• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.106-111
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• 1996

Purpose : Propose a surgical technique in donor harvesting method in free vascularized proximal fibular epiphysis. Methodology : Concerned about growth potentials of the transplanted epiphysis in our long term results of the epiphyseal transplanted 13 cases more than 4 years follow-up, anterior tibial artery which contains anterior tibial recurrent artery is most reliable vessel to proximal fibular epiphysis which is the best donor of the free vascularized epiphyseal transplantation. In vascular anatomical aspect proximal fibular epiphysis norished by latearl inferior genicular artery from popliteal, posterior tibial recurrent artery and anterior tibial recurrent artery from anterior tibial artery and peroneal artery through metaphysis. The lateral inferior genicular artery is very small and difficult to isolate, peroneal artery from metaphysis through epiphyseal plate can not give enough blood supply to epiphysis itself. The anterior tibial artery which include anterior tibial recurrent and posterior tibial recurrent artery is the best choice in this procedure. But anterior tibial recurrent artery merge from within one inch from bifucating point of the anterior and posterior tibial arteries from popliteal artery. So it is very difficult to get enough vascular pedicle length to anastomose in recipient vessel without vein graft even harvested from bifucating point from popliteal artery. Authors took recipient artery from distal direction of anterior tibial artery after ligation of the proximal popliteal side vessel, which can get unlimited pedicle length and safer dissection of the harvesting proximal fibular epiphysis. Results : This harvesting procedure can performed supine position, direct anterolateral approach to proximal tibiofibular joint. Dissect and isolate the biceps muscle insertion from fibular head, micro-dissection is needed to identify the anterior tibial recurrent arteries to proximal epiphysis, soft tissue release down to distal and deeper plane to find main anterior tibial artery which overlying on interosseous membrane. Special care is needed to protect peroneal nerve damage which across the surgical field. Conclusions : Proximal fibular epiphyseal transplantation with distally directed anterior tibial artery harvesting technique is effective and easier dissect and versatile application with much longer arterial pedicle.

• Korean Journal of Applied Biomechanics
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• v.31 no.2
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• pp.104-112
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• 2021

Objective: This study aimed to analyze the effects of consecutive whole body vibration through heel raise posture on the center of pressure and electromyography of anterior tibial muscle, lateral gastrocnemius and soleus muscles during single-leg stance. Method: The subjects of this study included 30 healthy males in their 20's, with the following inclusion criteria: no history of orthopaedic medical history, no participation in regular exercises, no history of whole body vibration exercise, and right leg being the dominant leg. The experimental procedure involved pretreatment measurement of eye open single-leg stance, application of whole body vibration for 30 seconds, post-treatment measurement (3 measurements in total). Static and dynamic movements have been measured over 2 separate experiments, with 72 hours gap between the experiments. Static movement involved maintaining single-leg heel raise posture for 30 seconds while applying whole body vibration, and dynamic movement involved heel raise (15 repetitions over 30 seconds) while applying whole body vibration. The strength of applied whole body vibration was 35 Hz frequency and 2~4 mm amplitude. Results: As the single-leg posture after static heel raise posture, mediolateral velocity of the center of pressure at post 2 and post 3 were significantly reduced compared to the pre-treatment measurement. In addition, the percentage for reference voluntary contraction in anterior tibial muscle and soleus and median frequency at anterior tibial muscle and lateral gastrocnemius muscle at post 3 were significantly decreased compared to the pre-treatment value. As the single-leg posture after dynamic heel raise posture, the mediolateral 95% edge frequency of the center of pressure and median frequency at anterior tibial muscle, lateral gastrocnemius muscle, and soleus muscle at post 3 were significantly reduced compared to the pre-treatment value. Conclusion: Acute whole body vibration via static and dynamic heel raise posture have positive effect on mediolateral posture control during single-leg stance.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.69-71
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• 2016

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A $5.0{\times}0.5cm$ size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.

• Archives of Reconstructive Microsurgery
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• v.23 no.1
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• pp.18-20
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• 2014

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.

• Journal of International Academy of Physical Therapy Research
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• v.2 no.2
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• pp.324-328
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• 2011

The purpose of this study is to measure the effect of change in heel height on lower extremities activity of young women on high-heeled shoes that young women prefer from more kinetic and realistic perspective as this study changes the degree of slope on a treadmill. The study subjects are 15 young and healthy women who do not have any external injuries or problem with walking and understand the purpose of this study clearly. They wore three different height of heels(1cm, 7cm, 12cm) and walked on a treadmill at a constant speed of 3km/h. EMG value of four muscles (anterior tibial muscle, gastrocnemius muscle, straight muscle of thigh, and biceps muscle of thigh) were collected when walking and the change according to the height of heels were analyzed using one-way ANOVA. Multiple comparison analysis on anterior tibial muscle and heel height showed that the group with 12cm heel showed significantly high muscle activation compared to the groups with 1cm and 7cm heels. The result of this study can be used for various perspectives from inferring and mediating problems caused by wearing high heels on different ground slopes for a long time.

