• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.93-99
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• 2007

Purpose: To report the clinical results and efficacies of one stage reverse lateral supramalleolar adipofascial flap for soft tissue reconstruction of the foot and ankle joint. Material and Methods: We performed 5 cases of one stage reverse lateral supramalleolar adipofascial flap from Jan 2005 to Sept 2005. All patients were males and mean age was 50(36~59) years old. The causes of soft tissue defects were 1 diabetic foot, 2 crushing injuries of the foot, 1 open fracture of the calcaneus, and 1 chronic osteomyelitis of the medial cuneiform bone. Average size of the flap was 3.6(3~4)${\times}$4.6(4~6) cm. All flaps were harvested as adipofascial flap and were performed with the split-thickness skin grafts (STSG) above the flaps simultaneously. Results: All flap survived completely and good taking of STSG on the flap was achieved in all cases. There were no venous congestion and marginal necrosis of the flap. In diabetic foot case, wound was healed at 4 weeks after surgery due to wound infection. There was no contracture on the grafted sites. Ankle and toe motion were not restricted at last follow up. All patients did not have difficulty in wearing shoes. Conclusion: The reverse lateral supramalleolar adipofascial flap and STSG offers a valuable option for repair of exposure of the tendon and bone around the ankle and foot. Also one stage procedure with STSG can give more advantages than second stage with FTSG, such as good and fast take-up, early ambulation and physical therapy, and good functional result.

• 대한족부족관절학회지
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• 제27권2호
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• pp.58-66
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• 2023

Purpose: This study aimed to evaluate the effectiveness of deltoid ligament repair on syndesmotic stabilization in patients with acute ankle fractures with ruptured deltoid and syndesmotic ligaments. Materials and Methods: The medical records of 41 patients (41 ankles) who underwent surgery for Weber type B ankle fracture with ruptured deltoid and syndesmotic ligaments were retrospectively analyzed. The mean follow-up duration was 36 months (range 18~65 months). Patients were divided into two groups: those that underwent deltoid ligament repair (the deltoid group) and those who did not (the non-deltoid group). Both groups were also divided into two subgroups, namely, the D1/S1 group, which underwent syndesmotic screw fixation, or the D2/S2 group, which did not. Medial clear space (MCS), tibiofibular clear space (TFCS), anterior fibular line (AFL) ratio, and posterior fibular line (PFL) distance were measured, and visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Foot Function Index (FFI) scores were evaluated. Results: TFCS changed significantly after surgery in the D2 and S1 groups (p=0.01, p=0.03, respectively). Subgroup MCSs, TFCSs, and AFL ratios were not significantly altered by surgery in the four subgroups (p=0.82, p=0.45, p=0.25, respectively). However, postoperative PFL distances were significantly different in the D2 and S1 groups and the S1 and S2 groups (p=0.02, p=0.02, respectively). Mean TFCS decreased significantly after surgery in the D2 and S1 groups. The postoperative VAS, AOFAS scores, and FFI were not significantly different between the subgroups (p=0.44, p=0.40, and p=0.46, respectively). Conclusion: Deltoid ligament repair seemed to restore ankle stability without addressing syndesmosis in Weber type B ankle fractures with rupture of deltoid and syndesmotic ligaments.

• 대한족부족관절학회지
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• 제25권3호
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• pp.117-125
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• 2021

Purpose: The aim of this study was to evaluate biological ligament healing quantitatively after suture-tape augmentation for chronic lateral ankle instability. Materials and Methods: Thirty-two patients underwent magnetic resonance imaging (MRI) at a minimum of 2 years after lateral ligament augmentation using suture-tape. Signal/noise ratios (SNRs) and widths of anterior talofibular ligaments (ATFLs) were measured on preoperative and postoperative MRI by three researchers. ATFL biological healing degrees were analyzed using changes in SNRs and widths of ATFLs and by comparing these metrics with those of normal contralateral ankles. Clinical evaluations were performed using foot and ankle outcome scores (FAOSs), Foot and Ankle Ability Measure (FAAM) scores, and ankle stress radiographs. Results: Mean FAOS and FAAM scores improved significantly from 62.4 to 93.6 and 58.3 to 92.3, respectively, at final follow-up (p<0.001). Mean SNRs and ATFL widths improved insignificantly from 8.49 to 8.21 and 2.07 to 2.15 mm, respectively, at final follow-up (p=0.424, p=0.718). Significant differences in mean SNRs and ATFL widths were found between ipsilateral and contralateral sides (p<0.001, p=0.002). Spearman's correlation analysis revealed no significant association between clinical outcomes and degrees of biological healing of ATFLs based on MRI findings. Conclusion: Despite improvements in clinical outcome measures, the effects of suture-tape augmentation for chronic lateral ankle instability on biological ligament healing were insignificant. In addition, no significant correlation was found between clinical outcomes and degrees of biological healing of ATFLs.

