• 한국전문물리치료학회지
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• 제18권2호
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• pp.60-66
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• 2011

Foot posture is important in the development of the musculoskeletal structure in the lower limbs because it can change the mechanical alignment. Although foot orthotics are widely used for the correction of malalignments in the lower extremities, the biomechanical effects of wedges have not yet been cleared. The aim of this study was to investigate whether medial wedges affect the electromyographic (EMG) activity of the knee and hip joints in healthy adults that are performing one leg standing. Seventeen healthy volunteers performed the one leg standing under two foot conditions: A level surface, and a $15^{\circ}$ medial wedge. The subjects' EMG data for the gluteus maximus (Gmax), gluteus medius (Gmed), tensor fasciae latae (TFL), biceps femoris (BF), vastus lateralis (VL), and vastus medialis oblique (VMO) were recorded, along with the surface EMG, and all were analyzed. The EMG activity of the Gmed and TFL had significantly decreased under the medial wedge condition during one leg standing. Further study is needed in order to investigate whether medial wedges influence the EMG activity and kinematic data of the knee and hip joints as well as the ankle joints in adults with flexible flatfoot, while they are performing one leg standing.

• 대한의용생체공학회:의공학회지
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• 제25권4호
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• pp.289-293
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• 2004

본 연구에서는 경사각도가 다른 내, 외측 후족 왯지를 착용하고 보행하는 동안 삼차원 동작분석시스템과 무선가속도측정시스템을 이용하여 무릎관절의 내번토크와 내외측 방향 가속도를 측정하였다. 내번토크와 외측 가속도는 하중수용기와 전유각기에서 각각 양의 절정값을 나타내었다. 하중수용기에 내측 왯지의 경우 내번토크와 외측 가속도가 맨발에 비하여 증가되었으며, 외측 왯지의 경우 내번토크와 외측 가속도값이 감소하였다. (p<0.05). 이러한 변화는 왯지의 경사각이 커질수록 더욱 뚜렷한 상관성을 보였다(p<0.05). 그러나 전유각기에서는 왯지의 방향과 경사에 따른 무릎의 내번토크와 내외측 가속도의 상관성을 확인할 수 없었다. 본 연구의 견과를 통하여 외측 왯지 사용 시 무릎관절의 내번토크가 감소되어 퇴행성 무릎관절염의 치료에 도움을 줄 수 있다. 또한, 보행 중 무릎관절의 내번토크 대신에 외측방향 가속도를 측정함으로써 간단히 왯지의 효과를 결정할 수 있을 것이다.

• Radiation Oncology Journal
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• 제23권4호
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• pp.230-235
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• 2005

목적: Siemens사 선형가속기에 장착된 가상쐐기를 이용하여 반대측 유방에 흡수되는 선량을 기존쐐기와 비교 연구하고자 하였다. 대상 및 방법: 반대측 유방선량을 인체모형에서 이극진공관을 사용하여 측정하였다. 이극진공관을 조사영역의 내측 경계선으로부터 반대쪽 외측방향으로 5.5 cm (1번 위치), 9.5 cm (2번 위치), 14 cm (3번 위치) 떨어진 곳에 위치하였다. 6 MV X-선을 이용하여 50도와 230도에서 $17{\pm}10cm$의 비대칭조사영역을 사용하여 접면 조사를 실시하였다. 첫번째 실험은 4가지의 치료방법을 시도하였다; (i) 개방 내측조사와 30도 기존쐐기를 사용한 외측조사; (ii) 15도 기존쐐기를 사용한 내측 및 외측조사; (iii) 개방 내측조사와 30도 가상쐐기를 사용한 외측조사; (iv) 15도 가상쐐기를 사용한 내측 및 외측조사. 두번째 실험은 개방조사, 15도 및 60도 기존쐐기 및 가상쐐기 모두를 사용하여 내측조사를 시행하였으며, 이때 동일한 모니터단위로 조사하였다. 모든 실험은 3회 반복되었다. 결과: 첫번째 실험은 반대측 유방선량은 1번 위치, 2번 위치, 3번 위치의 순으로 감소한다. 또한 기존쐐기 및 가상쐐기와 무관하게 내측에 쐐기를 사용한 경우($3.25{\pm}1.59%$)보다는 사용하지 않은 경우(2.70{\pm}1.45%$) 선량이 낮았고, 이러한 차이는 가상쐐기($0.10{\pm}0.01%$)보다 기존쐐기($0.99{\pm}0.18%$)의 경우 더 컸다. 가상쐐기의 사용은 같은 기법의 기존쐐기를 사용한 것에 비해 처방선량 대비 $0.12{\sim}1.20%$의 반대측 유방선량을 감소시켰다. 두번째 실험시 1번 위치에서는 개방빔, 가상쐐기, 기존쐐기 순으로 선량이 높았으며, 2, 3번 위치에서는 기존쐐기, 개방빔, 가상쐐기 순으로 선량이 높았다. 결론: Siemens사 선형가속기에 장착된 가상쐐기를 사용할 경우 반대측 유방선량을 줄일 수 있으며, 위치에 따른 선량분포는 Varian사 것과 차이가 있었다.

