobu 30 vte\u0159in, pak vym\u011bn\u00edme nohy. Ob\u011b strany n\u011bkolikr\u00e1t vyst\u0159\u00edd\u00e1me.
\nKdy\u017e z\u00edsk\u00e1me jistotu, sledujeme postaven\u00ed p\u00e1nve a za\u010dneme s\u00a0n\u00ed pohybovat. Na stran\u011b stoj\u00edc\u00ed nohy ji pomalu stahujeme, na lev\u00e9 stran\u011b zved\u00e1me za pomoci b\u0159i\u0161n\u00edho svalstva. Nesm\u00edme se p\u0159i tom proh\u00fdbat v k\u0159\u00ed\u017ei. Pata stoj\u00ed vzp\u0159\u00edmen\u011b. Cel\u00e1 doln\u00ed kon\u010detina stoj\u00ed rovn\u011b a t\u011b\u017ei\u0161t\u011b t\u011bla z\u016fst\u00e1v\u00e1 pevn\u011b soust\u0159ed\u011bno na plochu stoj\u00edc\u00ed nohy. P\u00e1nev se nesm\u00ed pohybovat do strany.
\nPosilov\u00e1n\u00edm sval\u016f nohy zlep\u0161\u00edme stabilizaci paty a hlezenn\u00edho kloubu a sou\u010dasn\u011b podpo\u0159\u00edme jeho pohyblivost. Vhodn\u00e9 je tak\u00e9 chozen\u00ed naboso po nerovn\u00e9m ter\u00e9nu. Pom\u016fckou \u201ena doma\u201c mohou b\u00fdt r\u016fzn\u00e9 druhy nestabiln\u00edch plo\u0161in a cviky na protahov\u00e1n\u00ed zkr\u00e1cen\u00fdch l\u00fdtkov\u00fdch sval\u016f. Pokud nem\u016f\u017eeme chodit naboso, po\u0159izujeme speci\u00e1ln\u00ed vlo\u017eky do bot, kter\u00e9 stabilizuj\u00ed zadn\u00ed a st\u0159edn\u00ed segment nohy za \u00fa\u010delem zlep\u0161en\u00ed statiky a biomechaniky nohy a n\u00e1sledn\u011b ovliv\u0148uj\u00ed spr\u00e1vn\u00e9 postaven\u00ed cel\u00e9ho t\u011bla. Jejich funkce je zalo\u017eena na hlubok\u00e9 patn\u00ed misce, kter\u00e1 podporuje spr\u00e1vn\u00fd biomechanick\u00fd pohyb nohy v\u00a0ka\u017ed\u00e9 f\u00e1zi kroku.<\/p>\n

\u00a0<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Bl\u00ed\u017e\u00ed se l\u00e9to – \u010das, kdy odkl\u00e1d\u00e1me nejen svetry a dlouh\u00e9 ruk\u00e1vy, ale tak\u00e9 uzav\u0159enou obuv. D\u00edky lehk\u00fdm sand\u00e1lk\u016fm \u010di \u017eabk\u00e1m vystavujeme sv\u00e9 nohy slunci i pohled\u016fm ostatn\u00edch lid\u00ed – proto je d\u016fle\u017eit\u00e9 o nohy pe\u010dovat, db\u00e1t o jejich zdrav\u00ed i vzhled. Pokud\u00a0 na sv\u00e9 nohy zat\u00edm tak trochu „zapom\u00edn\u00e1te“, je mo\u017en\u00e1 na\u010dase jim za\u010d\u00edt v\u011bnovat pozornost. \u0158adu rad a tip\u016f najdete v knize Pavla Klouda Nohy, no\u017eky, no\u017ei\u010dky, kter\u00e1 p\u0159ed \u010dasem vy\u0161la v medu\u0148kov\u00e9 edici. Koukn\u011bte na www.knihovnickamedunky.cz Nohy, no\u017eky, no\u017ei\u010dky… V\u00a0\u010cesk\u00e9 republice