• The Journal of Korean Physical Therapy
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• v.35 no.1
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• pp.24-30
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• 2023

Purpose: The purpose of this study was to investigate the effectiveness of the elastic compression stockings and Kinesio taping on muscle activity and mechanical properties in healthy women during the heel raise exercise that causes muscle fatigue. Methods: Participants were divided into the elastic compression stockings group (ESG, n=8), Kinesio taping group (KTG, n=8), and control group (CG, n=8). All participants performed the heel raise exercise to cause muscle fatigue. Muscle activity, stiffness, and the muscle tone of the gastrocnemius and tibialis anterior were measured before and after the heel raise exercise. Results: In the gastrocnemius, muscle activity was significantly increased after the heel raise exercise in both the ESG and KTG (p<0.05). There was a significant difference in the change in the gastrocnemius muscle activity between the groups (p<0.05). Post hoc analysis showed that the ESG exhibited a significantly greater change in gastrocnemius muscle activity than the CG (p<0.05). The muscle stiffness of the gastrocnemius was significantly decreased after the heel raise exercise in the ESG (p<0.05). The muscle tone of the gastrocnemius was significantly increased after the heel raise exercise in the control group (p<0.05). There were no significant differences in the change in the gastrocnemius stiffness and muscle tone between the groups (p>0.05). In the tibialis anterior, there were no significant differences in muscle activity, stiffness, and muscle tone between and within the groups (p>0.05). Conclusion: Our findings suggest that the use of elastic compression stockings and Kinesio taping during the heel raise exercise are beneficial and delay muscle fatigue in the gastrocnemius.

• The Journal of Korean Physical Therapy
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• v.33 no.1
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• pp.28-33
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• 2021

Purpose: This study examined the effects of heel raise exercises combined with neuromuscular electrical stimulation (NMES) on the muscle strength and postural control ability of subjects with functional ankle instability (FAI). Methods: Twenty-two subjects with FAI participated in this study. They were assigned randomly to two groups: 11 each in the NMES and the sham-NMES groups. Heel raise exercise was applied, and NMES electrodes were attached to the peroneus longus muscles. The NMES group applied NMES during the heel raise exercise. NMES was applied for 20 minutes during the heel raise exercise. The heel raise exercise was performed four times a week for five weeks. The muscle strength and balance error scoring system (BESS) were measured before and after the intervention. Results: A comparison of before and after the intervention within the groups revealed improved muscle strength in the NMES and Sham-NMES groups, but the BESS was improved under all conditions only in the NMES group. The Sham-NMES group showed no improvement in the unstable support surface. Furthermore, when comparing the amount of change before and after the intervention between the groups, there were significant differences in the total score and unstable support in the BESS and muscle strength. Conclusion: NMES had a positive effect on the functional activities of the functional ankle instability subjects, such as balancing on an unstable support surface during postural control and increasing muscle strength.

• PNF and Movement
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• v.21 no.2
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• pp.213-222
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• 2023

Purpose: The purpose of this study was to investigate the effects of heel-raise-lower with Kinesio Taping (HKT) on spasticity and balance ability in patients with chronic strokes. Methods: The participants were divided randomly into the HKT group and heel-raise-lower with sham (control group), with 38 participants assigned to each group. Both groups received heel-raise-lower lifting 100 times, 5 times/week for 4 weeks. The HKT group applied Kinesio Taping to the calf muscles. The control group applied Kinesio Taping transversely to the ankle joint and tibialis anterior muscle. The composite spasticity score was used to evaluate the ankle plantar flexors. The center of pressure with the eyes open and closed and limited stability was measured using BioRescue equipment. Both groups evaluated spasticity and balance ability before the experiment and after 4 weeks. Statistical methods before and after working around spasticity and balance ability were independent t-tests. Results: After training, spasticity showed significant improvement in the HKT group and in the control group (p < 0.05). Similarly, balance ability was significantly more improved in the HKT group after 4 weeks of training compared to the control group (p < 0.05). Conclusion: We confirmed the effects of heel-raise-lower with Kinesio Taping (HKT) on spasticity and balance ability in patients with chronic strokes.

• The Journal of Korean Physical Therapy
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• v.36 no.4
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• pp.131-138
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• 2024

Purpose: Muscle weakness of the lower extremity is one of the causes of chronic ankle instability, and the heel raise exercise has been proposed as a means of increasing ankle stability. This study sought to investigate the most effective weight-bearing posture for adults with chronic ankle instability during the heel raise exercise. Methods: Thirteen patients with chronic ankle instability participated in this study. Each subject performed the heel raise exercise in three postures: neutral weight-bearing posture, medial weight-bearing posture, and lateral weight-bearing posture. The participants performed 10 heel raises per posture. This routine was carried out for 3 days except on the first day for the measurement of % maximum voluntary isometric contraction (MVIC). The Cumberland Ankle Instability Tool (CAIT) was used for the data analysis. Results: The muscle activity assessed according to the weight-bearing posture was significant in the tibialis anterior, the peroneus longus, and the medial gastrocnemius, but not in the lateral gastrocnemius. In addition, there was a significant difference in the activity of all four muscles when compared in the lateral and neutral weight-bearing posture. However, in the comparison of neutral and medial weight-bearing posture, there was no significant difference in activity among the four muscles. Conclusion: For patients with chronic ankle instability, the heel raise exercise in the lateral weight-bearing posture increases the risk of ankle injury by inducing inversion and is ineffective in improving muscle strength. Therefore, we suggest using the neutral and medial weight-bearing postures during the heel raise exercise for the highest improvement in effective muscle strength.

