• Archives of Plastic Surgery
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• v.37 no.2
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• pp.129-136
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• 2010

Purpose: Anatomically, the foot is provided with insufficient blood supply and is relatively vulnerable to venous congestion compared to other parts of the body. Soft tissue defects are more difficult to manage and palliative treatments can cause hyperkeratosis or ulcer formation, which subsequently requires repeated surgeries. For weight bearing area such as the heel, not only is it important to provide wound coverage but also to restore the protective senses. In these cases, application of flaps for hind foot reconstruction is widely recognized as an effective treatment. In this study, we report the cases of soft tissue reconstruction for which various types of flaps were used to produce good results in both functional and cosmetic aspects. Methods: Data from 37 cases of hind foot operation utilizing flaps performed between from June 2000 to June 2008 were analyzed. Results: Burn related factors were the most common cause of defects, accounting for 19 cases. In addition, chronic ulceration was responsible for 8 cases and so forth. Types of flaps used for the operations, listed in descending order are radial forearm free flap (18), medial plantar island flap (6), rotation flap (5), sural island flap (3), anterolateral thigh free flap (2), lattisimus dorsi muscular flap (2), and contra lateral medial plantar free flap (1). 37 cases were successful, but 8 cases required skin graft due to partial necrosis in small areas. Conclusion : Hind foot reconstruction surgeries that utilize flaps are advantageous in protecting the internal structure, restoring functions, and achieving proper contour aesthetically. Generally, medial plantar skin is preferred because of the anatomical characteristics of the foot (e.g. fibrous septa, soft tissue for cushion). However alternative methods must be applied for defects larger than medial plantar skin and cases in which injuries exist in the flap donor / recipient site (scars in the vicinity of the wound, combined vascular injury). We used various types of flaps including radial forearm neurosensory free flap in order to reconstruct hind foot defects, and report good results in both functional and cosmetic aspects.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.201-206
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• 2011

Purpose: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. Materials and Methods: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. Results: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). Conclusion: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

• Journal of radiological science and technology
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• v.42 no.3
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• pp.167-173
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• 2019

The Cobey method and the modified Cobey method are most commonly used in clinical practice. Therefore, the purpose of this study was to investigate the radiological differences between Cobey and modified Cobey and provide radiographic information about changes of hindfoot image with X-ray entrance center and tube angle change in modified Cobey. This study was performed on foot and ankle phantom. First, for image comparison of Cobey and modified Cobey, the images obtained by applying the same X-ray entrance center to the ankle joint were compared and analyzed. Second, in the modified Cobey, the X-ray entrance center is set as ankle joint and lateral malleolus. The X-ray tube angle was varied from $10^{\circ}$ to $40^{\circ}$ at $5^{\circ}$ intervals for each X-ray entrance center. The images obtained by varying the X-ray tube angle from $10^{\circ}$ to $40^{\circ}$ at intervals of $5^{\circ}$ for each X-ray entrance center were compared and analyzed. The irradiation conditions were the same with 110 kVp, 200 mA, 10 ms, and 110 cm of source - image receptor distance (SID). Image evaluation was performed by two radiologists. Measurements were made on the lateral point, middle point, and calcaneus width based on a hypothetical line parallel to the calcaneal tuberosity. Data were analyzed by using descriptive statistics as the mean of the distance to each measurement location. The modified Cobey was longer than the Cobey by an average of 3 to 4 mm lateral and medial points, and the calcaneus width was similar (ICC = 0.939). In modified Cobey method, when the X-ray entrance center is ankle joint, the lateral point is about 3 mm and the medial point is about 4.3 mm longer than lateral malleolus. Also, when the X-ray tube angle is more than $20^{\circ}$, the degree of distortion is large. The ICCs for the lateral, medial point, and calcaneus width were 0.998, 0.961, and 0.997, respectively, as the X-ray entrance center and tube angle were changed. There was no significant difference between Modified Cobey and Cobey. Modified Cobey showed no need to compensate the $20^{\circ}$ detector angle of the Cobey. In addition, we suggest that tube angle should be limited within $20^{\circ}$ when modified Cobey is performed.

