• 대한족부족관절학회지
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• 제2권2호
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• pp.88-92
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• 1998

The course of the sural nerve in the calf has been well documented, but there is a general lack of information concerning the distal course of the nerve. The purpose of this study was to describe the distal course of the sural nerve and its surgical implications. Seven fresh amputated specimens were dissected to show the anatomy of the sural nerve in the foot and ankle. At the level of about 10cm proximal to the plantar surface, the sural nerve coursed anteriorly and inferiorly away from the Achilles tendon. 2 to 4 lateral calcaneal branches arose. The first branch of the lateral calcaneal branches coursed along the lateral border of the Achilles tendon, and it arose at 8cm proximal to the plantar surface in 2 specimens, 12cm proximal to the plantar surface in 4 specimens, and at 12cm proximal to the plantar surface in one specimen. The main nerve trunk continued distally plantar to the peroneal tendons and divided into two terminal branches and crossed peroneus longus tendon at the level of the inferior border of the calcaneo-cuboid joint, at about 3cm(range, $2.5\sim3.0$)cm from the plantar surface. In conclusion, a longitudinal incision lateral to the Achilles tendon would cross the path of the sural nerve at about 10cm proximal to the plantar surface. When the first branch of them arise more than 10cm above the plantar surface, a logitudinal incision lateral to the Achilles tendon may be made without damage. The other lateral calcaneal branches will be cut when we make transverse incision paralled to the plantar surface. The terminal branch also may be in danger by the same transverse incision.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.15-21
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• 1999

Soft tissue defect on heel area of the foot present difficult problems particularly because of anatomic property of plantar surface of the foot. There is a paucity of available local tissue in the foot for coverage. In addition to having little expandable tissue, the foot's plantar surface has a unique structure, making its replacement especially challenging. Plantar skin is attached to the underlying bone by fibrous septa, preventing shear of the soft-tissue surfaces from the underlying skeleton. Plantar surface of foot is in constant contact with the environment. Protective sensibility also would be maintained or restored in the ideal reconstruction. So the ideal flap for reconstruction of the heel should include thin, durable hairless skin with potential for reinnervation. The aim of this article is to present a clinical experience of free lateral arm neurosensory flap for reconstruction of the heel. From March 1995 to December 1997, a total 16 lateral arm free flaps were performed to soft tissue defects on the weight-bearing area of the hindfoot. we used tibial nerve as recepient nerve in 11 and calcaneal branch of tibial nerve in 5 for restoration of sensibility of flap. All cases survived completely. A static two-point discrimination of 14 to 34mm was detected in the flap. Radial nerve palsy which was caused by hematoma in donor site occured in one case, but recorverd in 3 weeks later completely. In conclusion, the lateral arm free flaps are versatile, reliable and sensible cutaneous flap and especially indicated for soft tissue defect on plantar surface of the hindfoot which are not good indications for other better-known flaps.

• Physical Therapy Rehabilitation Science
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• 제11권2호
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• pp.235-244
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• 2022

Objective: The aim of this study was to investigate of the foot plantar pressure and usability after gait training using the ExoAtlet wearable exoskeleton robot in an incomplete spinal cord injury (SCI) patient. Design: A case study Methods: Six participants with an asymmetry in motor and sensory function completed the gait training using ExoAtlet wearable exoskeleton robot for 15 sessions, five per weeks, 3weeks. They were divided into two groups (low and high strength group) and group differences were evaluated about session at stating of gait, gait distance at final session and foot plantar pressures and useability after training. Results: Low strength group was faster than high strength group on adaptation of robot gait. And high strength group increased faster than low strength group on the gait distance during training. In standing and gait, weaker leg was higher than stronger leg on mean foot plantar pressure in low strength group. And stronger leg was higher than weaker leg on foot plantar pressure in high strength group. The length of the anterior-posterior trajectory of the center of pressure during gait was similar in low strength group, but different in high strength group. useability was positive about ExoAtlet wearable exoskeleton gait after training. Conclusions: ExoAtlet wearable exoskeleton robot gait training was positive about improving gait in all participants regardless of differences in severity of symptoms and gait abnormalities.