• Korean Journal of Applied Biomechanics
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• v.17 no.1
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• pp.99-109
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• 2007

The purpose of the study is to examine the effect of the spring shoe through the comparison of spring shoe to general shoe. For this, 12 healthy females in the age from 20 to 30 years participated in the E.M.G. experiment with testing kinematic variables. Results indicated that there was significant differences in angle of ankel between the general and spring shoe. Specifically, the spring shoe showed a bigger angle of take on and a smaller angle of take off in walking than the general shoe. This mesns that the spring shoe does not have a significant effect to produce efficient and smooth walking. In addition, the spring shoes revealed a bigger rear-foot angle than the general shoe in the evaluation of rear-foot control function. This means that the rear-foot control function of the spring shoe is low compared to trhe general shoe. Meanwhile, there is no significant differences in angle of knee and angle of Achilles tendon between both shoes. In an analysis of E.M.G., the significant differences were found in gastrocnemius muscle, anterior tibial musculi, musculi rectus femoris, biceps muscle of thigh between both the general and spring shoe groups by the section. In the case of gastrocnemius muscle, the spring shoe showed a low muscle production of anterior tibial musculi than the general shoe. This is a result from structural nature of the sole of a foot of the spring shoe. The spring shoe performs a rolling movement through slightly large pronation toward front-foot from rear-foot in supprt time before taking-off of toe and the power for this movement is mainly produced from musculi rectus femoris.

• Physical Therapy Rehabilitation Science
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• v.8 no.4
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• pp.218-224
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• 2019

Objective: This reliability study examined the effects of applying varying induced inward pressures using a transducer placed at 0° neutral ankle position (NEU) and 15° ankle dorsiflexion (DF) on tibialis anterior (TA) muscle thickness using a custom-made device with a force indicator during rehabilitative ultrasound imaging. Design: Cross-sectional study. Methods: Twenty-four healthy subjects were recruited in this study. Two examiners measured the muscle thickness of the TA at 0° NEU and 15° DF in 3 conditions of inward pressures (1.0 N, 2.0 N, and 4.0 N) using a custom-made holder. The muscle thickness was measured three times for each of the conditions arranged in random order. For intra- and inter-rater reliability, the intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement, minimal detectable change, and coefficient of variation were analyzed. One-way repeated measures analysis of variance was conducted for investigating changes of TA muscle thickness according to the inward pressures of the transducers. Results: The intra-rater reliability of TA muscle thickness measurement was excellent (ICC_3,1: 0.92-0.96) for all conditions (at both ankle joint angles per varying inward pressure). Likewise, the inter-rater reliability of TA muscle thickness measurement was excellent (ICC_2,1: 0.89-0.97) under same conditions. The mean of TA thickness showed the trend of decreasing significantly with increased inward pressures at all ankle joint angles (p<0.05). Conclusions: Use of this custom-made device with a force indicator is useful to accomplish the high intra- and inter-rater reliability of TA muscle thickness measurement at both ankle joint angles in reducing the measurement error.

• Journal of Korean Foot and Ankle Society
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• v.20 no.4
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• pp.182-186
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• 2016

The tibialis anterior tendon functions as a major dorsiflexor of the ankle. A rupture in this tendon can cause serious problems in the ambulatory function. A closed traumatic rupture without open wound or an atraumatic rupture can delay diagnosis and treatment. There are not enough guidelines for an effective surgical treatment on this chronic condition. Herein, we report two cases of chronic tibialis anterior disruption successfully treated by semitendinosus autograft.

• The Journal of Korean Obstetrics and Gynecology
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• v.29 no.4
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• pp.46-56
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• 2016

Objectives: The purpose of this study is to evaluate the clinical effects of Muscle Energy Technique (MET) for peroneal nerve palsy after normal delivery. Methods: Two patients with peroneal nerve palsy were treated with acupuncture, moxibustion, cupping and MET. MET was performed in piriform, gluteus medius, anterior tibial and adductor muscles. To evaluate the effect of MET, we analyzed Ankle dorsiflexion range of motion (ROM), Manual Muscle Test (MMT), Numerical Rating Scale (NRS) and Ankle Hindfoot Scale (AHS). Results: In Case 1, ROM score was changed from −5 to 20, and MMT score was changed from 0 to 4. NRS score was changed from 5 to 1, and her AHS score was changed from 54 to 94 after treatment. In Case 2, ROM score was changed from 0 to 20, and her MMT score was changed from 1 to 5. NRS score was changed from 4 to 1, and her AHS score was changed from 64 to 97 after treatment. Conclusions: MET may be a useful treatment for patients who, shortly after childbirth or while breastfeeding, strongly refuse to treat the irritation.

• Korean Journal of Acupuncture
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• v.40 no.3
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• pp.128-133
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• 2023

Objectives : There are many variations in the ST36 acupoint location. The purpose of this article is to suggest a method of locating the ST36 acupoint. Methods : Based on the available research and the neuroanatomical characteristics of the underlying acupoint, we summarized the proper procedure for finding the ST36 acupoint. Results : ST36 is 3 B-cun inferior to ST35 and is vertically situated on the line that connects ST35 and ST41. The ST36 acupoint corresponds to the deep peroneal nerve, which is situated in the tibialis anterior muscle's back. The neurovascular bundles that are located on the interosseous membrane between the interosseous crests of the tibia and fibula include the deep peroneal nerve, anterior tibial artery, and anterior tibial vein. According to both classical and modern literature, this acupoint can be found horizontally between the two muscles, tibialis anterior and extensor digitorum longus. Conclusions : Based on a review of the literature and neuroanatomical features, we suggest that ST36 can be positioned horizontally between tibialis anterior and extensor digitorum longus. Additional imaging studies and clinical proof are required to determine ST36 acupoint.