• Journal of Korean Foot and Ankle Society
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• v.26 no.3
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• pp.130-135
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• 2022

Purpose: Smart insoles are wearable devices that are inserted into shoes. Smart insoles with built-in pressure and acceleration sensors can measure the plantar pressure, stride length, and walking speed. This study evaluated the validity and reliability of the plantar pressure measurements of smart insoles during walking on flat ground. Materials and Methods: Twenty one subjects were included in this study. After wearing smart insoles, I-SOL^® (Gilon, Seongnam, Korea), the subjects walked a 10 m corridor six times at a rate of 100 steps/min, and the middle three steps, free from direction changes, were chosen for data analysis. The same protocol was repeated after wearing Pedar-X (Novel Corporation, Munich, Germany), an insoletype plantar pressure measurement equipment with proven validity. The average maximum pressure (P_peak, kPa) and the time at which P_peak appeared (P_time, %stride) were calculated for each device. The validity of smart insoles was evaluated by using the interclass correlation coefficient (ICC) of P_peak and P_time between the two instruments, and Cronbach's alpha was obtained from the P_peak values to evaluate the reliability. Results: The ICC of P_peak was 0.651 (good) in the hallux, 0.744 (good) in the medial forefoot, 0.839 (excellent) in the lateral forefoot, and 0.854 (excellent) in the hindfoot. The ICC of P_time showed 0.868 (excellent) in the hallux, 0.892 (excellent) in the medial forefoot, 0.721 (good) in the lateral forefoot, and 0.832 (excellent) in the hindfoot. All ICC values showed good or excellent results. The Cronbach's alpha of P_peak measured in the smart insoles was 0.990 in the hallux, 0.961 in the medial forefoot, 0.973 in the lateral forefoot, and 0.995 in the hindfoot; all indicated excellent reliability in all areas. Conclusion: The plantar pressure measurements of smart insoles during walking on a flat ground showed validity compared to Pedar-X, and high reliability after repeated measurements.

• Archives of Plastic Surgery
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• v.42 no.6
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• pp.810-813
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• 2015

• Journal of Korean Medicine Rehabilitation
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• v.20 no.1
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• pp.141-152
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• 2010

Objectives : The purpose of this study is to compare with the effect of acupuncture treatment with or without indirect moxibustion treatment for acute ankle sprain. Methods : This study was carried out on the 48 patients who had been treated for acute ankle sprain from June 1st to November 30th 2009 in the Dept. of Oriental Rehabilitation, Pohang Oriental Medical Hospital, Daegu Hanny University. The patients were divided into 3 groups ; Group A took near acupuncture point_needling, Group B took remote acupuncture point needling, Group C took remote acupuncture point needling with indirect moxibustion. 3 Groups had been co-treated with rest, ice, compression and elevation(RICE) therapy, physical treatment and administered Ojeok-san(Wuji-san) extract granule. To evaluating the efficiency of each treatment, Ankle-Hindfoot Scale(AHS) and Visual Analogue Scale(VAS) were applied before treatment and after 3rd treatment. Results : In results, the AHS scores were increased and the VAS scores were decreased after 3rd treatment in all group. Also, AHS scores and the VAS scores of intergroup were showed no significant change. Conclusions : In this study, there is no significant effect between only acupuncture treatment and moxibustion co-treatment for acute ankle sprain.

• Journal of The Korean Society of Integrative Medicine
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• v.5 no.4
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• pp.1-9
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• 2017

Purpose : This study was conducted among 195 adults in their 20s. To analyze the impact of the slope types of the scapulae on the plantar surface of the foot, the average pressure (AP), the maximum pressure (MP), the average of local distribution values, and the average movement of the center of pressure (COP) of the different slope types of the scapulae were compared. Method : The anterior-posterior slopes of the scapulae were measured by comparing the slopes of the left and right sides of the scapulae based on the differences in the height and the slope of the coracoid process and the angulus inferior scapulae. Those whose left side of the scapulae had an anterior slope were categorized as type 1, and those whose right side of the scapulae had an anterior slope, as type 2. The average plantar pressure, the center of plantar pressure, the maximum plantar pressure, and local distribution values were analyzed using a plantar pressure analyzer of the FSA. Result : In terms of the AP of the left and right feet, there was no statistically significant difference both in types 1 and 2 on the left and right feet. The comparison results of the MP and the average of local distribution values of the two slope types of the scapulae showed that there was no statistically significant difference on the X-axis both in types 1 and 2 on the left and right feet, but that there was a large statistically significant difference on the Y-axis both in types 1 and 2. That is, the MP of the right foot of the left anterior slope type was located more on the hindfoot than that of the right anterior slope type, and the MP of the left foot of the left anterior slope type was located more on the hindfoot than that of right anterior slope type. Conclusion : This study can be used as fundamental data to predict differences in the location and size of the COP and changes in plantar pressure distribution depending on the slope types of the scapulae, and control the distribution for therapeutic purposes.

