• 대한족부족관절학회지
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• 제28권2호
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• pp.75-79
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• 2024

Ankle arthrodesis was performed on a 55-year-old male patient with an active lifestyle who developed severe arthritis in the left ankle. Over the follow-up period, high tibial valgization osteotomy was conducted for painful medial knee joint arthritis with genu varum deformity to correct overall lower limb alignment from varus to valgus with respect to the fused ankle. This study was conducted to investigate how hindfoot alignment would change when the overall alignment of the lower limb shifted from varus to valgus with the ipsilateral ankle in a fused state. Conclusively, while no intrinsic changes in the hindfoot alignment were observed following the alteration of lower limb alignment, the hindfoot naturally adjusted to valgus deviation in response to limb valgus realignment. Moreover, symptoms changed in line with this adjustment. Given the absence of similar case studies or reports, a review of relevant literature is included to contribute to knowledge of this subject.

• 한국운동역학회지
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• 제32권1호
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• pp.9-16
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• 2022

Objective: The purpose of this study was to investigate how the chronic ankle instability affects postural control during forward jump landing. Method: 20 women with chronic ankle instability (age: 21.7 ± 1.6 yrs, height: 162.1 ± 3.7 cm, weight: 52.2 ± 5.8 kg) and 20 healthy adult women (age: 21.8 ± 1.6 yrs, height: 161.9 ± 4.4 cm, weight: 52.9 ± 7.2 kg) participated in this study. For the forward jump participants were instructed to stand on two legs at a distance of 40% of their body height from the center of force plate. Participants were jump forward over a 15 cm hurdle to the force plate and land on their non-dominant or affected leg. Kinetic and kinematic data were obtained using 8 motion capture cameras and 1 force plates and joint angle, vertical ground reaction force and center of pressure. All statistical analyses were using SPSS 25.0 program. The differences in variables between the two groups were compared through an independent sample t-test, and the significance level was to p < .05. Results: In the hip and knee joint angle, the CAI group showed a smaller flexion angle than the control group, and the knee joint valgus angle was significantly larger. In the case of ankle joint, the CAI group showed a large inversion angle at all events. In the kinetic variables, the vGRF was significantly greater in the CAI group than control group at IC and mGRF. In COP Y, the CAI group showed a lateral shifted center of pressure. Conclusion: Our results indicated that chronic ankle instability decreases the flexion angle of the hip and knee joint, increases the valgus angle of the knee joint, and increases the inversion angle of the ankle joint during landing. In addition, an increase in the maximum vertical ground reaction force and a lateral shifted center of pressure were observed. This suggests that chronic ankle instability increases the risk of non-contact knee injury as well as the risk of lateral ankle sprain during forward jump landing.

• 한국운동역학회지
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• 제25권2호
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• pp.191-198
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• 2015

Objective : The purpose of this study was to conduct biomechanical analysis of varying backpack loads on the lower limb movements during downhill walking over $-20^{\circ}$ ramp. Method : Thirteen male university students (age: $23.5{\pm}2.1yrs$, height: $175.7{\pm}4.6cm$, weight: $651.9{\pm}55.5N$) who have no musculoskeletal disorder were recruited as the subjects. Each subject walked over $20^{\circ}$ ramp with four different backpack weights (0%, 10%, 20% and 30% of body weight) in random order at a speed of $1.0{\pm}0.1m/s$. Five digital camcorders and two force plates were used to obtain 3-d data and kinetics of the lower extremity. For each trial being analyzed, five critical instants were identified from the video recordings. Ground reaction force, loading rate, decay rate, and resultant joint moment of the ankle and the knee were determined by the inverse dynamics analysis. For each dependent variable, one-way ANOVA with repeated measures was used to determine whether there were significant differences among four different backpack weight conditions (p<.05). When a significant difference was found, post hoc analyses were performed using the contrast procedure. Results : The results of this study showed that the medio-lateral GRFs at RHC in 20% and 30% body weight were significantly greater than the corresponding value in 0% of body weight. A consistent increase in the vertical GRFs as backpack loads increased was observed. The valgus joint movement of the knee at RTO in 30% body weight was significantly greater than the corresponding values in 0% and 10% body weight. The increased valgus moment of 30% body weight observed in this phase was associated with decelerating and stabilizing effects on the knee joint. The results also showed that the extension and valgus joint moments of the knee were systematically affected by the backpack load during downhill walking. Conclusion : Since downhill walking while carrying heavy external loads in a backpack may lead to excessive knee joint moment, damage can occur to the joint structures such as joint capsule and ligaments. Therefore, excessive repetitions of downhill walking should be avoided if the lower extremity is subjected to abnormally high levels of load over an extended period of time.