se odborn\u00edkovi, kter\u00fd je znal\u00fd komplexn\u00ed p\u00e9\u010de o nohy, \u0159\u00edk\u00e1 zkr\u00e1cen\u011b podiatr, co\u017e je v\u00fdraz p\u0159ejat\u00fd z\u00a0angli\u010dtiny. Setkat se m\u016f\u017eeme tak\u00e9 s\u00a0ozna\u010den\u00edm podolog \u2013 to je v\u00fdraz pou\u017e\u00edvan\u00fd v\u00a0p\u0159ev\u00e1\u017en\u011b n\u011bmecky mluv\u00edc\u00edch zem\u00edch. Oba v\u00fdrazy znamenaj\u00ed tot\u00e9\u017e. Podiatrie (podologie) je obor, kter\u00fd sdru\u017euje odborn\u00edky z mnoha oblast\u00ed zab\u00fdvaj\u00edc\u00edch se p\u00e9\u010d\u00ed o nohy. Je to mlad\u00e1, mnohostrann\u00e1 discipl\u00edna, kter\u00e1 se zab\u00fdv\u00e1 bolest\u00ed nohou, hygienou a vyu\u017e\u00edv\u00e1 p\u0159i tom nejnov\u011bj\u0161\u00ed poznatky z t\u011bchto medic\u00ednsk\u00fdch obor\u016f: dermatologie, ortopedie, neurologie, diabetologie, rehabilitace, pediatrie, flebologie, traumatologie. S\u00a0p\u00e9\u010d\u00ed o nohy ov\u0161em souvis\u00ed i dal\u0161\u00ed obory \u2013 pedik\u00fara, v\u00fdroba obuvi a individu\u00e1ln\u00edch ortopedick\u00fdch pom\u016fcek, v\u0161eobecn\u00e1 anatomie, hygiena, prvn\u00ed pomoc, reflexologie a fyzioterapie. Podiatr (podolog) m\u00e1 z\u00e1kladn\u00ed v\u011bdomosti ze v\u0161ech zm\u00edn\u011bn\u00fdch obor\u016f a mus\u00ed m\u00edt dovednosti, mezi kter\u00e9 pat\u0159\u00ed dob\u0159e proveden\u00e1 pedik\u00fara (mokr\u00e1 i p\u0159\u00edstrojov\u00e1), rovn\u00e1n\u00ed neht\u016f, nehtov\u00e1 protetika, vy\u0161et\u0159ov\u00e1n\u00ed chodidel, zhotovov\u00e1n\u00ed drobn\u00fdch korek\u010dn\u00edch pom\u016fcek a jin\u00e9. Noha versus doln\u00ed kon\u010detina Sta\u010d\u00ed mal\u00fd zku\u0161ebn\u00ed test\u00edk mezi nejbli\u017e\u0161\u00edmi, abychom zjistili, \u017ee v\u011bt\u0161ina z\u00a0n\u00e1s (nem\u00e1me-li medic\u00ednsk\u00e9 vzd\u011bl\u00e1n\u00ed) nem\u00e1 v\u00a0t\u00e9to terminologii \u00fapln\u011b jasno. Tak tedy: Mluv\u00edme-li o NOZE, mysl\u00edme t\u00edm \u010d\u00e1st doln\u00ed kon\u010detiny od kotn\u00edku dol\u016f. Zm\u00edn\u00edme-li DOLN\u00cd KON\u010cETINU, je \u0159e\u010d o CEL\u00c9 doln\u00ed kon\u010detin\u011b, kter\u00e1 za\u010d\u00edn\u00e1 stehnem a kon\u010d\u00ed chodidlem. Zdrav\u00e1 noha vytv\u00e1\u0159\u00ed na vnit\u0159n\u00ed stran\u011b pod\u00e9lnou klenbu, kter\u00e1 je na zevn\u00ed hran\u011b minim\u00e1ln\u00ed, a p\u0159\u00ed\u010dnou klenbu v m\u00edst\u011b kost\u00ed z\u00e1n\u00e1rtn\u00edch \u2013 