• The Korean journal of sports medicine
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• v.36 no.4
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• pp.221-226
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• 2018

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation within the synovial membrane of the articular joint. Smaller joints are rarely affected and it may be progressed to osteochondromatosis after ossification or calcification of metaplastic cartilage. It is commonly presented in the third to fourth decade of life, but rarely presented in adolescence. We report a unique case of synovial osteochondromatosis of the subtalar joint in 14-year-old baseball player. Arthroscopic removal of loose body and complete excision of the osteochondral mass with concomitant synovectomy resulted in satisfactory outcome without recurrence at final follow-up.

• Journal of Korean Foot and Ankle Society
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• v.21 no.4
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• pp.144-150
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• 2017

Purpose: To assess the clinical and radiographic results and complications of arthroscopy-assisted reduction and percutaneous fixation for patients with tongue-type Sanders type II calcaneal fractures. Materials and Methods: Between August 2014 and December 2015, 10 patients who underwent surgery using subtalar arthroscopic assisted reduction and percutaneous fixation for tongue-type Sanders type II calcaneal fractures were reviewed. The mean age was 50.8 years (36~62 years), and the mean follow-up period was 24 months (12~40 months). The clinical results were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at the regular follow-ups, and the foot function index (FFI) at the last follow-up. The subtalar range of motion (ROM) was evaluated and compared with the uninjured limb at the last follow-up. The radiographic results were assessed using the Bohler's angle from the plain radiographs and the reduction of the posterior calcaneal facet using computed tomography (CT). The postoperative complications were assessed by a chart review. Results: The VAS and AOFAS ankle-hindfoot score improved until 12 months after surgery. The FFI was 15 (1.8~25.9) and subtalar ROM was 75.5% (60%~100%) compared to the uninjured limb at the last follow-up. The $B{\ddot{o}}hler^{\prime}s$ angle was increased significantly from $2^{\circ}$ ($-14^{\circ}{\sim}18^{\circ}$) preoperatively to $21.8^{\circ}$ ($20^{\circ}{\sim}28^{\circ}$) at the last follow-up. The reduction of the posterior facet was graded as excellent in five feet (50.0%) and good in five (50.0%) on CT obtained at 12 months after surgery. One foot (10.0%) had subfibular pain due to a prominent screw head. One foot (10.0%) had pain due to a longitudinal tear of the peroneal tendon that occurred during screw insertion. Conclusion: Subtalar arthroscopic-assisted reduction of the posterior calcaneal facet of the subtalar joint and percutaneous fixation is a useful surgical method for tongue-type Sanders type II calcaneal fractures.

• 대한관절경학회:학술대회논문집
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• 2009.10a
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• pp.108-113
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• 2009

• Physical Therapy Korea
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• v.3 no.1
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• pp.1-11
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• 1996

The purpose of this study was to analyse the subtalar joint movement characteristics in human stance phase. The data of subtalar joint movement patterns are collected by CTA(calcaneus to tibia angle) measurements. CTA is defined as a angle formed between the bisect of the posterior shank and bisect of the posterior heel, as determined by placement of the retroreflective markers. The angle measured in degrees. The participants are 74 healthy individuals (37 men and 37 women) who have no orthopedic and neurological impairment, aged from 19 to 29 years(mean 22.95). Prior to participation, each subjecct informed the procedures of experiment from researcher and assistant researcher. The equipments of this study are walking grid, marking tapes, goniometer, video camera, monitor and ink for foot print are used in the study. In order to determine the statistical significance of result, the paired t-test and Pearson correlation were applied at the 0.05 level of significance. The results were as follows : 1. The reliability of measured CTA value are showed a high correlation, ranged from .86 - .94. 2. The mean value of step width are 7.67cm in men and 6cm in women. So, significant difference between men and women in 0.05 level of significance. 3. There was significant difference between man and women's TOA(toe out angle)(p<0.05). 4. The CTA of female's is more higher than male's one, however not statistical difference between man and women(p>0.05). 5. The CTA is reduced according to increasing TOA(p<0.05).

• Physical Therapy Rehabilitation Science
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• v.5 no.3
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• pp.132-137
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• 2016