• 대한정형도수물리치료학회지
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• 제11권1호
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• pp.65-73
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• 2005

Osteoarthritis has been considered a disease of the elderly because it is uncommon before the age of 40 years and is seen in approximately 80% of United States citizens older than 65 years. general population on kuri city in korea revealed that prevalence of knee osteoarthritis is 10.2%, increasing with age. High level of physical activity in men and age, post-menopause and obesity in women can be risk factor. Osteoarthritis is no evidence that a acquired process initiated much earlier in life through mechanical, metabolic, genetic, or other origins. A high tibial osteotomy alters static lower extremity alignment thereby decreasing medial compartment loading. As well, conservative treatment strategies, such as knee braces and valgus heel wedges, affect lover limb mechanics and attempt to reduce medial compartment loading. It was hypothesized that valgus heel wedges and modified orthoses would shift the center of pressure laterally on the foot during level walking, reducing the moment arm of the adduction moment in the frontal plane, thereby resulting in a decrease in the knee adduction moment. In the 1980s, the effect of wearing a laterally wedged insole on osteoarthritic patients with a varus deformity of the knee was firsted, and since then, kinematic and kinetic analyses concerning this condition have mainly focused on a static standing position. Since the early 1990s, the beneficial effect of wearing a laterally wedged insole to treat osteoarthritis of the knee has also been reported in dynamic conditions, but these studies did not answer the question of the kinematic and kinetic mechanisms that resulted in the reduced symptoms in patents with knee osteoarthritis. therefore, the effect of wearing laterally wedged insole has not been sufficiently studied.

• 한국전문물리치료학회지
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• 제9권3호
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• pp.11-21
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• 2002

The purpose of this study was to find the effect of rear foot wedge angle on peak plantar pressures on the forefoot during walking. Twenty normal healthy subjects (10 female, 10 male) were recruited. Peak plantar pressure was measured using pressure distribution platforms (MatScan system) in medial forefoot (under the first, second metatarsal head) and lateral forefoot (under the third, fourth, fifth metatarsal head). The subjects walked at the comfortable velocity under seven conditions; bare footed, $5^{\circ}$, $10^{\circ}$ and $15^{\circ}$ wedges under the medial and lateral sides of the hindfoot. The three averaged peak plantar pressures were collected at each condition at stance and toe off phases. The results showed that a significant increase in lateral forefoot plantar peak pressure investigated in the medial wedge and a significant decrease in lateral forefoot plantar peak pressure investigated in lateral wedge at stance phase (p<.05). These results suggest that rear foot wedge may be useful to modify the peak plantar pressure on the forefoot.

• 한국전문물리치료학회지
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• 제12권2호
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• pp.11-19
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• 2005

Patellofemoral pain syndrome (PFPS) is often attributed to malalignment and maltracking of patella within the patellofemoral joint. Most exercise for PFPS has focused on selectively strengthening the vastus medialis oblique muscle (VMO). This study was designed to identify the effect of medial, lateral wedge and difference of Quadriceps angle (Q-angle) on vastus medialis oblique/vastus lateralis muscle (VL) activity ratios. The subjects were twenty young adult males who had not experienced any knee injury. They were asked to perform isometric contraction exercises in three postures using medial and lateral wedge. The EMG activity of the VL and VMO were recorded in three postures by surface electrodes and normalized by %MVC values derived from seated, isometric knee extensions. The normalized EMG activity levels (%MVC) of the VL and VMO for the three postures of the lower extremities were compared using 2-way repeated measures ANOVA with 1 between-subject factor (group), and 1 within-subject factor (wedge). Results of repeated measures of ANOVA's revealed that the medial wedge isometric contraction exercise produced significantly greater EMG activity of VMO/VL ratios in Group I (Q-angle $18^{\circ}$ or less) (p<.05). But, the medial wedge isometric contraction exercise was no significant difference of VMO/VL ratios in Group II (Q-angle $19^{\circ}$ or more) (p>.05). These results have important implications for selective VMO muscle strengthening exercises in PFPS patients.

