• Archives of Plastic Surgery
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• v.34 no.5
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• pp.562-568
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• 2007

Purpose: Many studies reported anatomy of posterior tibial artery perforator. But, it is not easy to use this flap in clinical case. Methods: Authors performed cadaver dissection on 26 legs from 13 cadavers and identified the number, location, type, length and diameter of perforator. Based on anatomic study, posterior tibial artery perforator flap was performed on 3 clinical cases. Results: The perforator was found on a line drawn from the medial boarder of central patella to posterior boarder of medial malleolus. The main perforator which was longer and greater caliber than others was found was found 13 to 17cm distant from medial boarder of central patella in 23 of 26 leg(88.5%). Average length was 6.2cm and average diameter was 1.4mm. The main perforator was musculocutaneous perforator at 20 of 26 leg(77%). The posterior tibial artery perforator flap was clinically use in 3 cases. All flap were survived without any complication. Conclusion: The author found the main perforator of posterior tibial artery perforator flap was located 15cm distant from medial boarder of central patella within the circle drawn with a radius of 4cm. The posterior tibial artery perforator flap is expected to be used as one of the option for the reconstruction of hand and foot.

• 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.

• Korean Journal of Acupuncture
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• v.37 no.1
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• pp.31-36
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• 2020

Objectives : The purpose of this study is to review needling depth and location of LU7, BL62 and KI6 by the medical classics' records. Methods : 1. We researched the medical classics describing LU7, KI6 and BL62, and reorganized data about the location and needling depth. 2. We compared the medical classics' records on LU7, KI6 and BL62 with description of WHO standard acupuncture point location. 3. We reviewed different location and needling depth of LU7, BL62, and KI6 recorded in the medical classics with the anatomical structure. Results : 1. The common needling depth of LU7 is about 0.2 chon. But in some medical classics, the depth of LU7 is 0.8 chon. Needling depth of LU7 varied depending on the patient's hand posture. In the 'half-up' position with the thumb upward, it is possible to stimulate acupuncture on LU7 by 0.8 chon because there is a space between the tendons. 2. In WHO standard acupuncture point location, the locations of BL62 and KI6 are just below the lateral and medial malleolus. But in some medical classics, the locations of BL62 and KI6 are between the bones and muscles below the malleolus. In the locations between the bones and muscles below the malleolus, it is possible to stimulate acupuncture on BL62 and KI6 by penetrating acupuncture because there is no bone structure. Conclusions : 1. By the 'half-up' position with the thumb upward, it is possible to stimulate vertically acupuncture on LU7 by 0.8 chon. 2. By the locations of BL62 and KI6 between the bones and muscles below the malleolus, it is possible to stimulate on BL62 and KI6 by penetrating acupuncture.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.135-139
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• 2005

Purpose: This study was performed to investigate the radiological characteristics of the degenerative arthritis of the ankle using the standing radiographs. Materials and Methods: From June 2001 to May 2005, 36 patients (56 ankles) who were treated for osteoarthritis of ankle were analysed. Angle of tibial shaft and tibial joint surface on AP view (TSA), angle of tibial joint surface on lateral view (TLS), tibial and medial malleolus angle (TMM) and talo-1st metatarsal angle were checked on standing radiograph. The patients with medial joint and total joint involvement were categorized into three stages according to the location of involvement. The degree of joint space narrowing was categorized into two groups. Results: There were no significant differences in TSA, TLS, TMM and talo-1st metatarsal angle with regard to the stage of arthritis. However, the difference between the less severe group and the severe group existed. Conclusion: Angular deformity was not correlated with stage, but correlated with severity. The deformity of distal tibial articular surface does not seem to be a cause of primary osteoartiritis, but rather a result from it.

• Journal of Korean Foot and Ankle Society
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• v.5 no.2
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• pp.129-135
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• 2001

Purpose: To evaluate the radiographic results of the treatment for Danis-Weber type B lateral malleolar fracture with 2 cannulated screws. Materials and Methods: Thirty-four cases of Danis-Weber type B lateral malleolar fracture were available. Follow-up averaged 8 months (6-25 months). The medial clear space for lateral displacement of talus, talo-crural angle for lateral malleolar shortening, and malunion evidence of lateral malleolar fracture were observed. Results: Medial clear space was from 2mm to 4mm in 34 cases. Talo-crural angle was from $73^{\circ}$ to $82.5^{\circ}$ in 33 cases. One case was complicated with malunion of lateral malleolus. But, we found the same condition in the immediate post- operative radiographic film. Conclusion: We believe that the 2 cannulated screws fixation for Danis-Weber type B lateral malleolar simple fractures is an excellent treatment method.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.128-134
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• 2008

Purpose: We evaluated the complications and failures after total ankle arthroplasty during at least 2 years short term follow up. Materials and Methods: There were 45 cases of 42 patients of HINTEGRA$^{{R}}$ (Newdeal SA, Lyon, France) model from November 2004 to August 2006. Follow up averaged at least 2 year. We evaluated the complications and analyzed the cause of the failures. Results: There were totally 15 cases of complication, 5 cases of medial impingement syndrome, 3 cases of varus malposition, 2 cases of delayed healing of wounds, and each one case of deep peroneal nerve problem, medial malleolus fracture, post-operative deep infection, gouty arthritis pain, and Achilles tendinitis. Conclusion: Total ankle arthroplasty had higher complication rate than any other joint arthroplasty, so we need a more meticulous preoperative and peri-operative care.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.114-115
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• 2004