p\u0159edev\u0161\u00edm jejich hlavi\u010dek. Prsty jsou voln\u011b pohybliv\u00e9 a rovn\u00e9, pod\u00e9ln\u00e1 osa palce je v pod\u00e9ln\u00e9 ose chodidla. Pata je u\u017e\u0161\u00ed ne\u017e pr\u016fm\u011br kotn\u00edk\u016f p\u0159i pohledu zezadu a stoj\u00ed kolmo k podlo\u017ece v pokra\u010dov\u00e1n\u00ed pod\u00e9ln\u00e9 osy b\u00e9rce p\u0159i pln\u00e9m zat\u00ed\u017een\u00ed ve stoje. Prsty i chodidla jsou bez otlak\u016f, puch\u00fd\u0159\u016f, bradavic. D\u011btsk\u00e1 noha m\u00e1 v m\u00edst\u011b pod\u00e9ln\u00e9 klenby tukov\u00fd pol\u0161t\u00e1\u0159, kter\u00fd ji vypl\u0148uje a vyvol\u00e1v\u00e1 dojem ploch\u00e9 nohy, kter\u00fd ve v\u011bku dvou a\u017e t\u0159\u00ed let miz\u00ed. Probl\u00e9m je, kdy\u017e je patn\u00ed kost ve stoji uch\u00fdlena od osy b\u00e9rce, nebo kdy\u017e je chodidlo vylo\u017een\u011b prohnut\u00e9. Noha d\u011btsk\u00e1 a dosp\u011bl\u00e1 se li\u0161\u00ed, a pokud nen\u00ed chodidlo deformov\u00e1no n\u011bkterou z vrozen\u00fdch vad, z\u00e1vis\u00ed dal\u0161\u00ed v\u00fdvoj d\u011btsk\u00e9 nohy na spr\u00e1vn\u00e9m celkov\u00e9m r\u016fstu a rozvoji hybnosti, mo\u017enostech chozen\u00ed naboso, spr\u00e1vn\u00e9 v\u00fd\u017eiv\u011b, odpov\u00eddaj\u00edc\u00ed v\u00e1ze t\u011bla a na spr\u00e1vn\u00e9m obouv\u00e1n\u00ed. NEJ\u010cAST\u011aJ\u0160\u00cd PORUCHY NOHOU Deformity nohou a jejich l\u00e9\u010den\u00ed Nohy n\u00e1s nos\u00ed cel\u00fd \u017eivot, a pokud dob\u0159e slou\u017e\u00ed, v\u011bt\u0161ina z\u00a0n\u00e1s to s\u00a0p\u00e9\u010d\u00ed o n\u011b p\u0159\u00edli\u0161 nep\u0159eh\u00e1n\u00ed. Jsou za norm\u00e1ln\u00edch okolnost\u00ed dob\u0159e p\u0159izp\u016fsobeny b\u011b\u017en\u00e9 z\u00e1t\u011b\u017ei a funguj\u00ed jako dokonal\u00fd anatomick\u00fd syst\u00e9m. Vlivem cel\u00e9 \u0159ady r\u016fzn\u00fdch faktor\u016f se v\u00a0pr\u016fb\u011bhu \u017eivota m\u011bn\u00ed odolnost nohou k\u00a0zat\u00ed\u017een\u00ed a vznikaj\u00ed typick\u00e9 deformity. Nej\u010dast\u011bji vznikaj\u00ed r\u016fzn\u00e9 odli\u0161nosti v d\u016fsledku chybn\u00e9ho a z\u00e1rove\u0148 dlouhodob\u00e9ho zat\u00ed\u017een\u00ed nohy a nedostatku tr\u00e9ninku. Po pl\u00eds\u0148ov\u00fdch infekc\u00edch tvo\u0159\u00ed statick\u00e9 deformity nej\u010detn\u011bj\u0161\u00ed skupinu onemocn\u011bn\u00ed nohou. Trp\u00ed jimi a\u017e pades\u00e1t procent dosp\u011bl\u00e9 populace a ka\u017ed\u00fd dvac\u00e1t\u00fd je v\u00a0oblasti nohou operovan\u00fd. Probl\u00e9my vznikaj\u00ed