• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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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.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• The Journal of Korean Physical Therapy
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• v.9 no.1
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• pp.127-145
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• 1997

The purpose of this study wa9 to analyse the gait patterns of two female children with hemiplegic cerebral palsy by using the three-dimensional video motion analysis technique. Case 1 has mild spastic hemiplegia on the right side while Case 3 has moderate spastic hemiplegia on the left side. A group of 10, normal female children of the same age(7-8 years old) were selected as the control group for comparison. Time and distance variables as well as the Center of Mass displacement, and the pelvic and joint motions in three anatomical planes were analysed for this purpose. The following observations were made through the analysis : Case 1 revealed an asymmetrical gait pattern in which the step length of the unaffected side was shorter than that of the affected side, which wan a result of the effort to minimize loading on the affected leg by shortening the swing phase of the unaffected leg. Case 1 scored similar phase ratios, cadence and walking velocity to the normal group. A slight posterior tilt of the pelvis was observed throughout the gait cycle. Less hip and knee flexion than the normal group was observed, and demonstrated hyperextension of the knee in the terminal stance phase. The main problem in case 1 originated from the insufficient dorsiflexion of the affected foot during the swing phase. Therefore, Case 1 has difficulty with foot clearance in the swing phase. Usually, this is compensated for by using exessive hip abduction and medial rotation in conjuction with trunk elevation as well as increased vortical displacement of the center of mass. Case 1 revealed a foot-flat initial contact pattern. Case 2 was characterized by a consistent retraction ef the affected aide of the body througout the gait cycle, As a result, an asymmetrical gait pattern with increased stance phase ratios of the unaffected side was observed. In spite of this the step lengths of both sieds were similar. Case 2 scored lower cadence and walking speed than the normal group with lower gait stability. The main problem in Case 2 originated from an excessive plantaflexion of the affected foot which, in turn, rebutted in high hip and knee flexion. Hyperextension of the knee was observed at mid-stance, and execessive anterior tilt of the pelvis throughout the gait cycle was noticed. A gait pattern with high hip abduction and medial circumduction was maintained for the stability in the stance phase and foot clearance in the swing phase. Case 2 revealed a forefoot-contact initial contact pattern.

• Journal of Biomedical Engineering Research
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• v.29 no.6
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• pp.484-492
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• 2008

Sit to stand(STS) movement is one of the most common activity in daily life. In addition, Korean traditionally stand up from various sitting heights in one's daily life compared to other foreigners. As Korea enter rapidly to the aging society, needs of the elderly's independent life are increasing. Therefore the importance of research about the analysis of elderly's activity in daily life is rapidly increasing. In this study, we analyzed joint movements and changes of muscle length during STS(sit-to-stand) at various sitting heights(table seat, bath seat, bottom) in the Korean elderly's daily life by using the motion analysis and musculoskeletal modeling. Ten Korean elderly and young were participated in this experiment. Three heights of sitting posture which could represent typical sitting in Korean daily life were chosen as table seat(42cm), bath seat(21cm) and bottom(0cm). As the results, the elderly showed both smaller knee/hip flexion and larger trunk flexion relatively in comparison to the young during table seat STS. The elderly also showed larger dorsiflexion and smaller ROM of knee, hip, trunk compared to the young during bath seat STS. Additionally, the elderly showed larger plantarflexion, hip flexion, smaller knee flexion and trunk flexion during the first half of bottom STS and larger knee flexion, hip flexion and trunk flexion during the second half of bottom STS. In addition, we could know contraction and relaxation characters of major muscles in lower limb during various STS through the analysis of changes in muscle length by musculoskeltal modeling.

