• Journal of Yeungnam Medical Science
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• v.36 no.2
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• pp.92-98
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• 2019

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

• The Journal of Korean Physical Therapy
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• v.27 no.6
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• pp.434-438
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• 2015

Purpose: The purpose of this study was to determine the effects of calcaneal taping on peak plantar pressure of rearfoot and forefoot while walking. Methods: Fifteen healthy subjects with normal feet participated in this study. Inclusion criteria were as follows: (1) no disturbance of gait and foot pain, (2) normal range of motion of ankle joint, (3) no foot deformity. Pedoscan was used for recording of plantar pressure data during walking. The participants walked along a 12-m walkway before and after application of calcaneal taping. The plantar pressure gait was measured 3 times under barefoot and calcaneal taping conditions randomly at a speed practiced with the metronome during gait. The peak plantar pressure data were calculated for medial and lateral areas of the rearfoot and forefoot. The paired t-test was used to determine significant differences in peak plantar pressure of rearfoot and forefoot before and after application of calcaneal taping. A p-value less than 0.05 was accepted as significant. Results: The calcaneal taping resulted in statistically significant decreases in peak plantar pressure of the rearfoot (medial side: p=0.03; lateral side: p=0.01). However, there were no significant changes in peak plantar pressure of the forefoot (medial side: p=0.45; lateral side: p=0.40). Conclusion: The calcaneal taping is recommended to reduce plantar pressure of the rearfoot in weight-bearing activities in subjects with plantar heel pain caused by atrophy of the fat pad.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.212-216
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• 2014

A schwannoma is a benign neurogenic tumor derived from Schwann cells. A rare case of a large painful schwannoma in the foot with metatarsal deformity was presented. Due to suspicion of malignancy, amputation had been recommended previously. We report on a rare case of a large forefoot schwannoma causing pain and paresthesia of the forefoot.

• Korean Journal of Applied Biomechanics
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• v.21 no.1
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• pp.25-29
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• 2011

The purpose of this study was to analyze quantitative and qualitative differences according to shoe type for the grand jete landing in ballet. The subjects for this study were 9 female ballet majors with an average of 12 years of experience. Subjects jumped, performing a front split, and landed on 1 foot, a movement called the grand jete. Analysis was performed on the students' landing. Independent variables were 3 shoe types: split sole, traditional out sole, and 5-toed forefoot shoes, with bare feet as a control group. Dependent variables were vertical passive ground reaction force and qualitative elements. Passive ground reaction force variables(maximum passive peak value, number of passive peaks, passive force-time integral, and center of pressure) were measured by the Kistler 9281B Force Platform. Qualitative elements were comfort, cushioning, pain, and fit. Statistical analysis included both 1-way ANOVA and Tukey's test for follow-up. Finalized data demonstrated that the 5-toed forefoot shoe allows the forefoot to expand and the toes to individually press down upon landing, increasing foot contact with the surface. Five-toed forefoot shoes minimize passive peaks and pain, while increasing comfort, cushioning, and fit. Most ballet movements are composed of jumping, balancing, landing, and spinning. Wearing 5-toed forefoot shoes allows for a natural range of movement in each toe, to improve both technique and balance. Pain and injuries from ballet can be minimized by wearing the correct shoe type. According to this analysis, it is possible to customized ballet shoes to increase the efficiency of techniques and movements.

• Journal of Korean Foot and Ankle Society
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• v.24 no.1
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• pp.9-13
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• 2020

Metatarsalgia is a generalized term used to describe forefoot pain. The possible etiologies can range from direct to indirect pathologies. Metatarsalgia has several causes. This paper evaluates the recent literature to provide an in-depth review of metatarsalgia after forefoot surgery.

• Journal of Korean Foot and Ankle Society
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• v.21 no.3
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• pp.79-82
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• 2017

Metatarsalgia is one of the most common causes of patients complaining of pain in their feet. This pain is the plantar forefoot, including the second to fourth metatarsal heads and arises from either mechanical or iatrogenic causes. On the other hand, it is frequently accompanied by a deformity of the toes as well as of the first and fifth rays. The pain has a variety of causes, and sometimes the cause is difficult to distinguish. The variability of possible causative factors necessitates an individualized approach to treatment. To determine these causes, this paper presents an overview of the gait mechanics, plantar pressure, and the classification according to the etiology.