A 18-year-old male soccer player had painful triggering and occasional locking of the great toe caused by entrapment of the flexor hallucis longus tendon within the flexor sheath posterior to the right medial malleolus. After other treatment modalities failed, the condition was relieved by a surgical procedure that removed the nodule on the flexor hallucis longus tendon and the ganglion under flexor retinaculum. Tendon rupture was not found, although there was tendinitis.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.94-98
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• 2005

Purpose: To compare the radiographic evaluations between two radiographic views (AP and lateral views) and four radiographic views (AP, lateral and both oblique views) in ankle fractures. Materials and Methods: From January 2000 to June 2002, 60 cases of ankle fractures were treated with open reduction and internal fixation and its followed up periods were at least 2 years. All cases were classified into three groups according to the method of preoperative radiographic evaluation. Two radiographic views (AP and lateral views) were taken in group A and four radiographic views (AP, lateral and both oblique views) were taken in group B. 12 Cases were evaluated with three dimensional computed tomography (3D CT). Four radiographic views and 3D CT were taken in group C. All cases were classified according to the Danis-Weber and Lauge-Hansen classification. Displacement of fracture fragment of medial, lateral, posterior malleolus and size of fracture fragment of posterior malleous were measured using picture archiving communication system (PACS). Results: Although kappa value between two or four radiographic views were good or excellent in Danis-Weber classification and Lauge-Hansen classification of ankle fractures, the displacements of medial and lateral malleoli were statistically different. Four radiographic views evalulated the degree of displacement of medial and lateral fragments more accurately compared to two radiographic views. Conclusion: Four radiographic views will be more useful than two radiographic views to decide the method of treatment and operation considering the displacement of fracture fragment.

• Physical Therapy Rehabilitation Science
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• v.10 no.1
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• pp.1-9
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• 2021

Objective: Joint mobilization for arthrokinematics altered by the positional fault of chronic ankle instability (CAI) is an effective intervention for stabilization. In this study, we compared the effects of ankle dorsi flexion range of motion (DFROM) and dynamic balance ability (DBA) in CAI patients via passive joint mobilization (PJM), a method traditionally performed in previous studies, and active joint mobilization (AJM), a method that can have a greater effect on cortical excitability with spontaneous movements. Design: Single-blind two-arm randomized controlled trial Methods: A total of 30 participants were registered: 15 each to the PJM and AJM groups. Each participant received a total of 10 intervention sessions, 10 minutes per session, 5 times a week for 2 weeks. PJM used Maitland's mobilization method to apply joint mobilization with talus in the posterior direction and AJM used an angular joint motion to induce patient's voluntary motion of medial malleolus anterior gliding and lateral malleolus posterior gliding, respectively. DFROM of the ankle was measured by using tape and DBA was evaluated by using the balance system. Results: Significant improvement was observed after intervention in both the PJM and AJM groups except for the DBA-anterior and DBA-right variables of the PJM group. There were statistically significant differences between the AJM and PJM groups in the DFROM, DBA-anterior, DBA-posterior, and DBA-right variables. Conclusions: The overall improvement of DFROM and DBA was found to be more effective in joint mobilization including voluntary movement. When it is accompanied by voluntary movement, it further affects the neuromuscular system of the ankle.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.784-788
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• 2006

Purpose: For the reconstruction of the ankle joint as well as the soft tissue defect in the distal lower leg, a free flap or a local flap has been used, and because of the condition of patients, if a complex microvascular surgery under general anesthesia could not be performed, it could be reconstructed by using the distally based lateral supramalleolar fascio-cutaneous island flap using the perforating branch of the peroneal artery in the ankle area. Methods: The study subjects were 4 male patients between 53 years and 73 years of age. 2 cases were tissue defect in the medial malleolus area due to systemic diseases such as gouty arthritis accompanied traffic accident, diabetes mellitus foot, atherosclerotic obliterans, etc., 1 case was the defect in the pretibia area, and 1 case was the defect underneath the lateral malleolus, which was reconstructed by the distally based lateral supramalleolar fascio-cutaneous island flap. The donor area was the skin harvested from the groin, and the full thickness skin graft was performed. The size of the flap varied from $4{\times}3cm$ to $9{\times}6cm$. As the flap border, the medial side was to the tibialis anterior tendon, the lateral side was to the fibula crest, and the proximal area was less than the fibula size. Results: The consequence is that, in total 4 cases, the congestion in the flap began from 12 hours after the surgery, and the progression of congestion was ceased on the 5th day after the surgery, and finally epidermal bulla and sloughing, partial necrosis was developed. After the end of necrosis, the defect area was reconstructed successfully by the second full thickness skin graft. Conclusions: Although the distally based lateral supramalleolar fascio-cutaneous island flap has the shortcoming of requiring the second skin graft, it has the advantages that it does not require a long complex microsurgery, the flap itself is thin, it is similar to the color of the skin in the recipient area, and it does not leave a big scar in the donor area. Therefore, it is thought that for the cases who could not undergo a long complex surgery due to systemic diseases or the cases of patients whose condition of the recipient area is not suitable for microsurgery, the lateral supramalleolar fascio-cutaneous island flap is very useful for the reconstruction of the distal lower leg and the ankle joint area.