Objective: Eversion of the foot is created with internal rotation of the shank, and inversion of the foot is created with external rotation of the shank. The purpose of the study was to investigate the effect of continuous changes in the angle of the subtalar joint on lower extremity alignments. Design: Cross-sectional study. Methods: Seventeen healthy young adult subjects recruited. The subjects were asked to stand up in a natural standing position on a footplate with eye open and equal weight on each foot for 10s in two different conditions: The right subtalar joint was everted continuously $0^{\circ}-20^{\circ}$ and in separate segments of $0^{\circ}$, $5^{\circ}$, $10^{\circ}$, $15^{\circ}$, $20^{\circ}$. The averages of three trials were used. The observation of the changes in the lower extremity was performed with the use of 3-dimensional motion analysis. For data analysis, the SPSS 18.0 software using paired t-test and repeated measures analysis of variance (ANOVA) was applied. Results: The angle was significantly increased at the horizontal rotation angle of the shank, thigh, and ankle without anterior rotation of the pelvis (p<0.05). The maximum horizontal rotation angle at the thigh on $20^{\circ}$ was $-4.52^{\circ}$ in static, and $-3.10^{\circ}$ in the dynamic conditions compared to $0^{\circ}$. Conclusions: Increased unilateral foot pronation, thigh, shank, ankle horizontal rotation variance was significantly effective. The observation of the changes in foot abduction with the use of a 3-dimensional motion analysis augmented in predicting the angle values of each segment of the lower extremity. In further studies, a comparison of the right and left subtalar joints need to be investigated.

• The Journal of Korean Physical Therapy
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• v.23 no.4
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• pp.45-51
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• 2011

Purpose: To determine the correct measurement methods of the ankle joint complex range of motion for measuring the neutral position and evaluate the rater reliability. In addition, the impact of training on the rater reliability was also assessed. Methods: The subjects were eleven healthy women, who were evaluated by two physical therapists and one physical therapist recorded the results of the study. Standard goniometer was used as the measurement tool. The ankle and subtalar joint neutral position and the active range of motion of the ankle and subtalar joint were measured. Intra-rater reliability and inter-rater reliability measures were analyzed with intraclass correlation coefficients. Results: Intra-rater reliability and inter-rater reliability ranged from high to medium for the neutral position of the ankle joint complex. Intra-rater reliability for dorsiflexion and plantarflexion measurements was medium, while the inter-rater reliability was high. The range of motion of the subtalar joint was measured, and the intra-rater reliability and inter-rater reliability were low and medium, respectively Also, the intra-rater reliability was increased with formal training of the measurement techniques. Intra-rater reliability was reduced in case the raters had not undertaken the training. Conclusion: In summary, the results obtained with the measurement tools and joint measurement of position, indicate the consistency of repeated measurements made by the same observers. Under the same circumstances along with repetition of the same measurement technique during training caused an increase in the rater reliability of formally trained raters.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.2
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• pp.129-135
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• 2018

PURPOSE: The imbalance of pretibial muscles can be a factor contributing to the development of pes planus. However, no study has yet compared the muscle activity of the tibials anterior (TA) to that of the extensor digitorum longus (EDL). The purpose of this study was to determine whether there are differences in the electromyographic (EMG) TA and EDL amplitude indexes (AIs) between normal and pes planus feet. METHODS: A total of 14 subjects with normal feet and 15 subjects with bilateral pes planus participated in this study. TA and EDL muscle activities were measured using a wireless EMG system and the angles of ankle dorsiflexion and eversion of the subtalar joint were measured using a universal goniometer during active ankle dorsiflexion in the prone position. AI was calculated as follows: $\text{amplitude_{TA}-amplitude_{EDL}/(amplitude_{TA}+amplitude_{EDL})}/2{\times}100$. RESULTS: The AIs of the TA and EDL were significantly lower in pes planus feet than in normal feet (p<.05). The angle of subtalar eversion was significantly greater in pes planus feet than in normal feet during active ankle dorsiflexon (p<.05). However, there was no significant difference in the angle of ankle dorsiflexion between normal feet and pes planus feet (p>.05). CONCLUSION: This study showed that TA muscle activation was lower in pes planus feet than in normal feet, resulting from greater eversion range of motion during active ankle dorsiflexion. We suggest that the imbalance of ankle dorsiflexors must be considered in pes planus management.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.202-207
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• 2014

Purpose: The purpose of this study was to evaluate the radiological and clinical outcomes of tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail for patients with complex hindfoot problems, including Charcot arthropathy, osteonecrosis of talus, combined arthritis of the ankle and subtalar joint, failure of previous ankle arthrodesis, and failed total ankle arthroplasty. Materials and Methods: Eighteen consecutive patients (10 men and 8 women) with an average age of 54 years (range, 42~72 years) underwent tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail fixation. The mean duration of follow-up was 16 months (range, 12~23 months). Radiological evaluation included assessment of the union status of ankle and subtalar joints. Clinical evaluations included visual analogue scale (VAS) for pain and patient satisfaction, and postoperative complications were analyzed. Results: Radiological union was achieved in 14 ankle joints (77%) and 16 subtalar joints (88%) at an average of 16 weeks (range, 14~40 weeks) and 14 weeks (range, 12~24 weeks), respectively. The preoperative VAS were 4.6 (range, 4~8) at rest and 8.2 (range, 7~10) during walking, and the postoperative VAS were 2.2 (range, 0~3) and 4.6 (range, 4~6), respectively (p<0.05). There were 6 nonunions (4 ankle joints and 2 subtalar joints), 3 tibia fractures, 2 delayed union of ankle joints, and 2 breakage of the implant. Conclusion: Tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail may be considered as a viable option in patients with complex hindfoot problems.

