• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.251-255
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• 2002

Purpose: Chronic subtalar instability is not common and similar to chronic ankle instability and the incidence and cause chronic subtalar instability are not well known. Recently we have experienced chronic subtalar instability without chronic ankle instability which was treated with modified Brostrom procedures. Materials and Methods: The patient is 46 year old man who has suffered from left ankle sprain for 30 years and recently aggravated more than twice a day. On subtalar stress view, 14 degree angulation of subtalar joint was noted and on anterior drawer view, 8 mm anterior displacement of left ankle was seen. Results: In operation, there was no anterior talofibular ligament abnormility but calcaneofibular ligament loosening was found. Ligament reconstruction was performed using modified Brostrom procedure. At 12 months after operation, the patient complains no pain and no limit of motion and no instability. Conclusion: We experienced chronic subtalar instability without ankle instability treated with modified Brostrom procedures. No instability was found after treatment without complication.

• Journal of Korean Foot and Ankle Society
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• v.25 no.1
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• pp.38-45
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• 2021

Subtalar joint instability (STI) is one of the causes of persistent hindfoot pain even after treatment for ankle instability. Diagnosis of STI is often neglected because it is a poorly understood concept. However, understanding of the anatomy and injury mechanism of the subtalar joint is a prerequisite of appropriate treatment. Patients with STI usually complain of several symptoms, such as recurrent sprains or a giving way sensation and rolling over. Recently, various diagnostic tools and treatment methods have been investigated. This study was undertaken with the aim of helping clinicians by providing a comprehensive understanding of STI.

• Journal of Korean Foot and Ankle Society
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• v.20 no.4
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• pp.192-195
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• 2016

Diffuse pigmented villonodular synovitis (PVNS) involving ankle joint needs complete mass excision and total synovectomy to reduce recurrence rate, while surrounding ligaments can be easily damaged. So the concurrent ligament reconstruction should be considered for post-excisional instability in subtalar joint as well as lateral ankle joint. We describe our experience in the management of a diffuse type PVNS, invades lateral talocrural joint extended to subtalar joint and introduce a new technique of all-in-one reconstruction for anterior talofibular,calcaneofibular and cervical ligament. Our new reconstruction technique applying modified Chrisman and Snook technique is useful in stabilization for deficiencies of the ligament complexafter PVNS excisionat lateral ankle and subtalar joint.

• Korean Journal of Applied Biomechanics
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• v.29 no.2
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• pp.61-70
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• 2019

Objective: This study aimed to investigate the characteristics of the declination of the subtalar joint rotation axis and the structural features of the ankle joint complex such as rear-foot angle alignment and ligament laxity test between chronic ankle instability (CAI) patients and healthy control. Method: A total of 76 subjects and CAI group (N=38, age: $23.11{\pm}7.63yrs$, height: $165.67{\pm}9.54cm$, weight: $60.13{\pm}11.71kg$) and healthy control (N=38, age: $23.55{\pm}7.03yrs$, height: $167.92{\pm}9.22cm$, weight: $64.58{\pm}13.40kg$) participated in this study. Results: The declination of the subtalar joint rotation axis of the CAI group was statistically different from healthy control in both sagittal slope and transverse slope. The rear-foot angle of CAI group was different from a healthy control. Compared to healthy control, they had the structure of rear-foot varus that could have a high occurrence rate of ankle varus sprain. CAI group had loose ATFL and CFL compared to the healthy control. Conclusion: The results of this study showed that the deviation of the subtalar joint rotation axis and the structural features of the ankle joint complex were different between the CAI group and the healthy control and this difference is a meaningful factor in the occurrence of lateral ankle sprains.

• Korean Journal of Radiology
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• v.22 no.3
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• pp.384-394
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• 2021

Objective: To quantitatively assess biochemical alterations in the cartilage of the subtalar and midtarsal joints in chronic lateral ankle instability (CLAI) patients with isolated anterior talofibular ligament (ATFL) injuries and combined calcaneofibular ligament (CFL) injuries using MRI T2 mapping. Materials and Methods: This study was performed according to regulations of the Committee for Human Research at our institution, and written informed consent was obtained from all participants. Forty CLAI patients (26 with isolated ATFL injuries and 14 with combined ATFL and CFL injuries) and 25 healthy subjects were recruited for this study. All participants underwent MRI scans with T2 mapping. Patients were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) rating system. The subtalar and midtarsal joints were segmented into 14 cartilage subregions. The T2 value of each subregion was measured from T2 mapping images. Data were analyzed with ANOVA, the Student's t test, and Pearson's correlation coefficient. Results: T2 values of most subregions of the subtalar joint and the calcaneal facet of the calcaneocuboid joint in CLAI patients with combined CFL injuries were higher than those in healthy controls (all p < 0.05). However, there were no significant differences in T2 values in subtalar and midtarsal joints between patients with isolated ATFL injuries and healthy controls (all p > 0.05). Moreover, T2 values of the medial talar subregions of the posterior subtalar joint in patients with combined CFL injuries showed negative correlations with the AOFAS scores (r = -0.687, p = 0.007; r = -0.609, p = 0.021, respectively). Conclusion: CLAI with combined CFL injuries can lead to cartilage degeneration in subtalar and calcaneocuboid joints, while an isolated ATFL injury might not have a significant impact on the cartilage in these joints.