• 대한족부족관절학회지
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• 제25권2호
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• pp.55-60
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• 2021

This review article attempts to describe several pathological conditions that can arise from the shortening of the Achilles tendon. The tension and tightening of the gastrocnemius-soleus-Achilles tendon complex (GSAC) can cause disharmony in the movement of the entire foot as well as the ankle joint when subjected to weight-bearing or walking. In addition, since these phenomena are observed in various lesions of the ankle joint, the dynamic shortening caused by the tension of GSAC may not be the primary cause of various ankle joint lesions, but is still considered to be a significant contributing factor.

• PNF and Movement
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• 제4권1호
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• pp.45-50
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• 2006

발뒤꿈치 닿기 시 족관절은 약간 족저굴곡 위치에 있다가 발바닥 닿기까지 족저굴곡이 진행된다. 몸체가 지지하는 중간입각기동안 빨리 배굴로 변하고 입각기 말기에 발뒤꿈치 떼기 후에는 다시 저굴이 일어난다. 유각기의 시작인 발가락 떼기에서는 저굴이 되다가 유각기 중기에는 배굴로 바뀌고 발뒤꿈치 닿기에서는 약간 저굴로 변한다. 후족부의 운동은 발뒤꿈치 닿기 시에 편안히 서있을 때보다 더 회내되어 있고 발뒤꿈치 닿기 직후는 회내되고 중간입각기동안 다시 회내되는 양상을 보인다. 발끝떼기 시에 최대로 회내가 이루어진다. 발에서 일어나는 중요한 요소는 체중과 지면 반발력과의 충격을 흡수하는 역할이라 할 수 있다. 족관절 저굴은 뒤꿈치에 의한 초기 바닥 닿기의 즉각적인 반응으로 대부분의 최후 $10^{\circ}$는 짧은 발의 떨어짐으로 일어난다. 경골 전면 근육들의 활동은 동작을 유의하게 제한하고 즉각적으로 나타난다기보다는 오히려 보행주기에 8% 지점까지 전족에 의한 바닥접촉을 지연시킨다. 떨어지는 체중은 점차감소되고 두 번째로 충격을 흡수하는 기전은 슬관절에서 흡수한다. 위와 같이 보행 시에 발과 족관절의 운동성은 다양하다. 그러나 아직 임상에서는 발과 족관절에 대한 연구가 미흡하다. 따라서 발의 역학적인 범위의 다양성과 발의 내적인, 외적인 부하 사이의 관련성을 위한 더 많은 연구가 필요할 것으로 생각된다.

• 대한족부족관절학회지
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• 제19권1호
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• pp.1-6
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• 2015

Total ankle replacement has been performed for treatment of end stage arthritis of the ankle, hopefully being an alternative to ankle arthrodesis. However, due to its high failure rates, earlier versions of ankle replacements were not regarded as successful procedures. The latest design has shown increasingly positive results. Total joint replacement of the ankle itself is still regarded as a demanding procedure and much more challenging than that of the hip and knee in many aspects. Several studies, however, have pointed out that it is becoming the viable, accepted alternative for arthrodesis with advanced implants, appropriate patient selection, and proper training experience of procedures. Compared with arthrodesis, it shows equal or better outcomes in pain relief, range of motion, and patient's satisfaction. We are attempting to review its biomechanical characteristics, implant design, indications, complications, clinical outcomes, and survival rate.

• 대한족부족관절학회지
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• 제28권1호
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• pp.1-7
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• 2024

Despite the advances in total ankle replacement (TAR), TAR has emerged as a promising alternative to ankle arthrodesis, particularly in severe ankle arthritis. Restoring ankle stability and alignment is the most important technical consideration and the goal of TAR. Hence, additional procedures, such as soft tissue balancing and osteotomies, are often critical parts of surgical planning. This article reviews the basics of joint balancing, offering suggestions on procedure selection for ligamentous balancing and varus and valgus malalignment in TARs.

