• Journal of Korean Foot and Ankle Society
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• v.4 no.2
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• pp.83-86
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• 2000

A vascular necrosis of the talus has frequently been reported following trauma because talus has no muscle insertions, sixty percent of the surface of the talus is covered by hyaline cartilage, takes only a small area for entrance of a blood supply. Osteonecrosis is also associated with a variety of nontraumatic disorders. There are many indications for steroid usage, patient with rheumatoid arthritis, systemic lupus erythematosus, chronic obstructive pulmonary disease, and status- post renal or cardiac transplantation may be on long- term steroid usage, osteonecrosis may develop. A vascular necrosis of the talus secondary to chronic steroid usage is an unusual case. Delay in detection of osteonecrosis may lead to fragmentation and collapse of the talar body. When pain on range of motion is present and conservative treatment have been exhausted, surgical treatment is indicated, that is, fusion of the ankle joint. However it is important that conservative treatment may prevent its various sequelae with early diagnosis because steroid - treated patients have a more operative risk and increased risk for postoperative infection. We report a rare case of corticosteroid induced avascular necrosis of talus after cardiac transplantation.

• Journal of the Korean Society of Safety
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• v.23 no.1
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• pp.35-45
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• 2008

This study was performed to compare the kinematics among three different safety shoes(type 1: ergonomically designed and high quality shoes, 2: curved and cushioned safety shoes, and 3: regular safety shoes) and to find the effect of insole during walking. Ten healthy subjects were recruited for this study. The range of motion of knee and ankle joint, angle of rear foot and angle of heel contact were measured using a three dimensional motion analysis system. In the second peak, the angle of heel contact showed statistically significant difference between safety shoes and insole, however, there was no statistical significance among three different safety shoes. The angle of ankle increased significantly at initial contact, first peak, the second peak and the toe off phase compared with type 1 and 2 safety shoes, and the angle of ankle showed statistically significant difference between with and without applying the insole. During the first peak, the second peak and the toe off phase, the angle of knee was statistical significance between safety shoes and insole. In heel contact, the angles of Achilles' tendon showed statistically significant difference between safety shoes and insole. The rear foot angles showed statistically significant difference between safety shoes and insole during heel contact and early heel contact. These results suggest that the type 1 safety shoes were superior to others in the statistics, and applying insole could be a possible method to prevent fatigue of lower extremity and musculoskeletal disorders. Further studies are needed to find the effect of ergonomically designed safety shoes and insole on practical value in prevention of musculoskeletal disorder, fatigue and satisfaction of workers.

• Journal of Korean Foot and Ankle Society
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• v.25 no.4
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• pp.165-170
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• 2021

Purpose: This study sought to evaluate the clinical effectiveness of the shortening effect of the modified Weil osteotomy for the treatment of Freiberg's disease. Materials and Methods: We reviewed 21 cases treated with the modified Weil osteotomy for Freiberg's disease from November 2005 to June 2019. The average follow-up period was 32.5 months and the mean age of the patients was 38.3 years. The clinical results were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the visual analogue scale (VAS), and the range of motion (ROM) of the metatarsophalangeal joint. In the radiologic evaluation, the length of preoperative and postoperative metatarsal shortening was compared. Results: The average AOFAS lesser metatarsophalangeal-interphalangeal scale showed an improvement from 60.5 preoperatively to 90.9 at the latest follow-up. VAS showed a decrease from 5.4 preoperatively to 0.9 at the latest follow-up. ROM of the affected metatarsophalangeal joint increased from 40.2 degrees preoperatively to 58.6 degrees at the latest follow-up. The mean length of metatarsal shortening was 6.7 mm. There was no transfer metatarsalgia, osteonecrosis, and definite joint space narrowing. Conclusion: Modified Weil osteotomy with second layer cutting is an effective treatment option to restore the joint surface and painless joint motion for patients with Freiberg's disease.

