• Korean Journal of Applied Biomechanics
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• v.31 no.3
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• pp.205-213
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• 2021

Objective: The aim of this study was to analyze body stability Joint coordination pattern though as bending stiffness of shoes during stance phase of running. Method: 47 male subjects (Age: 26.33 ± 2.11 years, Height: 177.32 ± 4.31 cm, Weight: 65.8 ± 3.87 kg) participated in this study. All subjects tested wearing the same type of running shoes by classifying bending stiffness (A shoes: 3.2~4.1 N, B shoes: 9.25~10.53 N, C shoes: 20.22~21.59 N). They ran 10 m at 3.3 m/s (SD ±3%) speed, and the speed was monitored by installing a speedometer at 3 m intervals between force plate, and the measured data were analyzed five times. During running, ankle joint, MTP joint, coupling angle, inclination angle (anterior-posterior, medial-lateral) was collected and analyzed. Vector coding methods were used to calculate vector angle of 2 joint couples during running: MTP-Ankle joint frontal plane. All analyses were performed with SPSS 21.0 and for repeated measured ANOVA and Post-hoc was Bonferroni. Results: Results indicated that there was an interaction between three shoes and phases for MTP (Metatarsalphalangeal) joint angle (p = .045), the phases in the three shoes showed difference with heel strike~impact peak (p1) (p = .000), impact peak~active peak (p2) (p = .002), from active peak to half the distance to take-off until take-off (p4) (p = .032) except for active peak~from active peak to half the distance to take-off (p3) (p = .155). ML IA (medial-lateral inclination angle) for C shoes was increased than other shoes. The coupling angle of ankle angle and MTP joint showed that there was significantly difference of p2 (p = .005), p4 (p = .045), and the characteristics of C shoes were that single-joint pattern (ankle-phase, MTP-phase) was shown in each phase. Conclusion: In conclusion, by wearing high bending stiffness shoes, their body instability was increased during running.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.115-118
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• 2010

Purpose: To evaluate clinical features of ankle lesions, associated with anterior soft tissue impingement. Materials and Methods: We retrospectively reviewed 21 patients who had chronic anterior ankle pain as initial symptom and associated ankle lesions with anterior soft tissue impingement. Based on preoperative radiologic findings, physical examination intra-operative findings, appropriate procedures were done for lesions by either arthroscopic or minimal open procedure or combined. Clinical evaluation was done using American Orthopedic Foot and Ankle Society, ankle-hind foot score (AOFAS score) and visual analog scale (VAS) on last follow up. Results: Associated lesion(s) to anterior soft tissue impingement of the ankle were 16 cases of osteochondral lesion of talus, 14 cases of bony impingement, 6 cases of ankle lateral instability, 5 cases of loose body, 4 cases of os subfibulare. AOFAS score was $58.9\;{\pm}\;5.1$ preoperatively and $74\;{\pm}\;9.1$ on last follow up. Clinical satisfaction score using VAS showed excellent in 3 cases, good in 11, fair in 3, poor in 4. Conclusion: The patients who had anterior soft tissue impingement would have various associated lesions on their ankle. In such cases, preoperative counseling for variety of postoperative results would be needed.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.36-40
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• 2008

Purpose: The purpose of this study is to find out the normal results in ankle on varus stress, valgus stress, and anterior draw stress in young men in korea. This would be helpful as the basic data of measuring of ankle instability for operational indication. Materials and Methods: Varus and Valgus stress anteroposterior radiographs and Anterior drawing stress lateral radiographs of 600 normal ankles were reviewed. First, A line parallel was drawn parallel to the articular surface of the distal tibia, and another line was drawn parallel to the articular surface of the talus on anteroposterior radiographs. The interior angle that subtended by these two lines was measured. Second, the reference point is located at the posterior border of the tibia, and the shortest distance from this point to the proximal posterior articular surface of the talus is measured. Results: There were 300 males and 600 ankles. The mean age overall was 21 years (19-22 years) old. The mean length of ankle on anterior draw stress was $5.54{\pm}3.33\;mm$. The mean a interior angle of ankle on varus stress was $0^{\circ}-8.93^{\circ}$, and on valgus stress $0^{\circ}-7.78^{\circ}$. Conclusion: We can consider for operational indication at over the 8.87 mm on anterior draw stress, over the $8.93^{\circ}$ on varus stress, and over the $7.78^{\circ}$ on valgus.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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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.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.193-196
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• 2009