• Korean Journal of Applied Biomechanics
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• v.17 no.1
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• pp.135-144
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• 2007

The purpose of this study was to identify the effect of the subtalar sling ankle taping, by measuring changes in peak plantar pressure and subtalar angle during jump landing and walking in healthy subjects with subtalar sling ankle taping applied of the ankle joint. Fifty healthy subjects(8 males and 7 female, aged 22 to 25) were randomly divided into a participated in this study. They were free of musculoskeletal injury and neurologic deficit in lower extremity. The subjects were asked to perform 5M walking and single leg jump landing by under the guidance of physical therapists. Subtalar motions were typically measured as the angle made between the posterior aspect of the calcaneous and the posterior aspect of the lower leg during walking with taping or not. This measurement were made using a video system (30Hz sampling rate, rectified 60 Hz sampling rate). At the same time, peak lateral and vertical pressure were investigated using pressure distribution platforms(MatScan system) under foot during walking and single leg jump landing with taping or not. Statistical analysis was done by paired t-test and intraclass correlation coefficient [ICC(3.1)], using software SPSS. We have recently demonstrated significantly altered patterns of subtalr joint and peak plantar pressure when applied subtalar sling ankle taping(p<.05). Inversion angle of subtalar joint significantly decreased with taping(p<.05). The result suggest that pressure patterns observed in subjects are likely to result due to significant decrease in stress on ankle joint structures during jump landing and walking. Also, the result that the subtalar sling ankle taping procedure provides greater restiction of motion associated with ankle inversion. However, this study involved asymptomatic subjects without history of ankle inversion injury, further research is needed to assess the motion restraining effect of the subtalar sling ankle taping in subjects with lateral ankle instability.

• Korean Journal of Applied Biomechanics
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• v.31 no.3
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• pp.168-175
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• 2021

Objective: To investigate the static and dynamic analysis of ankle joint complex between subjects with chronic ankle instability (CAI) and healthy controls. Method: A total of 38 subjects and CAI group (N=19) and healthy control (N=19) participated in this first study. Variables that were measured in this study were as follows: 1) Subtalar joint axis inclination and deviation 2) Rearfoot angle 3) Navicular drop test 4) Heel alignment view in alignment analysis. Intra Correlation Coefficient (ICC) is used for reliability. A secondary 17 subjects are recruited including 9 of CAI and healthy for gait analysis between group. Lower extremity sagittal, frontal, and transverse kinematics were measured. All data were analyzed to ensemble curve analysis. Results: 1) There were statistically significant differences in standing rearfoot, navicular drop, heel alignment view, subtalar joint (STJ) inclination and deviation. 2) Only in sagittal, meaningful difference is showed during walking in gait analysis. Conclusion: Morphological problem can affect ankle sprain in aspect of structure with no relation to compensation of neuromuscular.

• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.49-54
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• 2018

Ankle sprains are among the most common injuries sustained during athletic activities and daily life. Acute ankle sprain is usually managed conservatively with functional rehabilitation but the failure of conservative treatment leads to the development of chronic ankle instability. The development of repetitive ankle sprains and persistent symptoms after injury has been termed chronic ankle instability. Acute ankle sprains and chronic ankle instability require a careful evaluation to detect other comorbidities, such as subtalar instability, osteochondral defect, peroneal tendinopathy, tarsal coalition, os trigonum, flexor hallucis longus tendinitis, calcaneus anterior process fracture, and neural injuries. For the successful treatment of acute ankle sprains and chronic ankle instability, the treatment of comorbidity lesions should be performed first.

• The Journal of Korean Physical Therapy
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• v.21 no.2
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• pp.97-101
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• 2009

Purpose: This study examined how the direction of carrying a load affects the foot stability and kinesiology while walking. Methods: The heel rotation, Hallux stiffness, foot balance, metatarsal load, toe out angle, subtalar joint flexibility were measured in 40 adults (men and women) who carried a load back and forth, walking on a 2-meter-long board. The measurement was carried out three times and the mean of the measurements was used to compare the difference between the front, back and the condition without a load. Results: While walking, heel rotation and hallux stiffness occurred most when a front load was applied compared to a back load or no load condition (p<0.05). A metatarsal load also appeared to be the highest with the frond load, but there was no significant difference in the balance of the whole foot. Both the toe out angle and subtalar joint flexibility appeared to increase significantly (p<0.05). Conclusion: Applying the front load causes subtalar joint instability and increases the plantar foot pressure imbalance during walking.

• Journal of Korean Foot and Ankle Society
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• v.22 no.3
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• pp.91-94
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• 2018

Ankle sprain is one of the most common musculoskeletal injuries. Although most ankle sprains respond well to conservative measures, chronic instability following an acute sprain has been reported to occur in 20% to 40% of patients. Some individuals are eventually indicated for a lateral ankle ligament reconstruction due to persistent ankle instability. More than 80 surgical procedures have been described to address lateral ankle stability. These range from direct repair of the anterior talofibular ligament (ATFL) and of the calcaneofibular ligament (CFL) to reconstructions based on the use of autograft or allograft tissues. However, the best surgical option remains debatable. The modified $Brostr{\ddot{o}}m$ procedure is most widely used for direct ligament repair, but not always possible because of the poor ATFL or CFL quality or deficiency of these ligaments, which prevents effective shortening imbrication. Furthermore, the importance of a CFL reconstruction has been emphasized recently. On the other hand, it is difficult to achieve an efficient CFL reconstruction during the $Brostr{\ddot{o}}m$ procedure. Others have reported that an anatomic reconstruction of injured ligaments restores the normal resistance to anterior translation and inversion without restricting subtalar or ankle motion, and as a result, anatomic reconstructions for lateral ankle instability utilizing an autograft or allograft tendon have gained popularity.