• Physical Therapy Korea
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• v.23 no.3
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• pp.21-28
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• 2016

Background: The toe-spread-out (TSO) exercise has been introduced as a strengthening exercise for the abductor hallucis muscle in subjects with hallux valgus. Visual biofeedback using ultrasound imaging during exercise, may increase the ability to selectively contract the abductor hallucis muscle, compared with exercise alone. Objects: The aim of this study was to investigate the effects of ultrasound imaging visual feedback during the TSO exercise with respect to its influence on the angle of the first metatarsophalangeal joint (1st MPJ) and the cross-sectional area (CSA) of the abductor hallucis muscle in subjects with hallux valgus. Methods: Twenty-five healthy young subjects with a mean average age of 22.5 years, and a standard deviation of 2.3 years, were recruited for this study. Hallux valgus was defined as an angles greater than $15^{\circ}$ angle of 1st MPJ. Goniometric measurement was used to determine the angle of 1st MPJ. In addition, an ultrasound system was used to collect the CSA of the abductor hallucis muscle in each foot. The angle of the 1st MPJ and CSA of the abductor hallucis were measured in three positions; the resting position, during TSO exercise, and during TSO exercise in conjunction with real-time ultrasound imaging feedback. All data analyzed using a repeated analysis of variance with Bonferroni correction in order to compare the dependent variables in all three positions. Statistical level of significance was set up as p<.05. Results: The angle of the 1st MPJ was noted to be significantly reduced and the CSA of the abductor hallucis to be significantly greater during TSO exercise used in conjunction with ultrasound imaging visual feedback, compared to when the values were recorded during TSO exercise alone (p<.05). Conclusion: Based on these findings, it can be concluded that the application of ultrasound imaging visual feedback during TSO exercise is more effective in contracting selectively the abductor hallucis than the use of exercise alone.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.2
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• pp.121-128
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• 2020

PURPOSE: This study examined the changes in the cross-sectional area (CSA) of the abductor hallucis muscle during various ankle positions while performing toespread-out (TSO) exercise. METHODS: Thirty subjects with an average age of 22.1 years were recruited for this study. All subjects were firstly measured for the angle of their first metatarsophalangeal joint using a goniometer. Those with angles greater than 15° were allocated to the HV group. The remaining subjects were placed in the normal group. The CSA of the abductor hallucis was measured by ultrasound in the resting position with no movement and three ankle positions: neutral (0°), plantarflexion (30°), and dorsiflexion (30°). All data were analyzed using a two-way mixed analysis of variance between the groups (normal and HV group) and within the groups (resting, neutral, plantarflexion, and dorsiflexion) to determine the group x position interaction effects. RESULTS: During TSO exercise in the normal group, the CSA of the abductor hallucis was significantly greater in both the plantarflexion and neutral positions compared to the resting position (p_adj < .01), and plantarflexion was significantly greater than the dorsiflexion position (p_adj < .01). During the TSO exercise in the HV group, the CSA of the abductor hallucis for plantarflexion was significantly greater than it was for the resting, neutral, and dorsiflexion positions (p_adj < .01). CONCLUSION: Based on the above results, the TSO exercise in plantarflexion is an effective rehabilitation exercise for subjects with HV.

• Physical Therapy Korea
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• v.27 no.3
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• pp.206-211
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• 2020

Background: The longitudinal arch is important for individuals with pes planus. The toe spread out exercise (TSO) has been widely used to continuously support the longitudinal arch by increasing the abductor hallucis (AbdH) muscle activation. However, the AbdH muscle is commonly lack of the sufficient activation during the TSO especially in individuals with pes planus. Objects: This study was performed to investigate the effect of arch support on the muscle activity and strength of the AbdH during TSO in standing position in individuals with pes planus. Methods: Twenty subjects with pes planus between 20 and 30 years of age participated in this study. The muscle activity and strength of the AbdH were measured using surface EMG system and the Smart KEMA tensiometer system. The AbdH muscle was evaluated during TSO between individuals with and without longitudinal arch support in standing position. The longitudinal arch was supported by using the insole. The paired t-test was used. The level of statistical significance was set at α = 0.05. Results: The muscle activity and strength of the AbdH during TSO with arch support in standing position was significantly greater than that without arch support. Conclusion: The muscle activity and strength of the AbdH during TSO in standing position can be influenced by the longitudinal arch support in individuals with pes planus. The AbdH strengthening during TSO in standing with arch support can be recommended especially in individuals with pes planus in the clinical settings.

• PNF and Movement
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• v.16 no.3
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• pp.441-449
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• 2018

Purpose: This study aimed to compare the impact of proprioceptive neuromuscular facilitation leg patterns emphasizing hallux abduction (PNF-LPHA) on the intrinsic foot muscles of participants with hallux valgus (HV) using the toe-spread-out exercise (TSO). Methods: The present study recruited 12 individuals with HV. All the participants voluntarily agreed to participate in the study after hearing explanations of its purpose and process. All participants performed the TSO, PNF-LPHA 1, and PNF-LPHA 2. The participants' abductor hallucis (AbH), adductor hallucis (AdH), extensor hallucis longus (EHL), and flexor hallucis brevis (FHB) activity was measured, and the ratio of AbH:AdH was measured during the three interventions using electromyography. Additionally, the participants' AbH thickness was measured by ultrasonography. An intraclass correlation coefficient (ICC) was used to verify the intra-rater reliability of ultrasonography at rest and during contraction. Results: The intra-rater reliability was excellent at rest and during contraction ($ICC_{3,1}=0.90$ and $ICC_{3,1}=0.83$, respectively). There were no statistically significant differences in the activity of the AbH, the ratio of AbH: AdH, and the thickness of AbH between the TSO and PNF-LPHA2 groups. Additionally, EHL activity was significantly higher in the PNF-LPHA2 group than in the TSOgroup. Conclusion: PNF-LPHA 2 can be recommended as a method to optimize AbH and EHL activity, the ratio of AbH:AdH, and the thickness of AbH in individuals with HV.

• Physical Therapy Korea
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• v.31 no.1
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• pp.63-71
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• 2024

Background: Individuals with pes planus tend to overuse the extrinsic foot muscles, such as the tibialis anterior (TA) and peroneus longus (PL), to compensate for the weakened intrinsic foot muscles, such as the abductor hallucis (AbdH). Furthermore, differences in weight-bearing can affect the activity of muscles in both the intrinsic and extrinsic foot muscles. To date, no study has compared the effects of the short foot exercise (SFE) and toe spread-out exercise (TSO) on intrinsic and extrinsic foot muscle activity and the corresponding ratios in different weight-bearing positions. Objects: To compare the effects of the SFE and TSO on AbdH, TA, and PL activity and the AbdH/TA and AbdH/PL activity ratios in the sitting and standing positions in individuals with pes planus. Methods: Twenty participants with pes planus were recruited. Surface electromyography was used to assess the amplitudes of AbdH, TA, and PL activity. Participants performed both exercises while adopting both the sitting and standing positions. Results: No significant interaction between exercise and position was found regarding the activity of any muscle or ratio of the activity, except for PL activity. We observed a significant increase in AbdH activity during the TSO compared to the SFE, and no significant difference in TA and PL activity between the two exercises. AbdH, TA, and PL activity were significantly higher in the standing position than in the sitting position. Furthermore, the AbdH/PL activity ratio significantly increased in the sitting position, although there was a significant increase in AbdH activity in the standing position. Conclusion: In individuals with pes planus, we recommend performing the TSO in the sitting position, which may increase the activity of the AbdH while concurrently decreasing the activity of the TA and PL, thus strengthening the AbdH.