• Physical Therapy Rehabilitation Science
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• v.11 no.2
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• pp.113-118
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• 2022

Objective: This study was conducted to investigate the effect of heel-raise-lower exercise on spasticity, strength, and gait speed after the application of tapingin patients with stroke. Design: Randomized controlled study Methods: The participants were randomly divided into the heel raise-lower exercise+taping (HREx+T) group and the heel raise-lower exercise (HREx) group, with 20 participants assigned to each group. Both groups performed heel lifting exercise 100 times a day 5 times a week for 6 weeks. HREx+T group additionally applied taping to the plantar flexor muscles. The spasticity of the ankle plantar flexors was measured using the composite spasticity score. A handheld dynamometer and a 10-m walk test were used to measure plantar flexor strength and gait speed, respectively. Results: Spasticity was significantly more improved in the HREx+T group than in the HREx group (p<0.05). Similarly, plantar flexor strength was significantly more improved in the HREx+T group than in the HREx group (p<0.05). Moreover, participants assigned to the HREx+T group showed significantly greater improvement in gait speed than those in the HREx group(p<0.05). Conclusions: Thus, heel-raise-lower training combined with taping may be used to improve the spasticity, muscle strength and gait speed in stroke patients.

• 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.

• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.21-25
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• 2018

Purpose: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. Materials and Methods: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. Results: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and fortyfive patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p<0.001). Conclusion: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.

• Korean Journal of Applied Biomechanics
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• v.24 no.2
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• pp.111-119
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• 2014

The purpose of this study was to investigate the effects of localized muscle fatigue and whole body fatigue on postural control during single-leg stance after impairment induced by heel raise and the Harvard step test. Thirty-eight university students (19 men: age, $20.1{\pm}0.2$ yrs; height, $175.0{\pm}5.23cm$; weight, $66.8{\pm}5.6kg$; body mass index, $21.8{\pm}1.7kg/m^2$, 19 women: age, $20.6{\pm}1.1yrs$ ; height, $163.6{\pm}6.7cm$; weight, $58.8{\pm}4.6kg$; body mass index, $22.0{\pm}2.2kg/m^2$) were participated in this study. Subjects performed a series of single-leg postural tasks prior to, following, and 24 hours after completing: heel raise or the Harvard step test. This study showed that the root mean squared distance and velocity in the anteroposterior and mediolateral planes of the center of pressure decreased significantly due to heel raise exercise-induced fatigue. Furthermore, the root mean squared distance in the anteroposterior and mediolateral planes, and the 95% confidence ellipse area of the center of pressure also decreased significantly 24 hours after completing the Harvard step test. In conclusion, this study showed that both heel raise exercise- and Harvard step exercise-induced fatigue affects postural control during single-leg stance in AP and ML planes. Furthermore, this study suggests that changes in the postural control strategy may have occurred after the fatigue protocols during single-leg stance. Also vision can attenuate the postural deficits associated with the fatigues. In order to clarify these results, further studies using other equipment and variables are necessary.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.23-27
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• 2009

Purpose: The purpose of this study was to evaluate the clinical outcome of neglected Achilles tendon rupture treated with reconstruction and augmentation with flexor hallucis longus (FHL) tendon using one incision technique. Materials and Methods: Between July 2006 and March 2008, eleven patients with neglected Achilles tendon rupture received surgical treatment. Through one incision technique, augmentation with auto FHL tendon transfer was performed using a Bio-Interference screw (Arthrex, Naples, FL) and followed by V-Y advancement (5 cases) or gastronemius fascial turn-down flap procedure (6 cases). After mean follow up of 20.7 months (range, 11.8-33.3 weeks), clinical outcomes were evaluated with Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, 10 repetitive double heel raise test, 10 repetitive single heel raise test and subjective satisfaction. Results: The length of the gap after debridement was $5.4{\pm}2.0$ cm. The VAS improved from $4.1{\pm}0.9$ to $1.5{\pm}0.8$ at last follow up (p<0.05). The AOFAS score increased from $38.9{\pm}12.2$ to $91.5{\pm}8.9$ at last follow up (p<0.05). Eight patients were satisfied with excellent results and three were satisfied with good results. All patients were able to perform 10 repetitive double heel raise and nine out of eleven patients were able to perform 10 repetitive single heel raise at last follow up. There were no complications including deep infection or re-rupture. Conclusion: Augmentation with FHL tendon transfer and reconstruction with V-Y advancement or turn-down flap through one incision technique appeared to be effective and safe. This technique is recommendable for the treatment of neglected Achilles tendon rupture.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.4
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• pp.497-503
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• 2013

PURPOSE: The purpose of this study was to investigate the change of triceps surae activation during heel raise test in standing among knee flexion angles($0^{\circ}C$, $30^{\circ}C$, $45^{\circ}C$, $60^{\circ}C$). METHODS: Twenty healthy individuals performed unilateral plantarflexion in standing with $0^{\circ}C$, $30^{\circ}C$, $45^{\circ}C$, $60^{\circ}C$ knee flexion. Activity of medial gastrocnemius(MG), lateral gastrocnemius(LG), soleus(Sol) was recorded with surface electromyography(EMG). RESULT: The muscle activations induced the four different positions were compared and results showed that was significant difference MG and LG while the angle increase from $0^{\circ}C$ to $30^{\circ}C$, $45^{\circ}C$, $60^{\circ}C$ but Sol did not show significant differences in every angle. CONCLUSION: This study suggest that $30^{\circ}C$ knee flexion is required to induce a significant mechanical disadvantage of gastrocnemius.