• 대한추나의학회지
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• 제6권1호
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• pp.119-126
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• 2005

본 증례 2례 모두 요통(腰痛), 좌하지인통(左下肢引痛)을 호소하며 좌족하수(左足下垂)를 동반하여 내원했으며, L-spine MRI상 L4-5, L5-S1의 추간판탈출증을 진단받은 경우로, 외상의 병력이 없었고 이로 미루어 보아 L5 신경근과 S1 신경근 손상으로 발생된 족하수(足下垂)로 진단하였다. 입원치료 중 추나요법과 추나약물요법으로 요통(腰痛)과 하지부(下肢部) 인통(引痛)은 소설되었으나 족하수(足下垂)는 별다른 호전을 보이지 않아 족하수(足下垂)치료를 위해 M.S.T.를 시행하여 족배굴근력이 건측에 비해 <증례1>의 경우 30%에서 70%로, <증례2>의 경우 10%에서 70%의 향상을 나타내었다. 그리고 치료기간 중 SLR 검사와 족하수(足下垂)와의 상관관계는 발견할 수 없었으며, 호전속도는 Disc 탈출정도와 연관성이 있었다. 하지만 저자가 관찰, 치료한 본 증례 2례는 그 해당 임상증례가 많지 않았기에 향후 좀 더 다양한 임상증례와 비교연구가 뒤따라야 할 것이다.

• 대한족부족관절학회지
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• 제18권2호
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• pp.62-67
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• 2014

Purpose: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. Materials and Methods: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. Results: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from $27.5^{\circ}$ to $46.7^{\circ}$. In radiographic measurements, calcaneal pitch angle improved from $19.1^{\circ}$ to $15.8^{\circ}$, Meary angle from $13.0^{\circ}$ to $9.3^{\circ}$, Hibb's angle from $44.3^{\circ}$ to $37.0^{\circ}$, and tibio-calcaneal axis angle from varus $17.5^{\circ}$ to varus $1.5^{\circ}$ Conclusion: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

• 한국운동역학회지
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• 제32권1호
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• pp.17-23
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• 2022

Objective: The aim of this study was to investigate the effect Tiger-step walking on the movement of the lower extremities during walking. Method: Twenty healthy male adults who had no experience of musculoskeletal injuries on lower extremities in the last six months (age: 26.85 ± 3.28 yrs, height: 174.6 ± 3.72 cm, weight: 73.65 ± 7.48 kg) participated in this study. In this study, 7-segments whole-body model (pelvis, both side of thigh, shank and foot) was used and 29 reflective markers and cluster were attached to the body to identify the segments during the gait. A 3-dimensional motion analysis with 8 infrared cameras and 7 channeled EMG was performed to find the effect of tigerstep on uphill walking. To verify the tigerstep effect, a one-way ANOVA with a repeated measure was used and the statistical significance level was set at α=.05. Results: Firstly, Both Tiger-steps showed a significant increase in stance time and stride length compared with normal walking (p<.05), while both Tiger-steps shown significantly reduced cadence compared to normal walking (p<.05). Secondly, both Tiger-steps revealed significantly increased in hip and ankle joint range of motion compared with normal walking at all planes (p<.05). On the other hand, both Tiger-steps showed significantly increased knee joint range of motion compared with normal walking at the frontal and transverse planes (p<.05). Lastly, Gluteus maximus, biceps femoris, medial gastrocnemius, tibialis anterior of both tiger-step revealed significantly increased muscle activation compared with normal walking in gait cycle and stance phase (p<.05). On the other hand, in swing phase, the muscle activity of the vastus medialis, biceps femoris, tibialis anterior of both tiger-step significantly increased compared with those of normal walking (p <.05). Conclusion: As a result of this study, Tiger step revealed increased in 3d range of motion of lower extremity joints as well as the muscle activities associated with range of motion. These findings were evaluated as an increase in stride length, which is essential for efficient walking. Therefore, the finding of this study prove the effectiveness of the tiger step when walking uphill, and it is thought that it will help develop a more efficient tiger step in the future, which has not been scientifically proven.

• 대한족부족관절학회지
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• 제16권1호
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• pp.47-52
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• 2012

Purpose: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. Materials and Methods: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. Results: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. Conclusion: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.

• 대한족부족관절학회지
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• 제9권1호
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• pp.38-41
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• 2005

Purpose: To evaluate the drainage effect of silk suture following aspiration of the bursa as an early treatment of chronic lateral malleolar bursitis. Materials and Methods: Thirteen cases, which have over two weeks of history and over one year of follow-up, were investigated. The average duration of follow-up was 16.4 months. The average symptom duration before introduction into this study was 7.8 weeks. With an aseptic technique, the aspiration of the bursa was done with 18G needle and syringe and then the insertion of silk suture through the aspiration needle was performed. The amount of drainage was identified two or three times in a week and stitch out was done at the cessation of drainage. Over one year follow-up, recurrence, infection, pain, and limitation of range of motion were investigated by telephone interview. Results: Redness around the insertion site of silk suture was found in all cases, but there was no development of active infection or recurrence. The average duration of treatment is 10.4 days. Conclusion: The drainage with silk suture following aspiration of the bursa is less invasive and very effective method in the early treatment of chronic lateral malleolar bursitis.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.799-802
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• 2009

