• Journal of Acupuncture Research
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• 제22권3호
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• pp.243-252
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• 2005

목적 : 급성기 족관절 염좌 환자에 있어서 자락발관법이 실제 효과가 있는지 근거 중심 의학(Evidence Based Medicine)적으로 연구된 사례가 드물어서 이를 객관적으로 검증하기 위하여 본 연구를 시행하였다. 방법 : 골절이 배제되고, 명백한 외상력이 있으며, 발병 후 1주일 이내에 내원하였으며 다른 치료를 받지 않은 환자 29명을 대상으로 무작위로 실험군과 대조군으로 나누어 자락발관법 유무의 차이를 두고 시술하였다. 치료시작점과 3회 시술 후 Ankle-Hindfood Scale(AHS)와 Numerical Rating Scale(NRS)을 평가하여 비교 분석하였다. 결과 : 29명중 19명이 최종 평가되었다. 자락발관법을 시행한 실험군(n=11)이 자락발관법을 시행하지 않은 대조군(n=8)에 대해 AHS와 NRS 모두 통계적으로 유의한 차이를 보였다(p=0.041, 0. 026). 결론 : 급성기 족관절 염좌에 있어 자락발관법의 시행은 통증을 비롯한 증상 감소에 객관적인 효과가 있다.

• 대한족부족관절학회지
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• 제7권2호
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• pp.208-217
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• 2003

Introduction: Soft-tissue impingement syndrome is now increasingly recognized as a significant cause of the chronic ankle pain. As a method to detect soft-tissue ankle impingement, a characteristic history and physical examination, routine MR imaging, and direct MR arthrography were used. The efficacy of routine MR imaging has been controversial for usefulness because of low sensitivity and specificity. Direct MR artrhography was recommaned for diagnosis because of the highest sensitivity, specificity and accuracy, but it requires an invasive procedure. The purpose of this study is to investigate the diagnostic accuracy of Fat suppressed, contrast enhanced, three-dimensional fast gradient recalled acquisition in the steady state with rediofrequency spoiling magnetic resonance imaging(CE 3D-FSPGR MRI) and to evaluate the clinical outcome of the arthroscopic treatment in assessing soft-tissue impingement associated with trauma of the ankle. Materials and Methods: We reviewed 38 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies(3D-FSPGR MRI) for post-traumatic chronic ankle pain between January 2000 and August 2002. Among them, 24 patients had osteochondral lesion, lateral instability, loose body, malunion of lateral malleoli, and peroneal tendon dislocation. The patient group consisted of 23 men and 15 women with the average age of 34 years(16-81 years). The mean time interval from the initial trauma to the operation was 15.5 months(3 to 40 months), The mean follow-up duration of the assessment was 15.6months(12-48 months). MRI was simultaneously reviewed by two radiologists blinded to the clinical diagnosis. The sensitivity, specificity and accuracy of MRI was obtained from radiologic and arthroscopic finding. Arthroscopic debridement and additional operation for associated disease were performed. We used a standard protocol to evaluate patients before the operation and at follow-up which includes American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results: For the assessment of the synovitis and soft tissue impingement, fat suppressed CE 3D-FSPGR MR imaging had the sensitivity of 91.9%, the specificity of 84.4 and the accuracy of 87.5%. AOFAS Ankle-Hindfoot Score of preoperative state was 69.2, and the mean score of the last follow-up was 89.1. These were assessed as having 50% excellent(90-100) and 50% good(75-89). The presence of other associated disease didn't show the statistically significant difference(>0.05). Conclusion: Fat suppressed CE 3D-FSPGR MR imaging is useful method comparable to MR arthrography for diagnosis of synovitis or soft-tissue impingement, and arthroscopic debridement results in good clinical outcome.

• 대한족부족관절학회지
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• 제19권1호
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• pp.11-17
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• 2015