• Journal of Korean Foot and Ankle Society
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• v.16 no.2
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• pp.94-100
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• 2012

Purpose: The purpose of this study is to analyze the clinical features of distal tibia fractures and to evaluate the treatment outcomes of minimally invasive plate osteosynthesis (MIPO). Materials and Methods: From January 2004 to December 2009, 84 cases of 81 patients treated with plate fixation for distal tibia fracture were enrolled in this retrospective review. We investigated age, sex, injury mechanism, fracture patterns, and complications, and the clinical features were analyzed. To evaluate the treatment outcomes of MIPO, we divided into two groups. MIPO group consisted of 55 patients were treated with MIPO technique and conventional group consisted of 18 patients were treated with open reduction and internal fixation with conventional anterolateral plating. The results were compared between two groups by assessing bony union time, operation time, amount of blood loss, range of ankle motion, clinical score by American Orthopaedic Foot and Ankle Society (AOFAS) score, and post-operative complications. Results: The mean age of 81 patients with distal tibia fracture was 54.8 years. According to AO classification, A1:2:3 were 16, 20, 16 patients, B1:2:3 were 2, 8, 7, C1:2:3 were 1, 3, 11 patients. According to injury mechanism, slip down injury was patients, traffic accident was 26, fall from height injury was 14 patients respectively. The type A fractures were lower energy trauma and more older patients. The type C fractures were higher energy trauma and younger patients. MIPO group was better than conventional group in operative time, blood loss, bony union time, and ankle joint motion. In complications, MIPO group showed no nonunion and infection, one malunion, one skin necrosis, nine skin irritations, and one screw breakage. Conventional group showed two nonunion, four infections, two skin necrosis, and one metal failure. Conclusion: Distal tibial fractures caused by low energy trauma were on the increase. Minimal invasive plate osteosynthesis was shorter bony union time and operation time, less blood loss, and larger ankle motions than conventional open reduction and plate fixation.

• Physical Therapy Rehabilitation Science
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• v.6 no.4
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• pp.182-188
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• 2017

Objective: The purpose of this study was to compare ankle function between adults with and without Down syndrome (DS). Design: Cross-sectional study. Methods: Ten adults with DS and 18 without participated in this study and underwent manual muscle test (MMT), range of motion (ROM) assessment, star excursion balance test (SEBT), and functional movement screen (FMS). The tests were demonstrated to increase their accuracy and the actual measurements were assessed after one or two demonstrations. To minimize the standby time and fatigue, the travelled distance and measuring order were adjusted. To remove the influence of shoes on the measurements, the shoes were taken off and only socks were worn. Results: Dorsal and plantar flexion MMTs of both ankles were significantly weaker and plantar flexion ROM of both ankles were significantly lower in adults with DS compared with those without (p<0.05). However, dorsal flexion ROM of both ankles were not significantly different between them. There were significant differences in distances measured in all the directions (anterior, anterolateral, lateral, posterolateral, posterior, posteromedial, medial, and anteromedial directions) of SEBT (p<0.05). Significant differences were also demonstrated in the scores of hurdle step, inline lunge, shoulder mobility, and rotary stability among the seven items of FMS (p<0.05). Conclusions: To enhance the dynamic stability of adults with DS, it is necessary to improve ankle stability by strengthening the ankle dorsal and plantar flexors.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.109-114
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• 2010

Purpose: The purpose of this study was to report the surgical outcome of reconstruction of neglected chronic Achilles tendon ruptures with various methods including Achilles tendon allograft. Materials and Methods: Between October 2003 and November 2008, 8 consecutive neglected chronic Achilles tendon ruptures with the defect gap of more than 4 cm underwent surgical reconstruction including V-Y advancement, gastrocnemius fascial turn-down flap, flexor hallucis longus transfer and Achilles tendon allograft. There were 7 males and 1 female who were evaluated at more than 18 months after surgery. At the time of followup, all patients were assessed with regard to postoperative complications, their self-reported level of satisfaction, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, 10 repetitive single heel rise, single leg hopping test, and ankle range of motion. Results: The AOFAS score increased from average 71.4 (50-87) to 96.4 (86-100). All patients were able to perform 10-repetitive single heel raise and single leg hopping at the latest follow up. No patient experienced wound complications and deep infection. Six patients were rated as 'excellent' and the other two as 'good'. Conclusion: Neglected chronic Achilles tendon ruptures could be successfully treated with careful selection of the reconstruction method according to the amount of defect gap. With an extensive defect, Achilles tendon allograft can be a good option when the reconstruction is not feasible otherwise.

• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.51-58
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• 1997

The purpose of this study is to evalute the efficacy af the Ilizarov external fixation for the surgical treatment. of the tibial plafond fractures. We reviewed retrospectively fourteen cases of tibial plafond fractures with moderate to severe soft. tissue damage, which were fixed with Ilizarov external fixator. Using the AO Muler classification, there were four Type C1 fractures, six Type C2 and four Type C3. In most, of the cases, the ankles were operated on with other associated fractures within a few days after injury. We reduced the fracture indirectly by soft issue taxis and fixed externally across the ankle joint. using the circular external fixator with tensioned wires and ankle hinge. In cases of inadequate closed reduction, we applied limited open reduction and internal fixation. Range of motion exercise began immediately. Postoperative follow-up averaged fourteen months (ranges, 8-30 months). Overall clinical results rated good or excellent in 7 cases, fair in 4 and poor in 3. There were three cases of pin tract infection which were resolved with short-term antibiotics and local care; one delayed wound closure in a patient. whose fracture was associated with Type III open wound; one wound slough in a patient associated with Type II open wound, which was closed later by skin graft; and one osteoarthritis. From this review, we concluded that cross-ankle circular external fixation with tensioned wires with or without. limited open reduction is a reasonable alternative for the treatment of the tibial plafond fractures with severe soft tissue damage.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.709-715
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• 2014

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

• Journal of the Korean Applied Science and Technology
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• v.37 no.2
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• pp.206-213
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• 2020

The purpose of the study was to compare the differences among phases accoring to the gait time on the heel height during gait, investigate the effect on ROM of the lower limb on gait time. Ten female college students in their 20s participated in the study, and variables were calculated through 3D gait analysis on height of heel. As a statistical method, one-way ANOVA was performed for the differences between the three heel heights, and multiple regression analysis was performed to determine the effect of gait time on the ROM. As a result of the study, phase 2, the higher the heel, the longer the gait time, but phase 3, the higher the heel, the shorter the gait time. As a result of analyzing the effect of gait time on the ROM of the lower limb, in phase 2, the greater the ROM for the ankle and knee joint in 1 cm, and for the ankle joint in 5 cm, the longer the gait time. In phase 3, the greater the ROM for the hip joint in 1 cm, the longer the gait time, and the smaller the ROM for the ankle joint in 10 cm, the longer the gait time. Therefore, in the case of high-heeled shoes, it is suggested that the control of the ankle joint is important.

• Physical Therapy Rehabilitation Science
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• v.3 no.1
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• pp.38-42
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• 2014

Objective: In this study, we applied a neurodynamic sciatic nerve sliding technique to healthy adults to elucidate its effects on hamstring flexibility and postural balance. Design: Cross-sectional study. Methods: This study targeted twenty four healthy adults (16 men, 8 women). A neurodynamic sciatic nerve sliding technique was applied 5 times to all subjects' dominant leg. The subjects were asked to sit on the bed while performing cervical and thoracic flexion, as well as knee flexion with ankle plantar flexion. Then, they were asked to perform cervical and thoracic extension and knee extension with their ankle in dorsiflexion and maintain the position for 60 s. For postural balance, we measured postural sway while the subjects maintained a one-legged standing posture using the Good Balance System and measured the hip joint flexion range of motion using a standardized passive straight leg raise (SLR) test. Results: SLR test increased significantly from $79^{\circ}$ before the intervention to $91.67^{\circ}$ after the intervention (p<0.05). Regarding the participants' balance evaluated using the one-legged standing test, the X-speed decreased significantly from 18.61 mm/s to 17.17 mm/s (p<0.05), the Y-speed decreased from 22.28 mm/s to 20.52 mm/s (p<0.05), and the velocity moment was significantly decreased from $89.33mm^2/s$ to $74.99mm^2/s$ after the intervention (p<0.05). Conclusions: Application of the neurodynamic sciatic nerve sliding technique exhibited improved hamstring flexibility and postural balance of healthy adults.