The first metatarsophalangeal joint injury is common in professional soldiers and athletes. But this was rarely reported. A professional soldier has varus instability in the first metatarsophalangeal joint due to hyperextension. In the MR Imaging, weavy appearance in lateral collateral ligament and high signal change in plantar plate was shown. So he has surgical treatment using reconstructive procedure. At first, $4^{th}$ extensor digitorum longus tendon was splitted longitudinally and harvested, second triangular shape reconstruction on lateral joint line was done using harvested tendon. One year later, fifteen degrees was limited compared with intact side. Reconstruction using $4^{th}$ extensor digitorum longus tendon in traumatic dynamic hallux varus was good method.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.201-207
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• 2019

An osteochondral fracture is considered to be an injury involving the cartilage and subchondral bone. Acute traumatic osteochondral fractures can be related to joint instability because abnormal joint motion causes shearing and rotatory stress. Acute osteochondral fractures are frequently missed or misdiagnosed as a pure soft tissue injury. Thus, surgeons' proactive attention is highly required as articular cartilage has limited potential for self-repair and these lesions may develop osteoarthritis. In order to minimize the progression of post-traumatic osteoarthritis, it is important to properly identify and treat osteochondral fractures. Yet, little is known about the operative management of acute osteochondral fractures of the talus. We report here on a case of a middle-aged male with acute osteochondral fractures of the bilateral lateral talar dome. We applied different operative methods on each side with regard to fragment size and stability. A favorable clinical outcome was obtained at 18 months follow-up.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.69-77
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• 2011

Purpose: This study was retrospectively performed to compare the clinical outcomes of modified Brostrom procedures using the single suture anchor and the double suture anchor for chronic lateral ankle instability. Materials and Methods: Thirty-seven patients were followed up for more than 1 year after the modified Brostrom procedures using suture anchor. Single surgeon treated seventeen cases with single suture anchor and 20 cases with double suture anchor. The clinical evaluation was performed according to the Karlsson scale and Sefton grading system. Radiologic measurement of the talar tilt and anterior talar translation was performed through anterior and varus stress radiographs using Telos device. Results: The Karlsson scale had improved significantly from preoperative average of 45.2 points to 89.4 points in single suture anchor group, and from 46.4 points to 90.5 points in double suture anchor group. According to the Sefton grading system, 15 cases (88.2%) in single suture anchor group and 18 cases (90%) in double suture anchor group achieved satisfactory results. The talar tilt angle and anterior talar translation had improved significantly from preoperative average of $13.6^{\circ}$ and 8.6 mm to $5.4^{\circ}$ and 4.1 mm in single suture anchor group, from $14.1^{\circ}$ and 8.4mm to $3.9^{\circ}$ and 4 mm in double suture anchor group. Double suture anchor technique was significantly superior in postoperative talar tilt. Conclusion: Single and double suture anchor techniques produced similar clinical and functional outcomes except for talar tilt, which was significantly superior in double suture anchor group. Both modified Brostrom procedures using the single and double suture anchor appear to be effective treatment methods for chronic lateral ankle instability. Further evaluation of clinical outcomes and biomechanical studies in athletes are needed.