ji\u017e v\u00a0d\u011btsk\u00e9m v\u011bku, v\u017edy\u0165 nejm\u00e9n\u011b t\u0159etina dne\u0161n\u00edch d\u011bt\u00ed nikdy neb\u011bhala naboso a nav\u00edc nos\u00ed obuv, kter\u00e1 po\u0161kozuje zdrav\u00ed jejich nohou. Teprve kdy\u017e se nohy ozvou bolest\u00ed, za\u010dnou se jejich majitel\u00e9 sh\u00e1n\u011bt po odborn\u00e9 p\u00e9\u010di. Na za\u010d\u00e1tku takov\u00e9 pomoci by m\u011bla v\u017edy b\u00fdt jasn\u00e1 diagn\u00f3za. Ta je zalo\u017eena na\u00a0vy\u0161et\u0159en\u00ed nejen bolav\u00fdch nohou, ale tak\u00e9 anal\u00fdzy stoje, ch\u016fze a p\u0159\u00edpadn\u011b b\u011bhu. O\u0161et\u0159uj\u00edc\u00ed by m\u011bl v\u017edy srozumiteln\u011b vysv\u011btlit po\u017eadovan\u00e1 vy\u0161et\u0159en\u00ed, jejich o\u010dek\u00e1van\u00fd efekt a terapeutick\u00e9 postupy, kter\u00e9 z\u00a0p\u0159edchoz\u00edho vypl\u00fdvaj\u00ed. Vbo\u010den\u00e1 pata Vbo\u010den\u00e9 postaven\u00ed patn\u00ed \u010d\u00e1sti nohy stoj\u00ed v\u011bt\u0161inou na za\u010d\u00e1tku cel\u00e9 \u0159ady probl\u00e9m\u016f. Sledujeme je v pom\u011brn\u011b vysok\u00e9m zastoupen\u00ed. P\u0159i b\u011bhu se vych\u00fdlen\u00ed zv\u011bt\u0161uje a je p\u0159\u00ed\u010dinou chronick\u00e9ho p\u0159et\u00ed\u017een\u00ed kloub\u016f, sval\u016f a \u0161lach s\u00a0n\u00e1sledn\u00fdm poran\u011bn\u00edm p\u0159edev\u0161\u00edm hlezenn\u00e9ho kloubu. U d\u011bt\u00ed je tento jev v podstat\u011b fyziologickou z\u00e1le\u017eitost\u00ed. Ukazuje se (a nov\u00e9 studie to prokazuj\u00ed), \u017ee ne v\u017edy se tato vada sama s p\u0159ib\u00fdvaj\u00edc\u00edm v\u011bkem uprav\u00ed a \u017ee vybo\u010den\u00ed z\u00e1kladu se ve v\u00fdvoji d\u00edt\u011bte v\u00a0dosp\u011bl\u00e9ho automaticky v\u017edy neztr\u00e1c\u00ed. P\u0159i pohledu zezadu stoj\u00ed ob\u011b patn\u00ed kosti rovn\u011b a Achillova \u0161lacha prob\u00edh\u00e1 tak\u00e9 rovn\u011b ve svislici. Rovnom\u011brn\u00e9 zat\u00ed\u017een\u00ed pat je p\u0159edpokladem pro neporu\u0161enou no\u017en\u00ed klenbu s\u00a0dobrou funkc\u00ed prst\u016f. Svaly l\u00fdtek a Achillova \u0161lacha tak mohou rovnom\u011brn\u011b zat\u011b\u017eovat chodidla. N\u00e1prava nespr\u00e1vn\u00e9 z\u00e1t\u011b\u017ee stoj\u00ed na po\u010d\u00e1tku \u0159e\u0161en\u00ed probl\u00e9m\u016f s\u00a0velk\u00fdmi klouby i p\u00e1te\u0159\u00ed. Jsou-li paty v\u00fdrazn\u011b vbo\u010den\u00e9 dovnit\u0159, prob\u00edh\u00e1 Achillova \u0161lacha obloukovit\u011b. Mluv\u00edme o vbo\u010den\u00e9 