• 한국운동역학회지
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• 제34권2호
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• pp.45-52
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• 2024

Objective: The purpose of this study was to measure the morphological characteristics of the foot and biomechanical variables of the lower extremity joints during vertical jump and investigate the relationship between foot morphology and biomechanics of vertical jump. Method: 24 men in their 20s (age: 22.42 ± 1.41 yrs, height: 173.37 ± 4.61 cm, weight: 72.02 ± 6.21 kg, foot length: 251.70 ± 8.68 mm) participated in the study. Morphological characteristics of the foot included the length of the first toe, the length of the second toe, and the horizontal length from the center of ankle joint to the achilles tendon (Plantar Flexion Moment Arm [PFMA]). Biomechanical variables were measured for plantar flexor strength of the ankle joint and peak angular velocity, moment, and power of the lower extremity joint during vertical jump. Results: There was a significant correlation between the length of the first toe and plantar flexion strength at 30°/s [r=.440, p=.016], the angular velocity of the metatarsophalangeal [MTP] joint [r=-.369, p=.038] while significant correlations between PFMA and the angular velocities of the knee joint [r=.369, p=.038] and ankle joint [r=.420, p=.021] were found. There were also significant correlations between the length of the first toe and the maximum moment of the hip joint [r=.379, p=.034], and the length of the second toe and the power of the hip joint [r=-.391, p=.029]. Finally, significant correlations between PFMA and the power of the ankle joint [r=.424, p=.019] and MTP joint [r=.367, p=.039] were found. Conclusion: Based on the results of this study, the length of the toe and PFMA would be related to the function of the lower extremity joint. Therefore, this should be considered when designing the functional structure of a shoe. Furthermore, this relationship can be applied to intensive training for the plantar flexors and toe flexors to improve power in athletic performance.

• 한국전문물리치료학회지
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• 제20권4호
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• pp.55-64
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• 2013

The first purpose was to identify the plantar pressure distributions (peak pressure, pressure integral time, and contact area) during level walking, and stair ascent and descent in asymptomatic flexible flatfoot (AFF). The second purpose was to investigate whether peak pressure data during level walking could be used to predict peak pressure during stair walking by identifying correlations between the peak pressures of level walking and stair walking. Twenty young adult subjects (8 males and 12 females, age $21.0{\pm}1.7$ years) with AFF were recruited. A distance greater than 10 mm in a navicular drop test was defined as flexible flatfoot. Each subject performed at least 10 steps during level walking, and stair ascent and descent. The plantar pressure distribution was measured in nine foot regions using a pressure measurement system. A two-way repeated analysis of variance was conducted to examine the differences in the three dependent variables with two within-subject factors (activity type and foot region). Linear regression analysis was conducted to predict peak pressure during stair walking using the peak pressure in the metatarsal regions during level walking. Significant interaction effects were observed between activity type and foot region for peak pressure (F=9.508, p<.001), pressure time integral (F=5.912, p=.003), and contact area (F=15.510, p<.001). The regression equations predicting peak pressure during stair walking accounted for variance in the range of 25.7% and 65.8%. The findings indicate that plantar pressures in AFF were influenced by both activity type and foot region. Furthermore the findings suggest that peak pressure data during level walking could be used to predict the peak pressure data during stair walking. These data collected for AFF can be useful for evaluating gait patterns and for predicting pressure data of flexible flatfoot subjects who have difficulty performing activities such as stair walking. Further studies should investigate plantar pressure distribution during various functional activities in symptomatic flexible flatfoot, and consider other predictors for regression analysis.

• 한국콘텐츠학회논문지
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• 제10권8호
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• pp.257-265
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• 2010

본 연구는 내림 경사로를 내려오는 동안 경사로의 기울기 변화가 보행 시 족저 영역별 최고 압력과 입각기 동안 압력중심이동경로를 분석하고자 실시하였다. 보행에 문제가 없는 열다섯 명의 건강한 젊은 성인이 이 연구에 참여하였으며 각각 평지, 내림경사 $5^{\circ}$, $10^{\circ}$, $15^{\circ}$의 경사로를 내려오는 동안 입각기 발의 족저 최고 족저압과 압력중심이동경로를 측정하였다. 측정장비는 Tekscan사의 Footmat system을 이용하였으며, 대상자의 발을 일곱 개의 영역(두 개의 발가락 영역, 세 개의 전족부 영역, 한 개의 중족부와 후족부영역)으로 나누어 자료를 수집하였다. 내림경사로의 기울기에 따른 최고 족저압의 차이를 알아보기 위해 반복측정분산분석을 이용하였고 압력중심이동경로는 육안적 관찰을 통해 알아보았다. 본 연구를 통해 내림경사로의 기울기가 커질수록 입각기 동안 최고 족저압은 엄지발가락영역에서 유의하게 증가하였고 세개의 전족부 영역에서는 유의하게 감소하였다. 그리고 압력중심이동경로는 내림경사로의 기울기가 커질수록 전족부에서 압력 중심이 내측으로 이동하였고 엄지발가락까지 길어지는 경향을 볼 수 있었다. 따라서 내림경사로의 기울기가 $-5^{\circ}$에서부터 일부 족저영역의 압력분포가 유의하게 달라지며 이는 내림경사로의 기울기가 발의 구조와 기능에 영향을 미친다는 것을 알 수 있었다.