Purpose: To report the radiographic and clinical results of 6.5 mm cancellous full threaded buttress screw or Steinmann pin fixation to maintain a reduction of calcaneal posterior facet depression fracture. Materials and Methods: From June 2009 to June 2012, 50 consecutive cases with calcaneal joint depression fracture that underwent open reduction and screw or pin fixation were enrolled in this study. A 6.5 mm cancellous full threaded screw was inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet (group A) or Steinman pin was inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint (group B). Both preoperative and postoperative Bohler and Gissane angles were measured radiographically, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were assessed. Results: The mean age of patients was 44.1 years, and the mean follow-up period was 27.2 months. According to the Sanders classification, 28 cases were type II and 22 cases were type III. In Sanders type II, Bohler and Gissane angles improved significantly from $10.1^{\circ}$ and $126.2^{\circ}$ preoperatively to $27.2^{\circ}$ and $117.1^{\circ}$, respectively, in the immediate postoperative radiograph, and at the final follow-up, $26.6^{\circ}$ and $118.6^{\circ}$, respectively. In Sanders type III, Bohler and Gissane angles improved significantly from $5.0^{\circ}$ and $129.8^{\circ}$ to $29.9^{\circ}$ and $119.3^{\circ}$, respectively, in the immediate postoperative radiograph, and $26.9^{\circ}$ and $120.2^{\circ}$ at the final follow-up. All cases achieved bony union, and the average period until complete union was 13.3 weeks. AOFAS ankle-hindfoot scale was 82.6 in Sanders type II and 77.3 in Sanders type III at the final follow-up. Conclusion: A 6.5 mm cancellous full threaded buttress screw or Steinman pin fixation is a noninvasive treatment method with a merit of being able to maintain the bearing capacity of the posterior facet comparable to plate fixation.

• 대한족부족관절학회지
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• 제23권4호
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• pp.189-195
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• 2019

Purpose: The aim of this study is to evaluate if the Ilizarov external fixation procedure with axial compression can help to obtain fusion across the ankle joint in patients with a high risk of nonunion. Materials and Methods: From January 2006 to December 2015, the study reviewed 17 patients who underwent ankle arthropathy with a high risk of nonunion and who underwent ankle fusion using the Ilizarov external fixator with axial compression and auto bone grafting. After the lateral surface of the ankle joint was exposed through a lateral trans-fibular approach, massive removal of the articular cartilage and excision of any loose or avascular bone were done. With the cortical bone harvested from the pelvis as corticocancellous bone blocks, we inserted the two cortical blocks longitudinally into the anterior and posterior part of the free ankle space from lateral to medial to make the rectangular chamber to fill the cancellous bones. After the Ilizarov external fixator was equipped, we tightened the frame by 5 mm to compress the bone graft space. We accessed the American Orthopaedic Foot and Ankle Society (AOFAS) AnkleHindfoot score both preoperatively and postoperatively. Results: The average age at the time of operation was 63.4 years (range, 47~78 years). The mean frame time was 17.4 weeks (range, 15~23 weeks). The average follow-up period was 3.7 years (range, 2~6 years). Osseous fusion was obtained in 15 patients (88.2%). There were two stable pseudarthroses among the rheumatoid arthritis patients, and we continued their follow-up. The mean AOFAS AnkleHindfoot score improved from 48.5 to 73.7 points. Conclusion: Ankle arthrodesis using the Ilizarov external fixation with axial compression and auto bone grafting on the ankle arthropathy that had difficult conditions to achieve union is considered one of the useful methods with a correspondingly low incidence of complications.

• 대한한방부인과학회지
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• 제29권4호
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• pp.46-56
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• 2016

목 적: 자연분만 후 발생한 비골신경마비 환자에 대한 Muscle Energy Technique (MET)병행 치료가 족하수 증상감소 및 기능 회복에 미치는 영향을 알아보고자 한다. 방 법: 환자들은 침, 뜸, 부항치료와 병행하여 하루 한번, 일주일에 5회 MET 치료를 받았다. MET는 piriform muscle, gluteus medius muscle, anterior tibial muscle, adductor muscles을 중심으로 시행하였으며 총 20회의 MET치료를 받았다. 효과측정에는 Ankle dorsiflexion ROM, Manual Muscle Test, Numerical Rating Scale, Ankle Hindfoot Scale이 사용되었다. 결 과: Case 1의 경우 MET병행치료 후 ROM은 −5에서 20으로 MMT는 0에서 4, NRS는 5에서 1, AHS는 54에서 94로 변화하였다. Case 2의 경우 MET병행치료 후 ROM은 0에서 20으로 MMT는 1에서 5, NRS는 4에서 1, AHS는 64에서 97로 변화하였다. 결 론: 본 연구에서 MET를 분만직후 발생한 비골신경마비로 인한 족하수 환자에게 침 뜸 부항 등 여러 치료와 병행하여 시행하여 증상 및 기능회복에 효과가 있었다. 기존의 연구와 비교하여 MET치료를 적용한 환자들의 치료 결과가 비슷하거나 치료기간을 단축시킨 것으로 미루어, MET는 분만 직후 발생한 비골신경마비 환자들에게 사용가능한 치료법이라 사료된다.