• Korean Journal of Applied Biomechanics
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• v.31 no.1
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• pp.1-15
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• 2021

Objective: The aim of this study was to investigate 1) the difference in static lower extremity alignment (SLEA) according to a history of lateral ankle sprain (LAS), 2) to identify SLEA factors affecting LAS, and 3) to present the cut-off value and 4) the usefulness and limitations of the SLEA measurement. Method: This case-control study recruited 88 men (age: 27.78±4.69 yrs) and 39 women (age: 24.62±4.20 yrs) subjects with and without LAS. SLEA measurement protocol included Q angle, tibiofemoral angle, genu recurvatum, rear foot (RF) angle, tibal varum and torsion, navicular drop, ankle dorsiflexion range of motion (DF ROM). Independent t-test, logistic regression and receiver operating characteristic (ROC) curve were used for statistical analysis. Results: Men with a history of LAS had significantly smaller Q angles both in standing and in supine position, while women with a history of LAS had significantly greater DF ROM in non-weight bearing (NWB; p < 0.05). Logistic regression model suggests tibial varum (OR = 0.779, p = 0.021) and WB DF ROM (OR = 1.067, p = 0.045) were associated with LAS in men. In case of women, there were no significant SLEA factors for LAS, however, ROC curve analysis revealed standing RF angle (AUC = 0.647, p = 0.028) and NWB DF ROM (AUC = 0.648, p = 0.026) could be affecting factors for LAS. Conclusion: There are differences in SLEA according to the history of LAS, furthermore, the identified items were different by sex. In case of men, tibial varum and WB DF ROM affect LAS occurrence. Standing RF angle and NWB DF ROM of women could be a predictor for LAS. However, since the sensitivity and specificity in most of the SLEA measurements are low, kinematic in dynamic tasks should be considered together for a more accurate evaluation of LAS risk.

• Clinical Pain
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• v.20 no.2
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• pp.122-126
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• 2021

When a patient represents pain in foot, physician can easily overlook compression neuropathy of peripheral nerve as it is uncommon. Among nerve entrapment syndrome encountered in the foot, selective compression in lateral branch of deep peroneal nerve (DPN) is rare. We report a case of a patient with pain and dysesthesia in dorsolateral foot which turned out as lateral branch of deep peroneal nerve entrapment syndrome caused by talonavicular joint effusion. We would like to share diagnostic work up flow and conservative treatment courses. This case manifests the importance of the deep peroneal nerve and its branches in clinical setting of pain and ankle instability.

• Korean Journal of Applied Biomechanics
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• v.16 no.2
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• pp.1-8
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• 2006

The purpose of this study was to evaluate normalized jerk according to shoes, slope, and velocity during walking. Eleven different test subjects used three different types of shoes (running shoes, mountain climbing boots, and elevated forefoot walking shoes) at various walking speeds(1.19, 1.25, 1.33, 1.56, 1.78, 1.9, 2, 2.11, 2.33m/sec) and gradients(0, 3, 6, 10 degrees) on a treadmill. Since there were concerns about using the elevated forefoot shoes on an incline, these shoes were not used on a gradient. Motion Analysis (Motion Analysis Corp. Santa Rosa, CA USA) was conducted with four Falcon high speed digital motion capture cameras. Utilizing the maximum smoothness theory, it was hypothesized that there would be differences in jerk according to shoe type, velocity, and slope. Furthermore, it was assumed that running shoes would have the lowest values for normalized jerk because subjects were most accustomed to wearing these shoes. The results demonstrated that elevated forefoot walking shoes had lowest value for normalized jerk at heel. In contrast, elevated forefoot walking shoes had greater normalized jerk at the center of mass at most walking speeds. For most gradients and walking speeds, hiking boots had smaller medio-lateral directional normalized jerk at ankle than running shoes. These results alluded to an inverse ratio for jerk at the heel and at the COM for all types of shoes. Furthermore, as velocity increased, medio-lateral jerk was reduced for all gradients in both hiking boots and running shoes. Due to the fragility of the ankle joint, elevated forefoot walking shoes could be recommended for walking on flat surfaces because they minimize instability at the heel. Although the elevated forefoot walking shoes have the highest levels of jerk at the COM, the structure of the pelvis and spine allows for greater compensatory movement than the ankle. This movement at the COM might even have a beneficial effect of activating the muscles in the back and abdomen more than other shoes. On inclines hiking boots would be recommended over running shoes because hiking boots demonstrated more medio-lateral stability on a gradient than running shoes. These results also demonstrate the usefulness of normalized jerk theory in analyzing the relationship between the body and shoes, walking velocity, and movement up a slope.