• Journal of Korean Physical Therapy Science
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• v.10 no.2
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• pp.37-41
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• 2003

The aim of this study is to present the basic reference data Effect of uneffected side insole on Gait Pattern in Hemiplegia Patients. The basic gait parameters were extracted from 10 Adult Hemiplegia Patients, 5 left Hemiplegia Patients and 5 right Hemiplegia Patients, 50 to 60 years of age using VICON 512 Motion Analyzer. The results were as follows; 1) The mean Cadence of the shoes to the 1cm insole in shoes were $70.58{\pm}12.67\;steps/min$, to $77.28{\pm}14.58\;steps/min$.(p>0.05) 2) The mean Walking Speed of the shoes to the 1cm insole in shoes were $0.40{\pm}0.17\;m/s$, to $0.49{\pm}0.18\;m/s$.(p>0.05) 3) The mean Stride Length of the shoes to the 1cm insole in shoes were $0.67{\pm}0.20\;m$, to $0.75{\pm}0.19m$.(p>0.05) 4) The mean anterior angles of pint on the pelvic tilt for different the shoes to the 1cm insole in shoes were $13.22{\pm}7.25^{\circ}$, to $11.68{\pm}4.02^{\circ}$.(p>0.06) 5) The mean maximal angles of pint on the hip flexion motion for different the shoes to the 1cm insole in shoes were $24.62{\pm}8.35^{\circ}$, to $24.74{\pm}9.12^{\circ}$.(p>0.05) 6) The mean maximal angles of joint on the knee flexion motion for different the shoes to the 1cm insole in shoes were $34.27{\pm}16.71^{\circ}$, to $35.93{\pm}18.22^{\circ}$.(p>0.05) insole in shoes were $15.97{\pm}7.72^{\circ}$, to $18.77{\pm}11.03^{\circ}$.(p>0.05) 7) The mean maximal angles of joint on the ankle dorsiflexion motion for different the shoes to the 1cm. 8) The mean maximal angles of joint on the ankle plantarflexion motion for different the shoes to the 1cm insole in shoes were $-4.24{\pm}10.66^{\circ}$, to $-7.04{\pm}11.00^{\circ}$.(p<0.05)

• Physical Therapy Korea
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• v.11 no.1
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• pp.53-67
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• 2004

This simulation study investigated the characteristics of normal gait, $30^{\circ}$ crouch gait, $30^{\circ}$ crouch/equinus gait, $45^{\circ}$ crouch gait, $45^{\circ}$ crouch/equinus gait. The knee flexion angles were restricted using a specially designed orthosis. This study was carried out in a motion analysis laboratory of the National Rehabilitation Center. Fifteen healthy male subjects were recruited for the study. The purposes of this study were (1) to compare spatiotemporal parameters, kinematics, and kinetic variables in the sagittal plane among the different gait, (2) to investigate the secondary compensatory strategy, and (3) to suggest biomechanical physical therapy treatment methods. The pattern and magnitude observed in each condition were similar to those of normal gait, except the peak knee extension moment of the unrestricted ankle motion-crouch gait. However, the speed of the $45^{\circ}$ crouch gait was half that of a normal gait. The ankle joint moment in the crouch/equinus gait showed the double-bump pattern commonly observed in children with spastic cerebral palsy, and there was no significant difference in gait speed as compared with normal gait. The peak ankle plantar-flexor moment and ankle power generated during the terminal stance in the crouch/equinus conditions were reduced as compared with normal and $45^{\circ}$ crouch gaits (p<.05). The crouch/equinus gait at the ankle joint was an effective compensatory mechanism. Since ankle plantarflexion contracture can be exacerbated secondary to the ankle compensatory strategy in the crouch/equinus gait, it is necessary to increase the range of ankle dorsiflexion and the strength of plantarflexion simultaneously to decrease the abnormal biomechanical advantages of the ankle joint.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.1
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• pp.18-25
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• 1997