noze, cel\u00e1 noha je nato\u010den\u00e1 dovnit\u0159. Vbo\u010den\u00e9 nohy maj\u00ed za n\u00e1sledek nohy s pokleslou pod\u00e9lnou i p\u0159\u00ed\u010dnou klenbou. Vbo\u010den\u00ed pat ovliv\u0148uje vznik vbo\u010den\u00e9ho palce a r\u016fzn\u00fdch deformit prst\u016f. U d\u011bt\u00ed je tvar chodidla ovliv\u0148ov\u00e1n v\u00fdvojem osy kon\u010detin, kter\u00fd u zdrav\u00fdch d\u011bt\u00ed prob\u00edh\u00e1 tak, \u017ee novorozenec m\u00e1 nejd\u0159\u00edve doln\u00ed kon\u010detiny fyziologicky vyoseny do tvaru p\u00edsmene O. Ve dvou letech p\u0159ech\u00e1zej\u00ed do tvaru p\u00edsmene X, a v dosp\u011blosti jsou prakticky rovn\u00e9. \u017deny m\u00edvaj\u00ed doln\u00ed kon\u010detiny m\u00edrn\u011b ve tvaru X, u mu\u017e\u016f b\u00fdvaj\u00ed rovn\u00e9 nebo podle druhu zat\u011b\u017eov\u00e1n\u00ed m\u00edrn\u011b do O. U d\u011bt\u00ed do dvou let jsou paty, a t\u00edm cel\u00e1 chodidla, rovn\u011b\u017e tla\u010dena do O, s p\u0159et\u00ed\u017een\u00edm zevn\u00edho chodidla. U kon\u010detin do X je p\u0159et\u011b\u017eov\u00e1na vnit\u0159n\u00ed \u010d\u00e1st, co\u017e m\u016f\u017ee b\u00fdt po\u010d\u00e1tkem rozvoje statick\u00e9 ploch\u00e9 nohy, kter\u00e1 je p\u0159i nadv\u00e1ze nebo jin\u00e9m p\u0159et\u011b\u017eov\u00e1n\u00ed u d\u011bt\u00ed st\u00e1le \u010dast\u011bj\u0161\u00ed. Jak\u00e9koliv p\u0159etrv\u00e1v\u00e1n\u00ed deformity kon\u010detin do O p\u0159es dva roky v\u011bku d\u00edt\u011bte nebo nadm\u011brn\u00e9 vybo\u010den\u00ed osy kolen do X vy\u017eaduj\u00ed posouzen\u00ed odborn\u00edkem a l\u00e9\u010den\u00ed, kter\u00e9 za\u010d\u00edn\u00e1 p\u0159edev\u0161\u00edm cvi\u010den\u00edm, vytvo\u0159en\u00edm p\u0159irozen\u00e9ho prost\u0159ed\u00ed pro ch\u016fzi naboso a teprve potom n\u00e1sleduje korekce obuvi ortopedick\u00fdmi vlo\u017ekami. Rovn\u00e9 plochy, po kter\u00fdch se dnes v\u011bt\u0161inou pohybujeme, jsou bez dr\u00e1\u017ediv\u00fdch podn\u011bt\u016f pro plochu nohy, a t\u00edm se tak\u00e9 pod\u00edlej\u00ed na nep\u0159irozen\u00e9m v\u00fdvoji doln\u00edch kon\u010detin. Cvi\u010den\u00ed u vbo\u010den\u00fdch kotn\u00edk\u016f Vzp\u0159\u00edmen\u00e9 paty jsou prvn\u00edm krokem ke zdrav\u00fdm noh\u00e1m, co\u017e plat\u00ed jak pro nohy d\u011btsk\u00e9, tak pro nohy ve vysok\u00e9m st\u00e1\u0159\u00ed. Pokud jsou paty ji\u017e trochu vybo\u010den\u00e9, je d\u016fle\u017eit\u00e9 za\u010d\u00edt pravideln\u011b cvi\u010dit. C\u00edlem je aktivn\u00ed stabilizace