Purpose: Schwannoma is one of common neoplasm in the central and peripheral nervous systems. However, schwannoma of sciatic nerve is rare, especially large schwannoma arising in sciatic nerve is extremely rare. This is a report of our experience with large schwannoma arising in sciatic nerve with minimal neurologic symptoms. Methods: A 65 - year - old man presented with palpable mass in middle portion of posterior thigh. No definitive neurologic deficits were detected on physical examinations. CT and sonography showed well - defined mass with large dimension. The mass was excised and confirmed histologically as a schwannoma. In postoperative period, NCS and EMG were followed. Results: The patient complained of difficulty in dorsiflexion of ipsilateral ankle joint postoperatively. NCS and EMG obtained immediately and showed sciatic neuropathy. After 2 months postoperatively, NCS and EMG were followed and abnormal findings of previous NCS and EMG were not found. Dorsiflexion of ankle joint was improved to normal range of motion. Conclusion: We report a rare case of large schwannoma arising in sciatic nerve with no definitive neurologic symptoms.

• 한국전문물리치료학회지
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• 제1권1호
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• pp.1-9
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• 1994

This study was performed to determine the inter-rater reliability of manual tests of elbow, knee flexor, and ankle dorsiflexor muscle spasticity graded on the Modified Ashworth Scale. Two raters each independently graded the spasticity of 32 patients with intracranial lesions after moving the paretic limb passively through the available range of motion. The patients were asked to simultaneously squeeze therapeutic putty with their non-paretic hand for reinforcement. The ratings were compared by the Wilcoxon matched pairs signed-rank test and by the Kendall's coefficient of rank(tau) correlation. There was singificant correlation between two raters for spasticity at the elbow, knee flexor, and ankle dorsiflexor. The correlations of the two raters ranged from .6746 to .9308. The highest correlation was for the elbow with reinforcement and the lowest was for the knee without reinforcement. Poorer correlation was evident in the knee joint. The positive results of this study encourage the continued use of manual tests of muscle spasticity, using the Modified Ashworth Scale.

• 한방재활의학과학회지
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• 제25권3호
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• pp.127-136
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• 2015

Objectives This study was carried out to investigate the clinical effects of Korean medical treatment on acute peroneal nerve palsy caused by prolonged immobilization. Methods One patient with acute peroneal nerve palsy was treated with various korean medical techniques such as acupuncture, moxibustion, cupping and herbal medicine, bee-venom acupuncture for 12 weeks. Manual Muscle Test, Range of motion, Numerical Rating Scale, Ankle-hindfoot scale, Digital infrared thermographing imaging system were used to evaluate treatment effect. Results After treatment, all the scales mentioned above were improved significantly. Conclusions This result showed that Korean medical treatment is effective on acute peroneal nerve palsy caused by prolonged immoblization.

• Archives of Reconstructive Microsurgery
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• 제12권2호
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• pp.112-118
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• 2003

Purpose : Soft tissue defect and exposed tendons and bones with concomitant infection in the foot and lower leg have to be covered with vascularized flap as the one stage treatment. Authors have performed 6 cases of pedicled dorsalis pedis island flaps under the loupes magnification and evaluated the benefits. Materials and methods : From 1994 through 2003, we have performed 6 pedicled dorsalis pedis island flaps for reconstruction of soft tissue defects in the foot and lower leg. The causes were trauma in 3 cases, skin necrosis and secondary infection after Achilles tendon repair in 2 cases and acute osteomyelitis in 1 case. Average age was 38 years and 5 cases were male and 1 female. The results of the procedure was evaluated by survival of the island flap, comfort in putting on shoes and walking, comfort in the donor site, comfort in the recipient site and range of motion of the ankle joint. Results : All pedicled dorsalis pedis island flaps survived except 1. Three cases felt discomfort in the dorsum of foot as the donor site and 1 case of the Achilles tendon ruptured and repaired showed limited dorsiflexion of ankle joint. Conclusion : Nonmicrosurgical pedicled dorsalis pedis island flaps under the loupes magnification are one of the useful treatment methods because procedure is rapid, survival is confident and overall reconstructive results are good.

• Archives of Plastic Surgery
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• 제41권3호
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• pp.285-289
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• 2014

The composite anterolateral thigh flap with vascularized fascia lata has emerged as a workhorse at our institution for complex Achilles defects requiring both tendon and soft tissue reconstruction. Safe elevation of this flap, however, is occasionally challenged by absent or inadequate perforators supplying the anterolateral thigh. When discovered intraoperatively, alternative options derived from the same vascular network can be pursued. We present the case of a 74-year-old male who underwent composite Achilles defect reconstruction using a segmental rectus femoris myofascial free flap. Following graduated rehabilitation, postoperatively, the patient resumed full activity and was able to ambulate on his tip-toes. At 1-year follow-up, active total range of motion of the reconstructed ankle exceeded 85% of the unaffected side, and donor site morbidity was negligible. American Orthopaedic Foot and Ankle Society and Short Form-36 scores improved by 78.8% and 28.8%, respectively, compared to preoperative baseline assessments. Based on our findings, we advocate for use of the combined rectus femoris myofascial free flap as a rescue option for reconstructing composite Achilles tendon/posterior leg defects in the setting of inadequate anterolateral thigh perforators. To our knowledge, this is the first report to describe use of this flap for such an indication.