• 한국전문물리치료학회지
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• 제15권4호
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• pp.1-9
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• 2008

The purpose of this study was to assess the peak plantar pressure distribution under foot areas according to the height of heel lifts in obese adults and non-obese adults during walking. Thirty-one participants volunteered for this experiment. The average body mass index (BMI) value of the fourteen subjects in the obese group was $26.5{\pm}1.4kg/m^2$ (from 25.1 to 29.3 $kg/m^2$), and of seventeen subjects in the non-obese group was $20.0{\pm}1.1kg/m^2$ (from 18.7 to 22.7 $kg/m^2$). The subject ambulated while walking in the sneakers, walking with 2 cm heel lifts, and walking with 4 cm heel lifts in the shoes. We measured the peak plantar pressure under the hallux, 1st, 2nd, 3~4th, and 5th metatarsal head (MTH), mi foot, and heel using F-scan system. The obese group had significantly higher peak plantar pressure under all foot areas than the non-obese group regardless of the height of heel lifts (p<.05). The peak plantar pressure under the 5th MTH and heel was significantly decreased, also the peak plantar pressure under hallux, 1st, and 2nd MTH was significantly increased according to the height of heel lifts in the obese group and non-obese group (p<.05), We proposed that individuals with heel lifts in shoes should be careful, as there is high plantar pressure under the forefoot.

• 한국운동역학회지
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• 제23권4호
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• pp.335-345
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• 2013

The purpose of this study was to investigate the effects of foot type and ankle joint fatigue levels on the trajectories of center of pressure and center of mass during a single-leg stance. The study subjects included 24 healthy women (normal foot group, n=10; pronated foot group, n=14). Ankle joint muscle fatigue was induced by using an isokinetic dynamometer, where the fatigue levels were measured on plantar flexion and dorsiflexion at angular velocities of $30^{\circ}/s$ at 50% and 30% of the peak torque of ankle plantar flexion. Following assessments in the anteroposterior direction according to the level of fatigue, the pronated foot group showed decreased single-leg stance ability at 50% and 30% of the fatigue level. Moreover, the normal foot group showed better single-leg stance ability than the pronated foot group at 30% of the fatigue level. Following assessments in the mediolateral direction, we noted that the single-leg stance ability did not differ significantly according to the levels of fatigue or foot type. In conclusion, ankle plantar flexion at 50% and 30% of the peak torque reduced the ability of the pronated foot group to achieve a single leg stance in the anteroposterior direction. Moreover, the normal foot group showed better single-leg stance ability than the pronated foot group.

• 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.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.137-142
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• 2010

Purpose: Tumor ablation and traumatic intractable ulceration of the plantar surface of the foot results in skin and soft tissue defects of the weight-bearing sole. Simple skin grafting is not sufficient for reconstruction of the weight-bearing areas. Instead, the island medial plantar flap (instep flap) and distally-based island medial plantar flap was used for proper reconstruction of the weight bearing area. However, there are some disadvantages. In particular, an island medial plantar flap has a short pedicle limiting the mobility of the flap and the distally-based island medial plantar flap is based on a very small vessel. We investigated whether good results could be obtained using a reverse island medial plantar flap based on the lateral plantar vessel as a solution to the above limitations. Methods: Three patients with malignant melanoma were cared for in our tertiary hospital. The tumors involved the lateral forefoot, the postero-lateral heel, and the medial forefoot area. We designed and harvested the flap from the medial plantar area, dissected the lateral and medial plantar artery and vena comitans, and clamped and cut the vessel 1 cm proximal to the branch from the posterior tibial artery and vena comitans. The medial plantar nerve fascicles of these flaps anastomosed to the sural nerve, the 5th interdigital nerve, and the 1st interdigital nerve of each lesion. The donor sites were covered with skin grafting. Results: The mean age of the 3 subjects was 64.7 years (range, 57 - 70 years). Histologically, all cases were lentiginous malignant melanomas. The average size of the lesion was $5.3\;cm^2$. The average size of the flap was $33.1\;cm^2$. The flap color and circulation were intact during the early postoperative period. There was no evidence of flap necrosis, hematomas or infection. All patients had a normal gait after the surgery. Sensory return progressively improved. Conclusion: Use of an island medial plantar flap based on the lateral plantar vessel to the variable weight-bearing sole is a simple but useful procedure for the reconstruction of any difficult lesion of the weight-bearing sole.