• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.182-186
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• 2007

Purpose: We examined the relationship of interdigital neuroma occurring site and the surrounding structures, including the deep transverse metatarsal ligament (DTML) by cadaver study and clinical results. Materials and Methods: Seventeen fresh frozen cadavers study were done to evaluate the relationship of interdigital neuroma occuring site and the DTML at two phase of the gait cycle with 60 degree of metatarsophalangeal dorsiflexion and with 15 degrees of ankle dorsiflexion. We measured the distance from interdigital nerve bifurcation of the common digital nerve to anterior margin of the DTML and longitudinal length of DTML itself. Clinically, we checked the location of interdigital neuroma and DTML length during surgery in 32 feet. Results: In the second and third web space, the mean distance from bifurcation of the common digital nerve of foot to the anterior margin of DTML was 16.7 mm, 15.1 mm in the mid-stance position, and 15.9 mm. 14.6 mm in heel-off position. Second, Third web space ligament itself length were average 12.8 mm, 10.6 mm. Clinically, all of the cases of interdigital neuroma started at the bifurcation area of the common digital nerve and interdigital neuroma was average 7.5 mm (range; 6-11 mm). Conclusion: Interdigital neuroma were located more distally than DTML in both the mid-stance and heel off stage. The main lesion was located between metatarsal head and metatarsophalangeal joint and more distal than the DTML anterior margin.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.2
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• pp.1-11
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• 2016

PURPOSE: This study was conducted to assess the effects of local vibration on ankle plantarflexion spasticity and clonus in patients with spinal cord injury. METHODS: The subjects were 14 inpatients with complete or incomplete spinal cord injury (SCI) whose scores were higher than 1 on the Modified Ashworth Scale (MAS) and Spinal Cord Assessment Tool for Spastic Reflexes (SCATS) scale of paraplegia. A randomized single-blind cross-over design was used. Vibration treatment involved a single application of vibration for 10 min in the sitting position, and placebo treatment involved the patient remaining in the sitting position for 10 min. One day after treatment, vibration and placebo treatments were crossed over. Spasticity was measured by using the MAS, and resistance force, by using a hand-held dynamometer; clonus was gauged by using the SCATS scale and clonus burst duration. Additionally, the burst maximal frequency and voluntary ankle dorsiflexion angle of the triceps surae were measured. RESULTS: The application of vibration treatment in the sitting position significantly reduced the MAS scores and resistance force, but significantly increased the dorsiflexion angle of the ankle joint (p<0.05). Furthermore, the vibration treatment diminished the clonus burst duration and SCATS score significantly (p<0.05). Although it reduced the burst maximal frequency of the lateral gastrocnemius and medial soleus, this was significant only for the lateral gastrocnemius. The placebo treatment did not significantly affect any of the test parameters. CONCLUSION: Vibration treatment in the sitting position was effective in cases of spasticity and clonus caused by SCI.

• Journal of Korean Foot and Ankle Society
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• v.5 no.2
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• pp.142-148
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• 2001

Purpose: To investigate the short term result of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of rheumatoid arthritis, using a lag screw and dorsal mini-plate. Materials and Methods: From December 1999 to September 2001, The first metatarsophalangeal arthrodesis of 14 cases (9 patients) was underwent, using a lag screw and dorsal mini-plate. The follow-up period was averaged in 14.6 months. The subjective findings with respect to pain, functional aspect of ability to stand and walk, and to shoe-wearing were evaluated. The objective findings, such as the gross alignment and the radiological measurements for the hallux valgus angle, 1,2 intermetatarsal angle, and dorsiflexion angle were also studied. Results: After the arthrodesis of the first metatarsophalangeal joint, the subjective improvement in pain, function and alignment was graded as excellent in seven (50%) feet, good in seven (50%) feet, and fair or poor in none. The hallux valgus angle and 1,2 intermetatarsal angle were reduced from $44.1{\pm}7.1$ and $15.5{\pm}6.2$ degrees to $13.6{\pm}2.6$ and $10.2{\pm}2.2$ degrees respectively. The dorsiflexion angle was measured in $20.3{\pm}3.7$ degrees after the fusion. The radiological fusion was observed at average 8 weeks after the operation in all cases. The overall complication of the procedure was few, except the delayed wound healing in one. Conclusion: The arthrodesis of the first metatarsophalangeal joint using a lag screw and dorsal mini-plate was regarded as an excellent method of various operative modalities to correct the rheumatoid hallux valgus deformity.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.3
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• pp.27-37
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• 2018