• 한국운동역학회지
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• 제26권2호
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• pp.153-159
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• 2016

Objective: The purpose of this study was to investigate the effects of joint mobilization on foot pressure, ankle moment, and vertical ground reaction force in subjects with ankle instability. Method: Twenty male subjects (age, $25.38{\pm}3.62yr$; height, $170.92{\pm}5.41cm$; weight, $60.74{\pm}9.63kg$; body mass index (BMI), $19.20{\pm}1.67kg/m^2$) participated and underwent ankle joint mobilization. Weight-bearing distribution, ankle dorsi/plantar flexion moment, and vertical ground reaction force were measured using a GPS 400 and a VICON Motion System (Oxford, UK), and subsequently analyzed. SPSS 20.0 for Windows was used for data processing and paired t-tests were used to compare pre- and post-mobilization measurements. The significance level was set at ${\alpha}$ = .05. Results: The results indicated changes in weight-bearing, ankle dorsi/plantar flexion moment, and vertical ground reaction force. The findings showed changes in weight-bearing distribution on the left (pre $29.51{\pm}6.31kg$, post $29.57{\pm}5.02kg$) and right foot (pre $32.40{\pm}6.30kg$, post $31.18{\pm}5.47kg$). There were significant differences in dorsi/plantar flexion moment (p < .01), and there were significant increases in vertical ground reaction forces at initial stance (Fz1) and terminal stance (Fz2, p < .05). Additionally, there was a significant reduction in vertical ground reaction force at midstance (Fz2, p < .001). Conclusion: Joint mobilization appears to alter weight-bearing distribution in subjects with ankle instability, with resultant improvements in stability.

• 대한족부족관절학회지
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• 제23권3호
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• pp.100-104
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• 2019

Purpose: This study examined the clinical outcomes and assessed the average time to return to play following a peroneal tendon repair in Korean athletes. Materials and Methods: Between March 2004 and February 2017, a total of 30 athletes underwent peroneal tendon repair for a peroneal tendon tear. The indications of surgical treatment were chronic pain or intractable symptoms after a previous ankle sprain affecting sports activity refractory to conservative treatment for at least six months. The patient underwent tubulization for a longitudinal tendon rupture. Peroneus longus to peroneus brevis tenodesis was performed when tendon repair was impossible due to total rupture or multiple longitudinal rupture. Results: Twenty patients not included in this study were as follows: insufficient follow-up, previous surgery, and additional bone surgery. All 10 patients had a previous ankle sprain history, tenderness and swelling on the retromalleolar area. In the 10 patient population, there were five peroneus brevis tendon tears, three peroneus longus tendon tears, one peroneus longus and brevis tendon tear, and one peroneus brevis and superior peroneal retinaculum tear. In the 10 patients, six cases of peroneal brevis tendon repair and four cases of peroneal longus to brevis tenodesis were performed. The preoperative American Orthopaedic Foot and Ankle Society score was improved from a mean of 60.6 (standard deviation [SD], 8.64) to a mean of 90.2, postoperatively (SD, 4.4; p<0.012). The preoperative visual analogue scale was improved from a mean of 5.43 (SD, 1.2) to 0.5 (SD, 0.16), postoperatively (p<0.023). The mean length of time to return to play was 12.2 weeks (range, 8~16 weeks). Conclusion: Peroneal tendon tear can occur due to sports injuries. If there is tenderness at the retromalleolar area, the surgeon should consider a peroneal tendon lesion. Surgical repair of the peroneal tendon can be an effective treatment to help athletes to return to play.

• 대한족부족관절학회지
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• 제24권1호
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• pp.1-8
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• 2020

Acute ankle sprain is the most common injury in the lower extremities, and approximately 10% to 40% of acute lateral ankle ligament injury causes chronic pain or instability. For chronic symptoms lasting after an acute sprain, the possibility of joint damage, such as bony structures, ligaments, cartilage, and nerves around the ankle joint, should be considered. Patients with chronic lateral ankle instability usually complain of repeated sprains or giving way sensations. There has been steady progress in the treatment options until recently, however new treatments are still being attempted. This paper describes the causes, diagnosis, and recent trends in the conservative and operative treatment of chronic lateral ankle instability.