Prosthetic replacement is one of the most common methods of reconstruction after resection of malignant tumor around the knee. Gait analysis provides a relative objective data about the gait function of patients with prosthesis. The purpose of this study was to compare the gait pattern of the patients who underwent limb salvage surgery with prosthesis for distal femur and that of patients with prosthesis for proximal tibia. This study included ten patients (4 males, 6 females, mean age 22.7 years, range 14-36) who underwent a wide resection and Kotz hinged modular reconstruction prosthesis replacement and six normal adult(Control). The site of bone tumor was the distal femur (Group 1) in six patients and proximal tibia (Group 2) in 4 patients. The follow-up period ranged from 15 to 82 months (mean : 33 months). The evaluation consisted of clinical assessment, radiographic assessment, gait analysis using VICON 370 Motion Analysis System. The gait analysis included the linear parameters such as, walking velocity, cadence, step length, stride length, stance time, swing time, single support and double support time and the three-dimensional kinematics (joint rotation angle, velocity of joint rotation) of ankle, knee, hip and pelvis in sagittal, coronal and transverse plane. For the kinetic evaluation, the moment of force (unit: Nm/kg) and power (unit: Watt/kg) of ankle, knee and hip joint in sagittal, coronal and transverse plane. In the linear parameters, cadence, velocity, step time and single support were decreased in both group 1 and group 2 compared with control. Double support decreased in group 2 compared with control significantly(p<.05). In contrast to our hypothesis, there was no significant difference between group 1 and group 2. In Kinematics, we observed significant difference (p<.05) of decreased knee flexion in loading response (G2

• Proceedings of the Korea Contents Association Conference
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• 2005.05a
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• pp.156-164
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• 2005

The aim of this study was to analyze the isokinetic strength of ankle, lumbar and shoulder in fin swimmers. For this study, 7 male fin swimmers and 7 men general swimmers were selected. Isokinetic strength of ankle, lumbar and shoulder were measured by Biodex System 3,000. Statistical techniques for data analysis were a descriptive statistics and t-test. The results of this study were as following; The first, significant difference between two groups in right and left plantar flexion of ankle at $30^{\circ}/sec\;and\;180^{\circ}/sec$. But no significant difference was found between right and left in two groups. The second, significant difference between two groups in right dorsiflexion of ankle at $30^{\circ}/sec$. The third, significant difference between two groups in extension of lumbar at $60^{\circ}/sec$. The fourth, significant difference between two groups in right flexing of shoulder at $60^{\circ}/sec$ and $180^{\circ}/sec$. As result of this conclusion, the isokinetic strength of ankle and lumbar in fin swimming group showed significantly higher than non-fin swimming group.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.11
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• pp.5723-5729
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• 2013

The purpose of this study was to investigate the imbalance of muscle tone and frequent exposure to excessive gait training in patients with chronic spasticity due to stroke, the thickness of the plantar fascia to change and to evaluate. The subjects of this study was in 54 patients with chronic stroke from 18 patients Group I(MAS G0), 18 patients Group II(MAS G1), and 18 patients Group III(MAS G2) were selected. Measurement of clinical symptoms and physical examination, MAS(Modified Ashworth Scale), ultrasonographic, ROM(Range of Motion), VAS(Visual Analogue Scale), TUG(Timed Up and Go test) was measured. The study results were each group between the unaffected side and the affected side on plantar fascia thickness was statistically significantly thicker(p<.001). Each group between the unaffected side and the affected side on ankle dorsiflexion ROM was statistically significantly decrease(p<.001), VAS(p<.001), TUG(p<.001) statistically significantly increase(p<.001). In this study, the plantar fascia pathokinesiology ever presented by the contents of gait training in stroke patients is one of the information that you need to consider when presented.

• Korean Journal of Applied Biomechanics
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• v.19 no.3
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• pp.467-479
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• 2009

The purpose of this study was to present the quantitative data which riders can utilize teaching field by comparison analysis of kinematics according to skill level of rider during 2 strides rising trot with the JeJu's-Horse. Participated subjects was consisted of total 10 riders(unskilled: n=5, skilled: n=5). The method of experiment & analysis was based on 3D cinematography. Variables were consisted of temporal, linear & angular kinematics by each event & phase. The skilled assigned more ratio of elapsed time in air than support phase, had the less range of motion in up-down direction and more consistent velocity in lateral & forward direction and performed periodic up-down movement with alignment in vertical direction according to elapsing of phases. The skilled more flexed at elbow and extended backwardly according to elapsing of phases, while more flexed forwardly at hip & knee and plantarflexion at ankle. The skilled postured backward extension but the unskilled do forward flexion. That is, It was considered that the unskilled continued more unstable posture than the skilled during 2 strides in rising trot.