• Journal of Korean Foot and Ankle Society
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• v.15 no.3
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• pp.119-123
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• 2011

This article has reviewed the alignment of the ankle and hindfoot in varus ankle osteoarthritis. The indication and surgical technique of the supramalleolar osteotomy has been reviewed. Alignment of tibial plafond and hindfoot is variable in early stages of ankle osteoarthritis. Supramalleolar osteotomy is indicated for the treatment of ankle osteoarthritis in patients with minimal talar tilt and neutral or varus heel alignment.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.12 no.2
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• pp.1-10
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• 2006

The purpose are to assess the efficacy of a contact lateral-wedged insole with strapping on the femorotibial angle in patients with varus deformity osteoarthritis of the knee after treatment period. 25 outpatients with knee osteoarthritis (OA) were randomized to be treated with a contact lateral-wedge insole with strapping. Standing radiographs were used to analyze the femorotibial angle for each subject. The result of repeated two-way ANOVA's reveled that a contact lateral-wedged insole with strapping produced significantly differences in the femorotibial angle between groups after treatment period (P<0.05). and repeated one-way ANOVA's reveled that it produced significantly differences in the femorotibial angle between experimental groups after treatment period (P<0.05). We suggest that these results may be beneficial for manufacturing foot orthotic devices, such as wedged insoles, to control medial and later compartment forces in the knee varus-valgus deformity.

• Physical Therapy Korea
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• v.14 no.3
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• pp.23-31
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• 2007

The purpose of this study was to determine the influence of high-heeled shoes on walking of obese women as it was already proven an extrinsic factor of knee osteoarthritis in women with normal weight. In this study the aimed therefore in particular was to utilize high-heeled shoes in proving it's causal influence on knee osteoarthritis by measuring the angle and torque of the knee joint. Fifteen obese women (BMI>25 $kg/m^2$) were measured in their twenties. Each angle and torque of their knee joints during walking on 6.5 cm high-heeled shoes and with a bare feet, were compared with each other and analyzed with a 3D motion analysis system. There was no significant difference in walking speed, cadence and stride length between the two conditions. However, there was a significant increase in a double limb support time and the stance phase when walking on high-heeled shoes as when walking with bare feet. The peak knee flexion angle and peak knee varus torque was higher when walking on high-heeled shoes than with bare feet. On the contrary, the peak knee flexion angle in the swing phase was not statistically different. The prolongation of peak knee varus torque was also proven. There was a significant increase in peak knee varus torque in the initial and last stance phases during walking on high-heeled shoes as compared to walking on bare feet. Through the above results, it was proven that when obese women walked on high-heeled shoes, rather than with bare feet, peak knee flexor and varus torque increased along with the changes of the in knee joint angle. Therefore, the influence of high-heeled shoes might be a significant intrinsic factor in knee osteoarthritis of obese women.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.13 no.1
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• pp.26-35
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• 2007

The purpose are to demonstrate the pain, stiffness, and physical function by the Korean Western Ontario MacMaster University(KWOMAC) score of the patients with varus deformity osteoarthritis of the knee after treatment period. Twenty outpatients with knee osteoarthritis(OA) were randomized and divided into the control(n=10) and wedge(n=10) groups. The remission scores of the KWOMAC index of severity for knee OA were compared between the groups. The result of repeated two-way ANOVA's revealed that a contact lateral-wedged insole with strapping produced significantly differences in the pain and physical function score between groups after treatment period(P<0.05), but it was not significant differences in the stiffness score between groups(P>0.05). These results suggest that the pain relief and improvement in function reported by patients with osteoarthritis while using lateral-wedged insole with strapping may be achieved by a reduction in external varus moment and medial compartment load.

• Physical Therapy Korea
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• v.11 no.4
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• pp.31-41
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• 2004