• Journal of Korean Foot and Ankle Society
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• v.15 no.2
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• pp.58-61
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• 2011

Morton's neuroma is a common cause of forefoot pain, and is also known to be a entrapment neuropathy rather than a true tumor. Precise physical examination is necessary to differentiate from other diagnoses of similar symptoms. If proper conservative treatment modalities fail for this neuritis, neurectomy of interdigital nerve is generally performed, with the results of up to 80% of patient's satisfaction. However the failure rate of 2% to 35% should be improved by proper diagnosis and careful surgery.

• The Journal of Korean Physical Therapy
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• v.15 no.4
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• pp.13-23
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• 2003

The purpose of this study was to evaluate the change of lordosis according to plantar surface compliance in patients with chronic low back pain. Thirty patients with chronic low back pain aged between 20 and 40 were assigned to 3 groups: control group, experimental groups (FHRS group, FSRH group). The lordosis was examined before and after adaptation with corresponding foam types. The results were as follows : 1. As the result of comparing lordosis before and after test of the control group which any change did not exist in plantar surface compliance, there was not a significant difference(p>0.05). 2. As the result of comparing lordosis before and after test of the FHRS group which forefoot part of plantar surface is hard and rear foot part is soft, there was the significant increase(p<0.05). 3. As the result of comparing lordosis before and after test of the FSRH group which forefoot part of plantar surface is soft and rear foot part is hard, there was the significant decrease(p<0.05). 4. As the result of comparing lordosis of the FHRS group and FSRH group, there was not a significant difference before test(p>0.05). But, there was a significant difference after test(p<0.05).

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.171-176
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• 2007

Purpose: We assess the mid to long term follow up results of arthrodesis of the first metatarso-phalangeal (MTP) joint and resection arthroplasty of the lesser toes in rheumatoid arthritic forefoot deformity. Materials and Methods: Between 1998 to 2001 year, 25 cases (18 patients) rheumatoid forefoot deformities were surgically corrected. Follow up period was 83 months (range, 63 to 90 months). The clinical outcome was evaluated using subjective satisfaction and AOFAS score. The radiological measurements were hallux valgus angle, first and second intermetatarsal angle, second metatarso-phalangeal angle (MTP-$2^{nd}$ angle). Results: Subjective satisfaction was 76%. AOFAS score improved from 37 to 73. The hallux valgus angle improved from preoperative $39^{\circ}$ ($27{\sim}64^{\circ}$) to $14^{\circ}$ ($4{\sim}34$) at the last follow up. The intermetatarsal angle were preoperative $13^{\circ}$ ($6{\sim}22^{\circ}$) to $11^{\circ}$ ($3{\sim}13^{\circ}$) at the last follow up, The MTP-$2^{nd}$ angle were preoperative $24^{\circ}$ ($9{\sim}47$) to last follow up $15^{\circ}$ ($2{\sim}39^{\circ}$) respectively (p>0.05). Complication was intractable callus 10 cases, Interphalangeal arthritis 5 cases. Conclusion: Mid to long term outcomes rheumatoid forefoot reconstruction by first MTP arthrodesis and resection arthroplasty of lesser toes results a satisfaction and pain relief.

• Journal of Korean Foot and Ankle Society
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• v.21 no.3
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• pp.83-87
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• 2017

Metatarsalgia means the pain under the lesser metatarsal heads. The many causes of metatarsalgia can be categorized into three groups: local disease in the region, altered forefoot biomechanics, and systemic disease affecting the region. Surgical options need to be considered if nonsurgical treatment fails. The metatarsal osteotomies are designed primarily to reduce the weightbearing forces on the metatarsal head by elevating or shortening the metatarsal. Many lesser metatarsal osteotomies have been described, and their success depends on many factors. Regardless of the method employed, it is important to maintain or restore the metatarsal cascade to maintain an even pressure under the lesser metatarsal heads and prevent transfer lesions. The surgeon must understand the effects of the metatarsal osteotomy on the forefoot patho-biomechanics and decide, using a combination of clinical examinations and imaging, whether the desired effect of the osteotomy is to shorten or elevate the metatarsal head or both.