• The Journal of Korean Physical Therapy
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• 제26권2호
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• pp.117-122
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• 2014

Purpose: The purpose of this study was to compare the effects of force of ipsilateral versus contralateral cane usage on knee moments in healthy young adults. Methods: A convenience sample of 10 subjects volunteered for this study. Subjects walked over a force plate under three different conditions; unaided and ipsilateral cane and contralateral cane. Analysis of data on moment of the knee joint and ground reaction force was performed using the OrthoTrak program. Results: Flexion moment of the knee was decreased with the contralateral cane, but increased with the ipsilateral cane compared with normal gait. Extension moment of the knee was decreased with the contralateral cane compared with normal gait(p<0.05) and it was showed a greater decrease with the contralateral cane than with the ipsilateral cane gait(p=0.00). Valgus moment of the knee joint was increased with the ipsilateral cane but decreased with the contralateral cane. Vertical ground peak force was decreased with the ipsilateral cane compared with normal gait (p<0.05). Conclusion: The following conclusions were drawn from our data. Contralateral cane gait is more efficacious for persons with weakness of knee extensors, however, for a patient with varus deformity, the cane should be used in the ipsilateral hand.

• 한국전문물리치료학회지
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• 제28권4호
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• pp.266-272
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• 2021

Background: Considering the kinetic chain of the lower extremity, a pronated foot position (PFP) can affect malalignment of the lower extremity, such as a dynamic knee valgus (DKV). Although the DKV during several single-leg movement tests has been investigated, no studies have compared the differences in DKV during a single-leg step down (SLSD) between subjects with and without PFP. Objects: The purpose of this study was to compare the DKV during SLSD between subjects with and without PFP. Methods: Twelve subjects with PFP (9 men, 3 women) and 15 subjects without PFP (12 men, 3 women) participated in this study. To calculate the DKV, frontal plane projection angle (FPPA), knee-in distance (KID), and hip-out distance (HOD) during SLSD were analyzed by two-dimensional video analysis software (Kinovea). Results: The FPPA was significantly lower in PFP group, compared with control group (166.4° ± 7.5° and 174.5° ± 5.5°, p < 0.05). Also, the KID was significantly greater in PFP group, compared with control group (12.7 ± 3.9 cm and 7.3 ± 2.4 cm, p < 0.05). However, the HOD not significantly differed between two groups (12.7 ± 1.7 cm and 11.4 ± 2.5 cm, p > 0.05). Conclusion: The PFP is associated with lower FPPA and greater KID. When assess the DKV during SLSD, the PFP should be considered as a crucial factor for occurrence of DKV.

• 대한정형도수물리치료학회지
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• 제12권2호
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• pp.1-10
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• 2006

The purpose are to assess the efficacy of a contact lateral-wedged insole with strapping on the femorotibial angle in patients with varus deformity osteoarthritis of the knee after treatment period. 25 outpatients with knee osteoarthritis (OA) were randomized to be treated with a contact lateral-wedge insole with strapping. Standing radiographs were used to analyze the femorotibial angle for each subject. The result of repeated two-way ANOVA's reveled that a contact lateral-wedged insole with strapping produced significantly differences in the femorotibial angle between groups after treatment period (P<0.05). and repeated one-way ANOVA's reveled that it produced significantly differences in the femorotibial angle between experimental groups after treatment period (P<0.05). We suggest that these results may be beneficial for manufacturing foot orthotic devices, such as wedged insoles, to control medial and later compartment forces in the knee varus-valgus deformity.

• 한국전문물리치료학회지
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• 제11권4호
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• pp.31-41
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• 2004

The purpose of this study was to examine the effect of the angle of a wedged insole on knee varus torque during walking. Fifteen healthy subjects were recruited. Knee varus torque was measured using three-dimensional motion analysis (Elite). Knee varus torque was normalized to gait cycle (0%: initial contact; 100%: ipsilateral initial contact) and stance phase (0%: initial contact; 100%: ipsilateral toe off). The average peaks of knee varus torque during the stance phase of the gait cycle according to the different insole angles (10 or 15 degrees) were compared using one-way ANOVA with repeated measures. The results showed that in the early stance phase, the average peak knee varus torque increased significantly for both the medial 10 and 15 degree wedged insole conditions and decreased significantly for both the lateral 10 and 15 degree wedged insole conditions as compared with no insole (p<.05). However, there were no significant differences between the 10 and 15 degree wedged insole conditions with either the medial or lateral wedged insole (p>.05). In the late stance phase, the average peak knee varus torque increased significantly for the medial 10 and 15 degree wedged insole conditions (p<.05), but not for the lateral 10 and 15 degree wedged insole conditions as compared with no insole (p>.05). We suggest that these results may be beneficial for manufacturing foot orthotic devices, such as wedged insoles, to control medial and lateral compartment forces in the knee varus-valgus deformity. Further studies of the effects of wedged insole angle on knee varus torque in patients with medial-lateral knee osteoarthritis are needed.