PURPOSE: The purpose of this study was to investigate and evaluate muscle activity and foot pressure during gait, and isokinetic strength and balance in persons with functional ankle instability (FAI). METHODS: Nine healthy subjects (CON, n=9) without FAI and 11 patients (FAI, n=11) with FAI participated in the study after having been screened with an ankle instability instrument and a balance error scoring system. In addition, FAI was classified as non-involved (FAI-N) or involved (FAI-I), and CON was classified as dominant or non-dominant. All subjects were evaluated for isokinetic strength (plantar flexion, dorsiflexion, inversion and eversion of $30^{\circ}/sec$ and $60^{\circ}/sec$), balance (static and dynamic), muscle activity (tibialis anterior, peroneus longus and gastrocnemius) and foot pressure (static and dynamic) during gait. RESULTS: Results showed that plantar flexion (p<.05), dorsiflexion (p<.05), inversion (p<.01) and eversion (p<.00) of $60^{\circ}/sec$ were significantly decreased in FAI-I compared to those in FAI-N and CON. C 90 of static balance with eyes open (p<.01) and closed (p<.00) were significantly increased in FAI compared to those in CON. Forward position of dynamic balance (p<.01) was significantly decreased in FAI compared to that in CON. Gastrocnemius and peroneus longus of dynamic muscle activity (p<.01), left and right weight distribution of static foot pressure (p<.00) and pressure distribution of dynamic foot pressure (p<.00) were significantly decreased in FAI-I compared to those in FAI-N. CONCLUSION: We demonstrated that ankle strength, balance, muscle activity and foot pressure were significantly correlated with FAI.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.4
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• pp.63-70
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• 2019

PURPOSE: This study examined the effects of bilateral ankle dorsiflexors-strengthening exercise on the paralytic tibialis anterior activity, balance ability, and gait function of patients with chronic stroke. METHODS: Nineteen patients with chronic stroke were assigned randomly to the experimental and control groups. All participants received general physical therapy for 60-minutes per session, five times a week, for 6 weeks. In addition, the experimental group (n = 9) performed bilateral ankle dorsiflexion muscle-strengthening training three times a week, 30 minutes per session, for six weeks. The control group (n=10) performed the paraplegic ankle dorsiflexion muscle- strengthening training in the same manner. Before and after the intervention, the paralytic tibialis anterior muscle activity, timed up and go test (TUG), and 10m walking test (10 MWT) were performed. RESULTS: Both groups showed significant improvement in the post-intervention muscle activity of the paralytic tibialis anterior, TUG, and 10MWT compared to that before the intervention (p<.05), but the differences between the two groups were not significant (p >.05). CONCLUSION: Bilateral ankle dorsiflexors strengthening exercise is an effective cross-training method to improve the muscle activity of the paraplegic tibialis anterior, balance ability, and walking function in chronic stroke patients.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.4
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• pp.153-162
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• 2019

PURPOSE: This study compared ankle joint exercise and thigh exercise on the isometric strength of the lower limb and balance ability. METHODS: Twenty-seven subjects were divided into ankle joint exercise (AEG, n=9), tight exercise (TEG, n=9), and control group (CON, n=9). AEG and TEG performed ankle joint and tight exercises three times a week for four weeks. The following were measured before and four weeks after each exercise: isometric strength at knee flexion and extension of the lower limb; isometric strength at ankle plantar flexion and dorsiflexion of the lower limb; static balance of trace length and C90 area; and the dynamic forward, backward, leftward, and rightward balance for each region. RESULTS: The results showed that the isometric strength of plantar flexion (p<.05) was increased significantly in AEG compared to those in TEG and CON. The dynamic leftward (p<.05) and rightward balance (p<.05) were increased significantly in both AEG and TEG compared to that in CON. On the other hand, the static balance of the trace length and C90 area, isometric strength of ankle dorsiflexion, knee flexion and extension of the lower limb, and dynamic forward and backward balance did not show significant differences between the groups. CONCLUSION: Ankle joint exercise improves the isometric strength of plantar flexion compared to tight exercise.

• Korean Journal of Applied Biomechanics
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• v.16 no.3
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• pp.165-172
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• 2006

The purpose of this study was to determine effects of 12-week wearing of unstable shoe on the standing posture and gait mechanics. Nine healthy men were asked to wear the unstable shoes for 12-week and walk for 30 minute everyday. Their standing posture and gait mechanics were measured before and after treatment. Standing posture was measured for each side(anterior, posterior, lateral) for standing position. And gait analysis was measured joint angle of a right lower limb between first right heel contact and second right heel contact. Kinematic data were collected using video camera at 30 frame per seconds. Statistical analysis was paired t-test(p<.05) to compare before training with after that. A head tilt angle was significantly decreased for posterior side(p<.05). The angle of between center of line and surface was significantly decreased at midstance and take off during walking(p<.05). Ankle dorsiflexion significantly increased at heel contact2(p<.05) and ankle plantarflexion significantly increased at midstance and midswing(p<.05). The increase of ankle dorsiflexion showed that our results consisted with previous study. In conclusion, there was not large significant difference in static standing posture but joint angle of lower limb represented many changes with increasing of ankle motion during walking. These were of benefit to body by increasing leg muscle activity but it was necessary for man having a ankle problem to consider. Further studies concerning optimum outsole angle of unstable shoes are necessary.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.146-150
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• 2010