• Journal of Acupuncture Research
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• v.34 no.3
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• pp.139-152
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• 2017

Objectives : This study reports the clinical effects of miniscalpel needle therapy in patients with carpal tunnel or tarsal tunnel syndrome. Methods : Three patients with carpal tunnel syndrome (CTS) or tarsal tunnel syndrome (TTS) (first case, patient with CTS and TTS; second case, patient with CTS; and third case, patient with TTS) were treated with miniscalpel needle (MSN) therapy and integrative Korean medical treatment. The Numeric Rating Scale (NRS), Neuropathic Pain Scale (NPS), Boston scale score, and AOFAS (American Orthopaedic Foot and Ankle Society) ankle-hindfoot score were measured. Results : In general, outcome measures after treatment showed improvement in all cases. In the first case (CTS and TTS), scores on the NRS, NPS, and Boston scale decreased, and AOFAS ankle-hind foot scores increased. In addition, Tinel's sign showed improvement. In the second case (CTS), scores on the NRS, NPS, and Boston scale, and Tinel's sign, were decreased. In the third case (TTS), scores on the NRS and NPS, and Tinel's sign, showed improvement, and AOFAS ankle-hind foot scores were increased. Conclusion : These results suggest that MSN therapy has a meaningful clinical effect in CTS and TTS.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.187-191
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• 2007

Purpose: The authors intended to analyze the operative results of tarsal tunnel syndrome. Materials and Methods: Twenty-one patients with tarsal tunnel syndrome were followed for more than 1 year after operation. The mean age was 44 years, and the mean follow up period was 2 years and 9 months. Clinically preoperative and postoperative AOFAS ankle-hindfoot score and visual analogue scale for pain were analyzed. Radiologically the cause of disease was investigated, and the size of mass was measured, if possible. The duration of symptom, the presence of space occupying lesion (SOL), the effect of epineurolysis were statistically analyzed to see the relation with the operative results. Results: Operative release of tarsal tunnel was done in all cases, and epineurolysis was done in 11 cases. The causes of the disease were 10 soft tissue masses, 7 talocalcaneal coalitions, 1 nonunion of medial talar process fracture, and 1 pes planovalgus, and 3 idiopathic cases. The masses were subdivided into 7 ganglions, 2 neurilemmomas, and 1 lipoma. There was 1 case of combined talocalcaneal coalition and ganglion. Clinically AOFAS ankle-hindfoot score was increased from 62.7 points preoperatively to 84.3 points postoperatively. Visual analogue scale was improved from 6.5 preoperatively to 2.2 postoperatively. Two cases were graded as unsatisfactory. One was severe pes planovalgus, and the other was idiopathic case. The duration of symptom and the epineurolysis were not related with the results. However the presence of space occupying lesion was significantly related with the good results. Conclusion: Early operative release of tarsal tunnel appears to be important for the improvement of symptom. However the prognosis is limited in case that there is no SOL.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.15-21
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• 1999

Soft tissue defect on heel area of the foot present difficult problems particularly because of anatomic property of plantar surface of the foot. There is a paucity of available local tissue in the foot for coverage. In addition to having little expandable tissue, the foot's plantar surface has a unique structure, making its replacement especially challenging. Plantar skin is attached to the underlying bone by fibrous septa, preventing shear of the soft-tissue surfaces from the underlying skeleton. Plantar surface of foot is in constant contact with the environment. Protective sensibility also would be maintained or restored in the ideal reconstruction. So the ideal flap for reconstruction of the heel should include thin, durable hairless skin with potential for reinnervation. The aim of this article is to present a clinical experience of free lateral arm neurosensory flap for reconstruction of the heel. From March 1995 to December 1997, a total 16 lateral arm free flaps were performed to soft tissue defects on the weight-bearing area of the hindfoot. we used tibial nerve as recepient nerve in 11 and calcaneal branch of tibial nerve in 5 for restoration of sensibility of flap. All cases survived completely. A static two-point discrimination of 14 to 34mm was detected in the flap. Radial nerve palsy which was caused by hematoma in donor site occured in one case, but recorverd in 3 weeks later completely. In conclusion, the lateral arm free flaps are versatile, reliable and sensible cutaneous flap and especially indicated for soft tissue defect on plantar surface of the hindfoot which are not good indications for other better-known flaps.