The purpose of this study was to examine the effect of the angle of a wedged insole on knee varus torque during walking. Fifteen healthy subjects were recruited. Knee varus torque was measured using three-dimensional motion analysis (Elite). Knee varus torque was normalized to gait cycle (0%: initial contact; 100%: ipsilateral initial contact) and stance phase (0%: initial contact; 100%: ipsilateral toe off). The average peaks of knee varus torque during the stance phase of the gait cycle according to the different insole angles (10 or 15 degrees) were compared using one-way ANOVA with repeated measures. The results showed that in the early stance phase, the average peak knee varus torque increased significantly for both the medial 10 and 15 degree wedged insole conditions and decreased significantly for both the lateral 10 and 15 degree wedged insole conditions as compared with no insole (p<.05). However, there were no significant differences between the 10 and 15 degree wedged insole conditions with either the medial or lateral wedged insole (p>.05). In the late stance phase, the average peak knee varus torque increased significantly for the medial 10 and 15 degree wedged insole conditions (p<.05), but not for the lateral 10 and 15 degree wedged insole conditions as compared with no insole (p>.05). We suggest that these results may be beneficial for manufacturing foot orthotic devices, such as wedged insoles, to control medial and lateral compartment forces in the knee varus-valgus deformity. Further studies of the effects of wedged insole angle on knee varus torque in patients with medial-lateral knee osteoarthritis are needed.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.11 no.1
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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.

• Journal of Biomedical Engineering Research
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• v.25 no.4
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• pp.289-293
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• 2004

In the present study, knee varus torque and mediolateral accelerations were measured using the three-dimensional motion analysis system and a linear accelerometry in odor to determine the effect of heel wedges during walking. Wedges were inclined with 10$^{\circ}$ and 15$^{\circ}$ in medial and lateral directions respectively Both knee varus torques and mediolateral accelerations showed two distinct positive peaks in loading response and preswing. Medial wedges resulted in significantly increased both knee varus torque and lateral acceleration in loading response, compared with the barefoot walking(p<0.05). On the other hand, lateral wedges decreased them in loading response(p<0.05). This became more significant for more inclined wedges. However, no significant correlations were found between knee varus torque and lateral acceleration according to the angle of heel wedges in preswing. From this study, it was found that a lateral wedge would be helpful to treat osteoarthritis, decreasing knee varus torque in loading response. In addition, lateral acceleration of the knee joint might be an alternative to determine the effect of wedges and the alignment of the knee joint during walking, instead of measuring knee torque by the three-dimensional motion analysis.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.141-146
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• 2014

Low tibial osteotomy is an extra-articular procedure that realigns the mechanical axis, restoring ankle function. It is also an alternative surgical procedure to manage early osteoarthritis of the ankle joint. This can mainly address ankle varus/valgus, as well as procurvatum/ recurvatum, internal/external rotation, equinus, calcaneus, and limb length discrepancy. The authors describe the history, mechanism, indications, and limitations of low tibial osteotomy focused on osteoarthritis of the ankle with varus malalignment reviewing several articles published thus far.

• Journal of Korean Foot and Ankle Society
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• v.21 no.4
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• pp.122-127
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• 2017

This paper reviews the indications and surgical technique of supramalleolar osteotomy as one of the treatments for moderate degenerative ankle osteoarthritis. Although it is technically demanding and requires extensive preoperative planning, supramalleolar osteotomy will be a good treatment option for moderate degenerative ankle osteoarthritis. The osteotomy is designed to shift the weight bearing axis to the lateral side of the ankle joint and unload the medial side of the joint. In our experience, a supramalleolar osteotomy is effective to the treatment of moderate ankle osteoarthritis with a small amount of preoperative talar tilt and varus or normal heel alignment.

• Knee surgery & related research
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• v.30 no.4
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• pp.311-318
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• 2018

Purpose: The purpose of this study was to evaluate changes in the coronal alignment of the knee and ankle joints after open wedge high tibial osteotomy (OWHTO) to determine factors related to the recurrence (R) of the varus deformity by serial analysis. Materials and Methods: Sixty-four OWHTOs were enrolled in this study. The weight bearing line (WBL) ratio, joint line convergence angle (JLCA), knee joint inclination, mechanical axis-tibial plateau angle, talar inclination (TI), and distal tibia articular angle (DTAA) were serially assessed. Serial correlation analysis between all parameters was performed. Patients were divided into R group and no recurrence (NR) group according to the WBL ratio (55%) at postoperative one year. Results: The preoperative WBL ratio showed significantly negative correlation with serial changes of JLCA, TI, and DTAA (p<0.05). The JLCA, TI, and DTAA as well as WBL ratio showed a significantly larger degree of varus alignment in the R group than in NR group at postoperative 6 weeks and 1 year after OWHTO (p<0.05). Conclusions: Sufficient correction of the WBL and restoration of the JLCA during OWHTO are essential to prevention of the R of varus deformity after the surgery because they are the only modifiable factors during surgery. Level of Evidence: IV, Case series.