paty, kter\u00e1 podporuje pohyblivost a stabilitu hlezenn\u00edch kloub\u016f, posiluje hlubok\u00e9 svalstvo nohy a natahuje l\u00fdtkov\u00e9 svaly. Cvi\u010d\u00ed se na stup\u00ednku, nech\u00e1v\u00e1me klesat paty a zase je zved\u00e1me. Ne ov\u0161em \u00fapln\u011b na \u0161pi\u010dky, co\u017e by mohlo podporovat sni\u017eov\u00e1n\u00ed p\u0159\u00ed\u010dn\u00e9 klenby. Cvik prov\u00e1d\u00edme alespo\u0148 25x, a to dvakr\u00e1t denn\u011b. Postaven\u00ed pat kontroluje terapeut a u\u010d\u00ed klienta kontrolovat pohyb pomoc\u00ed zrcadla. Po\u0159izujeme kvalitn\u00ed vlo\u017eky do bot, stabilizuj\u00edc\u00ed postaven\u00ed paty v bot\u011b. Dal\u0161\u00ed cvi\u010den\u00ed podporuj\u00edc\u00ed spr\u00e1vn\u00e9 vn\u00edm\u00e1n\u00ed postaven\u00ed kotn\u00edk\u016f U\u010d\u00edme se poznat, jak a kdy doch\u00e1z\u00ed ke vbo\u010den\u00ed kotn\u00edku a n\u00e1sledn\u011b toto patologick\u00e9 postaven\u00ed odstranit. Nacvi\u010dujeme stoj s rovn\u00fdmi patami trvaj\u00edc\u00ed nejm\u00e9n\u011b 30 vte\u0159in. Cvi\u010d\u00edme p\u0159ed zrcadlem. M\u016f\u017eeme tak\u00e9 n\u011bkoho po\u017e\u00e1dat, aby pozoroval na\u0161e paty zezadu. Stoj\u00edme, o\u010di nap\u016fl p\u0159iv\u0159en\u00e9, a soust\u0159e\u010fujeme se na paty. St\u0159\u00eddav\u011b p\u0159en\u00e1\u0161\u00edme v\u00e1hu na vn\u011bj\u0161\u00ed okraje pat, pot\u00e9 na vnit\u0159n\u00ed. Pohybujeme se pomalu, dokud nez\u00edsk\u00e1me pocit, \u017ee paty stoj\u00ed pevn\u011b a rovn\u011b. Pak se ji\u017e nepohybujeme a sledujeme postaven\u00ed pat v\u00a0zrcadle. Srovn\u00e1v\u00e1me obraz v\u00a0zrcadle s\u00a0t\u00edm, jak postaven\u00ed vn\u00edm\u00e1me pocitov\u011b. Korigujeme odchylky pomoc\u00ed zrcadla a vyrovn\u00e1v\u00e1me je. Dal\u0161\u00ed variantou n\u00e1cviku rovn\u00e9ho postaven\u00ed pat je stoj na jedn\u00e9 noze po dobu asi 30 vte\u0159in s pevn\u011b vzp\u0159\u00edmenou patou, bez opory. Pokud si nejsme jisti rovnov\u00e1hou, cvi\u010d\u00edme v\u00a0dosahu opory v dostupn\u00e9 vzd\u00e1lenosti. Stoj\u00edme uvoln\u011bn\u011b, kolmo nap\u0159\u00edm\u00edme ob\u011b paty, ani\u017e bychom poru\u0161ili pevn\u00fd kontakt z\u00e1kladn\u00edch kloub\u016f palc\u016f s podlo\u017ekou. P\u0159eneseme v\u00e1hu na pravou kon\u010detinu, patu aktivn\u011b stabilizujeme. Opatrn\u011b zved\u00e1me levou kon\u010detinu. Takto setrv\u00e1me po dobu 30 vte\u0159in, pak vym\u011bn\u00edme nohy. Ob\u011b strany n\u011bkolikr\u00e1t vyst\u0159\u00edd\u00e1me. Kdy\u017e