• 대한족부족관절학회지
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• 제22권2호
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• pp.55-61
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• 2018

Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified $Brostr{\ddot{o}}m$ operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

• 대한족부족관절학회지
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• 제10권1호
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• pp.88-91
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• 2006

Purpose: To evaluate the effect on clinical course of heterotopic ossification of distal tibiofibular syndesmosis after ankle fractures. Materials and Methods: From June 2001 to May 2004, we found nine cases of heterotopic ossification of distal tibiofibular syndesmosis after ankle fractures. There were 8 male patients and 1 female patient; their mean age was 42 years old. There were 6 Weber type B and 2 Weber type C fractures, and there is 1 case with posterior malleolus fracture only. Among them, 8 ankle fractures were operated. Follow up period was averaged for 14 months. We were able to review radiographs at initial injury and to review clinical menifestation and radiographs at last follow up. We used an ankle-hindfoot scoring system of AOFAS which combined symptom, function and alignment with maximum score of 100 point. Results: In all cases ankle dorsiflexion and plantarflexion were not significantly different from that of the contralateral side. The patients who had developed heterotopic ossification in distal tibiofibular syndesmosis had a similar functional score. The mean ankle-hind foot score was 94 points. Conclusion: We concluded that the heterotopic ossification of distal tibiafibular syndesmosis after ankle fractures had little effect on clinical course and range of motion of ankle joint.

• 대한족부족관절학회지
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• 제1권1호
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• pp.38-42
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• 1997

It was well known that arthrodesis of the tarsal joint is an exellent procedure to correct the flatfoot deformity for relieving pain. Recently, concept of the selective tarsal joint fusion instead of the triple fusion was developedto preserve the joint motion. To investigate and compare the effect of the each different tarsal fusion, we measured the strain at the spring ligament, medial roof of the medial longitudianl arch. Five fresh frozen cadevar foot specimens, with distal half of the tibia were utilized. The superomedial portion of the spring ligament complex was dissected from the origin to the insertion. For each specimen, a calibrated open liquid metal strain guage was secured along the length of the superomedial portion. Under the specially devised test rig, measurement of the strain was taken at each test condition from the tare weight 18.2 lb followed by 38.2 lb., 82.2 lb and a maximum loads of 134.6 lb. : 1) unfused condition, 2) isolated subtalar fusion 3) isolated talonavicular fusion 4) combined subtalar and talonavicular fusion 5) triple fusion. Statistics showed that siginificant reduction in strain following the triple fusion, and from the subtalar fusion to triple fusion.

• 대한족부족관절학회지
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• 제11권2호
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• pp.123-129
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• 2007

Purpose: The aim of this study was to analyze radiological change of Kager's triangle in patients with retrocalcaneal disorders. Materials and Methods: Areas of Kager's triangle and calcaneus were calculated with Heron's Formula. Average of area ratio (area of Kager's triangle / area of calcaneus) was calculated for comparison and analysis, according to disease activity and aging process. One-tailed Z-test was done with the average of area ratio. Results: Average of area ratio (area of Kager's trianlge / area of calcaneous) tends to decrease according to aging process and disease existence. Conclusion: Because area of Kager's triangle in patients with retrocalcaneal disorders tends to change according to disease activity and aging process, we should consider clinical correlation between the anatomical structure of Kager's triangle and retrocalcaneal symptoms.

• The Journal of Korean Physical Therapy
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• 제19권5호
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• pp.11-19
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• 2007

Purpose: The purpose of this study was to examine effect of trunk control using pelvic movements upon the foot pressure in patients with hemiplegia. Methods: Twelve males with hemiplegia were the procedure executed turnk control using pelvic movements. The foot pressure were measured using Parotec-system. Results: The data were analysed with paired t-test. First, there was a significant increase in external and internal sensors of dynamic foot pressure change of the hindfoot before and after therapy. Also there was significant increase in hallux (p<0.05). Second, there was a significant increase of affected side in support phase(p<0.05) and decreased of affected side in overlapping phase(p<0.05). Third, there was a significant increase in foot floor contact time and impulse pressure rate between affected and non affected side(p<0.05). Conclusion: The trunk control with pelvic movement had an significant effect on the legs by increase activities of hip flexors and abductors. Also had an effect on ankle dorsiflexion and plantar flexor by biomechanical movement.