• Journal of Korean Foot and Ankle Society
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• v.28 no.2
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• pp.60-67
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• 2024

Purpose: Sinus tarsi syndrome (STS) is caused by various pathologies. However, the exact etiology of STS remains controversial. This study evaluated the imaging and arthroscopic findings of patients who underwent surgical treatment after conservative treatment for STS failed. Materials and Methods: Between December 2014 and August 2018, 20 patients (21 cases) who underwent surgical treatment for STS were included in the study. The clinical results were analyzed using the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scale. The radiographic results were analyzed using Meary's angle, calcaneal pitch angle, and hindfoot alignment angle. The pathologic conditions of sinus tarsi were confirmed by magnetic resonance imaging (MRI) and subtalar arthroscopy. Synovitis, bone edema, and accessory anterolateral talar facet (AALTF) were evaluated on MRI. Synovial thickening, cartilage damage, interosseous talocalcaneal ligament (ITCL) and cervical ligament rupture, soft tissue impingement, AALTF, and accessory talar facet impingement (ATFI) were evaluated by subtalar arthroscopy. Results: The mean duration of symptoms was 28.7 months (4~120). All patients showed significant improvement in the VAS and AOFAS ankle-hindfoot scale. Significant improvements in hindfoot alignment angle and Meary's angle postoperatively were noted in patients who underwent medial displacement calcaneal osteotomy. MRI confirmed synovitis in all patients, AALTF in 19 cases (90.5%), and ATFI with bone edema in seven cases (33.3%). In subtalar arthroscopy, pathologic conditions were observed in the following order: synovitis in 21 cases (100%), AALTF in 20 cases (95.2%), ITCL partial rupture in nine cases (42.9%), and soft tissue impingement in seven cases (33.3%). All cases had two or more pathological conditions, and 15 (71.4%) had three or more. Conclusion: In cases of STS that do not respond to conservative treatment, a comprehensive examination of the lesions of the tarsal sinus and lesions around the subtalar joint is essential.

• Journal of the Korean Society of Radiology
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• v.7 no.2
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• pp.107-112
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• 2013

There is an Ankle Oblique(Broden' low) as an examination for the patient whose ankle was encased in orthopedic plaster. Some types of Ankle Joint coalition - Calcaneonavicular coalition, Talocalcaneal coalition and Naviculocuneiform coalition. This study is focused on the relation between Ankle Joints and the structural change of soft tissues, also finding the most proper angle to obtain good images of Ankle Joint from the patient who wore a plaster on his ankle, when we x-ray with Harris-Beath View($30^{\circ}{\sim}55^{\circ}$) - for observing Subtalar joint, Calcaneus Fracture, Subtentaculum, Tali Fracture and Talocalcaneal coalition. We intend to get the angle which makes us achieve the good image that shows Calcaneus Fracture, Subtentaculum, and Tali Fracture by changing internal angles of the patient's ankle. We evaluated the images obtained from 51 patients with PACS monitor. The result of the evaluation, subtalar joint was not seperated but opened, and Subtentaculum Tali Fracture was seen overlaid. at the angle 30, we could observe Calcaneus Fracture, Subtentaculum Tali Frature and the front part of behind side of subtalar joint well. And Calcaneo Navicularcoalition, Talocal Canealcoalition, Naviculo Cuneiform coalition condition were clearly seen at that angle. At the angle 35, we could achieve the clear images of subtalar comminuted fracture, talus, the behind joint of heel bone and get the high definition image on the degree of talocalcaneal joint separation. In addition to, We could obtain the good wide image of Sinus Tarsi. At the area of 45, We can distinguish the soft tissues from gyps separation. The outer-talus and density of the bone were definitely seen and Calcaneus is more separated than that of at the angle of 35, but this image is distorted. Calcaneus, Subtentaculum Tali show $1.20{\pm}0.414$ at the angle 25, $2.47{\pm}0.516$ at the angle 30, $2.27{\pm}0.458$ at the angle 45. This difference is statistically meaningful. (p<0.05). Including the degree of distortion, The distortion appears less at the area of $30^{\circ}$ but at the area of 40, there is heavy distortion. So, We could get the best image for making a diagnosis. At the $30{\sim}35^{\circ}$ degree for X-raying ankle. and at the $30{\sim}40^{\circ}$ for Calcaneus Fracture, Subtentaculum Tali Fracture.