z\u00edsk\u00e1me jistotu, sledujeme postaven\u00ed p\u00e1nve a za\u010dneme s\u00a0n\u00ed pohybovat. Na stran\u011b stoj\u00edc\u00ed nohy ji pomalu stahujeme, na lev\u00e9 stran\u011b zved\u00e1me za pomoci b\u0159i\u0161n\u00edho svalstva. Nesm\u00edme se p\u0159i tom proh\u00fdbat v k\u0159\u00ed\u017ei. Pata stoj\u00ed vzp\u0159\u00edmen\u011b. Cel\u00e1 doln\u00ed kon\u010detina stoj\u00ed rovn\u011b a t\u011b\u017ei\u0161t\u011b t\u011bla z\u016fst\u00e1v\u00e1 pevn\u011b soust\u0159ed\u011bno na plochu stoj\u00edc\u00ed nohy. P\u00e1nev se nesm\u00ed pohybovat do strany. Posilov\u00e1n\u00edm sval\u016f nohy zlep\u0161\u00edme stabilizaci paty a hlezenn\u00edho kloubu a sou\u010dasn\u011b podpo\u0159\u00edme jeho pohyblivost. Vhodn\u00e9 je tak\u00e9 chozen\u00ed naboso po nerovn\u00e9m ter\u00e9nu. Pom\u016fckou \u201ena doma\u201c mohou b\u00fdt r\u016fzn\u00e9 druhy nestabiln\u00edch plo\u0161in a cviky na protahov\u00e1n\u00ed zkr\u00e1cen\u00fdch l\u00fdtkov\u00fdch sval\u016f. Pokud nem\u016f\u017eeme chodit naboso, po\u0159izujeme speci\u00e1ln\u00ed vlo\u017eky do bot, kter\u00e9 stabilizuj\u00ed zadn\u00ed a st\u0159edn\u00ed segment nohy za \u00fa\u010delem zlep\u0161en\u00ed statiky a biomechaniky nohy a n\u00e1sledn\u011b ovliv\u0148uj\u00ed spr\u00e1vn\u00e9 postaven\u00ed cel\u00e9ho t\u011bla. Jejich funkce je zalo\u017eena na hlubok\u00e9 patn\u00ed misce, kter\u00e1 podporuje spr\u00e1vn\u00fd biomechanick\u00fd pohyb nohy v\u00a0ka\u017ed\u00e9 f\u00e1zi kroku. \u00a0<\/p>\n","protected":false},"author":3,"featured_media":1123,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[28],"tags":[],"class_list":["post-1113","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-knihovnicka-medunky"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/1113","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/comments?post=1113"}],"version-history":[{"count":7,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/1113\/revisions"}],"predecessor-version":[{"id":3744,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/posts\/1113\/revisions\/3744"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media\/1123"}],"wp:attachment":[{"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/media?parent=1113"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/categories?post=1113"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.mojemedunka.cz\/index.php\/wp-json\/wp\/v2\/tags?post=1113"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}