• 한국운동역학회지
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• 제17권3호
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• pp.81-94
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• 2007

The purpose of this study was to critically review biomechanical studies on foot orthoses (FO) in normal and diseased foot and provide beneficial information obtained from researches until now and future researching focus. The search was performed by Medline and Embase database including studies published in English from January 1980 to April 2007. The searching terms were foot orthoses, foot orthotics, insoles and shoe insert. 57 studies including 54 journal articles and 3 abstracts were finally selected under the conditions of having clinical trials, FO, control condition, movement, scientific measuring system. The reviewed studies were divided into 10 categories according to subject characteristics; healthy normal, excessive pronation or flexible flat foot, rheumatoid arthritis, diabetes, medial knee osteoarthritis, forefoot varus, plantar fasciitis, patellofemoral syndrome, cavus foot and finite element model. In summary, first, soft and semirigid FOs with some degree of cushioning showed much higher comfort and efficacy than rigid FO. Second, no big differences between prefabricated and custom FO were shown. Third, the full length's FO was preferable to the half length's FO or simple arch supports. Fourth, the wearing of FO combining medial arch supports and metatarsal dome made positive roles to enhance comfort and functionality and redistribute plantar pressure under the foot. Fifth, for patients with knee-related diseases lateral wedges were preferable. Sixth, measuring systems were properly applied according to the types of foot diseases.

• 대한수의학회지
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• 제38권4호
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• pp.936-945
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• 1998

This study was performed to investigate the best surgical technique for normal stifle mobility by comparison with clinical signs and histopathological changes of articular cartilage after femoral trochleoplasty, trochlear chondroplasty and trochlear wedge recession. Twelve small mixed dogs who had grade I or II medial patellar luxation were used. The days that the dog had partial and full weight bearing were checked and histopathological changes 49 and 90 days after surgery were observed. The dogs had partial weight bearing in 3~6 days postoperatively and full weight bearing in 20~24 days. After femoral trochlepoplasty, the articular surface was irregular and rough, but smooth after trochlear chondroplasty and trochlear wedge recession. Histopathologic examination performed on the 49th and 90th days after femoral trochleoplasty revealed that articular surface was occupied by fibrocartilage but the hyaline cartilages are preserved after trochlear chondroplasty and trochlear wedge recession. In trochlear wedge recession, the wedges of all cases were firmly attached to underlying subchondral bone which were indicating complete healing. The results of this study suggested that the trochlear wedge recession was the best chondroplasty for correcting patellar luxation.

• 한국의학물리학회지:의학물리
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• 제18권1호
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• pp.7-12
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• 2007

유방암 환자의 방사선치료에서 유방의 모양에 따른 윗부분과 아랫부분의 두께의 차이 때문에 적절한 선량분포를 얻기 위해서는 쐐기모양 보상체가 필수적으로 이용된다. 유방보존절제술을 시행한 유방암 환자들을 방사선치료 할 때 일반적으로 비껴방향 치료방법으로 치료를 한다 비껴방향 치료방법에서 중심 쪽에서 가장자리 쪽으로 치료하는 빔에서는 쐐기모양 보상체에 빔이 일차적으로 부딪칠 때 저에너지의 방사선이 발생하여 피부에 영향을 미치게 된다. 이 때 피부에 조사되는 저 에너지 방사선을 최소화하기 위하여 가상 쐐기모양 보상체를 사용할 수 있다. 본원이 보유하고 있는 Eclipse 치료계획장치에는 가상 쐐기모양 보상체로 치료계획을 할 수 있도록 장착되어 있다. 저자들은 본원이 갖고 있는 실제 쐐기모양 보상체 15도, 30도, 45도, 60도와 가상 쐐기모양 보상체 15도, 30도, 45도, 60도의 선량분포 특성을 비교하여 유방암 환자에서 가상 쐐기모양 보상체의 임상 적용 타당성을 살펴본 결과 치료면적 $10{\times}10cm$의 대칭도의 비교에서 쐐기의 각도에 따른 차이가 없음을 알 수 있었으며, 치료면적의 크기에 따른 각각의 쐐기 각도에 대한 투과율의 특성에서 대칭도의 비교는 거의 선형적으로 변함을 볼 수 있어 가상 쐐기의 임상적용이 적합함을 알 수 있었다.