Purpose: Pilon fracture has several serious complications such as joint stiffness, arthrosis and delayed angular deformity. We report short-term results of new treatment modality using distracted dynamic external fixators and early controlled ankle motion. Materials and Methods: Eight cases of severe pilon fractures for which we tried small plate fixation and additional distracted dynamic external fixators from July 2007 to June 2009 were included. Half passive continuous ankle joint motion was allowed under free hinged ring fixators after the operation. The external fixators were removed after two or three months from the surgery. We investigated joint space by radiograph, joint pain, range of motion, patient's satisfaction of treatment protocol. Results: Joints were distracted when external fixators were applied and mean 28% of space loss developed after removal of external fixators. In most of cases, satisfactory alignments were maintained. Regarding range of joint motion, mean dorsiflexion angle was 15 degrees and mean plantarflexion angle was 32 degree in the condition of wearing external fixators. There was mean 8% reduction of range of motion but no further progression of ankle stiffness after removal of external fixators. Dorsiflexion was not improved after that, but plantarflexion angle was improved 10% even after removal of external fixators. Patients were generally in compliance with the treatment protocols with high level of satisfaction. Conclusion: We got good results with distracted dynamic external fixators and early continuous half-passive joint motion for pilon fractures in terms of joint pain and range of motion. Therefore we suggest this new protocol as an alternative modality for severe pilon fractures.

• Physical Therapy Korea
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• v.22 no.1
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• pp.30-36
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• 2015

The purpose of this study was to examine the relationships between the ankle dorsiflexion passive range of motion (DF PROM) under a non-weight bearing condition and the normalized reach distance in three directions of the Y-Balance Test (YBT). Sixty-one healthy adults (32 males and 29 females, age: $23.0{\pm}3.0$ years, height: $169.3{\pm}8.9cm$, weight: $61.9{\pm}5.4kg$) participated in this study. The ankle DF PROM was measured using a goniometer. To assess dynamic balance, all subjects performed three trials to determine the maximum lower extremity reach in the anterior, posteromedial, and posterolateral directions of the YBT. The relationship between the ankle DF PROM and both the normalized reach distance in each direction and the composite score of the YBT were analyzed using the Pearson correlation. Only the normalized reach distance in the anterior direction of the YBT was significantly related to the ankle DF PROM measured under a non-weight bearing condition (r=.50, p<.001). Neither the normalized reach distances in the posterior directions nor the composite score of the YBT were significantly correlated with the ankle DF PROM measured under a non-weight bearing condition. These findings suggest that ankle DF PROM does not affect the overall dynamic balance of the lower extremity, with only the anterior dynamic balance affected among the three directions.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.19-25
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• 1999

The purpose of this study Is to assess the retained range of motion[RROM] of the foot after arthrodesis of the ankle joint, which might help designing the angle of arthrodesis. We reviewed the results including the RROM in 14 cases of ankle arthrodesis. Underlying causes included trauma group(six posttraumatic arthritis) and disease group(three osteoarthritis, three Charcot joints, one chronic synovitis and one pyogenic arthritis). We measured the RROM on the lateral roentgenograms of the ankle in full dorsiflexion and plantarflexion, The results were assessed by the AOFAS hindfoot scale[score]. The RROM in sagittal plane was $23.4{\pm}5.3$ degrees and the score was 71.5 points on average. The RROM and the score were $26.8^{\circ}{\pm}2.1$, 81.2 points respectively in trauma group and $20.8^{\circ}{\pm}5.6$, 64.3 points in disease group; $26.6^{\circ}{\pm}2.3$, 83.4 points in cases younger than 40 years of age and $21.6^{\circ}{\pm}5.7$, 64.9 points in the older. The mean score was 77.3 points in cases whose RROM were $24^{\circ}$ or more and 61 points in cases of less RROM; 69.6 and 73.4 points in cases with and without adjacent degenerative arthritis respectively. The score was 69.7, 73.3 and 71.5 points in cases whose angle of arthrodesis was in dorsiflexion, neutral, plantarflexion respectively. In conclusion, after ankle arthrodesis RROM of the foot was $23.4^{\circ}$, and the more the RROM, the higher the score. In cases with sufficient amount of RROM, the angle of fusion on sagittal plane might not influence the result significantly.