• 대한족부족관절학회지
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• 제20권4호
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• pp.145-151
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• 2016

Purpose: To evaluate the reliability of preoperative and postoperative distal metatarsal articular angle (DMAA) measurements and to determine whether such reliability is different in accordance with the foot and ankle fellowship and the number of years in practice. Materials and Methods: Between July 2012 and June 2014, a total of 20 patients (24 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic hallux valgus deformity. DMAA were measured twice with an interval of two weeks between the preoperative and postoperative dorsoplantar radiographs by four observers; two of whom were foot and ankle surgeons (A and B), one knee surgeon, and one senior resident. The intraobserver reproducibility and interobserver reliability were assessed by intraclass correlation coefficients. Moreover, the limit of agreement between the preoperative and postoperative DMAA measurements were assessed using a Bland-Altman plot. Results: The intraobserver reproducibility of the foot and ankle surgeon A, knee surgeon, and senior resident improved from 0.796, 0.575, and 0.586 preoperatively to 0.968, 0.864, and 0.864 postoperatively, respectively. The interobserver reliability of foot and ankle surgeon A-B, foot and ankle surgeon A-knee surgeon, and foot and ankle surgeon A-senior resident improved from 0.874, 0.688, and 0.677 preoperatively to 0.971, 0.917, and 0.838 postoperatively, respectively. Conclusion: The intra- and interobserver reliabilities for DMAA measurement improved after proximal chevron osteotomy. Therefore, the necessity of additional procedures to correct the increased DMAA should be reevaluated after proximal chevron osteotomy in the hallux valgus with an increased DMAA.

• 한국운동역학회지
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• 제24권2호
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• pp.121-129
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• 2014

The purpose of this study was to investigate the effect of the toe headings on the biomechanics of knee joint in drop landing in an attempt to find the potential risk of non-contact anterior cruciate ligament (ACL) injury. Seventeen male college students ($20.5{\pm}1.1$ yrs; $175.2{\pm}6.4$ cm; $68.8{\pm}5.8$ kg), having no neuromuscular injury within an year, participated in this study. Three different toe headings such as toe-in (TI), neutral (N), and toe-out (TO) positions were tested. Motion capturing system consisting of eight high speed cameras and two force platforms were used to collect three-dimensional motion data and ground reaction force data during landing. Results indicated joint angles and peak joint moments were significantly affected by the toe headings. TI position produced larger valgus angle due to reduce knee distance in addition to higher flexion and valgus moment than other positions, which was somewhat vulnerable to the potential risk of non-contact ACL injury. TO position caused the largest internal rotation angle with smaller joint moments. Therefore, it is recommended that athletes need to land on the ground with neutral toe-heading position as possible in order to minimize the potential risk of non-contact ACL injury.

• 한국전문물리치료학회지
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• 제29권3호
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• pp.208-214
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• 2022

Background: Pronated foot posture (PFP) contributes to excessive dynamic knee valgus (DKV). Although foot orthoses such as medial arch support (MAS) are widely and easily used in clinical practice and sports, few studies have investigated the effect of MAS on the improvement of DKV during stair descent in individuals with a PFP. Moreover, no studies reported the degree of improvement in DKV according to the severity of PFP when MAS was applied. Objects: This study aimed to examine the immediate effect of MAS on DKV during stair descent and determine the correlation between navicular drop distance and changes in DKV when MAS is applied. Methods: Twenty individuals with a PFP (15 males and five females) participated in this study. The navicular drop test was used to measure PFP severity. The frontal plane projection angle (FPPA) was calculated under two conditions, with and without MAS application, using 2-dimensional video analysis. Results: During stair descent, the FPPA with MAS (173.1° ± 4.7°) was significantly greater than that without MAS (164.8° ± 5.8°) (p < 0.05). There was also a significant correlation between the navicular drop distance and improvement in the FPPA when MAS was applied (r = 0.453, p = 0.045). Conclusion: MAS application can affect the decrease in DKV during stair descent. In addition, MAS application should be considered to improve the knee alignment for individuals with greater navicular drop distance.