• Physical Therapy Korea
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• v.22 no.2
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• pp.1-10
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• 2015

The common features of walking in patients with stroke include decreased gait velocity and increased asymmetrical gait pattern. The purpose of this study was to identify important factors related to impairments in gait velocity and asymmetry in chronic stroke patients. The subjects were 30 independently ambulating subjects with chronic stroke. The subjects' impairments were examined, including the isokinetic peak torque of knee extensors, knee flexors, ankle plantarflexors, and ankle dorsiflexors. Passive and active ranges of motion (ROM) of the ankle joint, ankle plantarflexor spasticity, joint position senses of the knee and ankle joint, and balance were examined together. In addition, gait velocity and temporal and spatial asymmetry were evaluated with subjects walking at their comfortable speed. Pearson correlations and multiple regressions were used to measure the relationships between impairments and gait speed and impairments and asymmetry. Regression analyses revealed that ankle passive ROM and peak torque of knee flexors were important factors for gait velocity ($R^2=.41$), while ankle passive ROM was the most important determinant for temporal asymmetry ($R^2=.35$). In addition, knee extensor peak torque was the most significant factor for gait spatial asymmetry ($R^2=.17$). Limitation in ankle passive ROM and weakness of the knee flexor were major contributors to slow gait velocity. Moreover, limited passive ROM in the ankle influenced the level of temporal gait asymmetry in chronic stroke patients. Our findings suggest that stroke rehabilitation programs aiming to improve gait velocity and temporal asymmetry should include stretching exercise for the ankle joint.

• The Journal of Korean Physical Therapy
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• v.32 no.4
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• pp.238-244
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• 2020

Purpose: This study compared the effects of the fascial distortion model (FDM), foam rolling (FR), and self-stretching (SS) on the ankle dorsiflexion range of motion (ROM). Methods: Thirty subjects who had no more than 30° of ankle dorsiflexion ROM at the weight-bearing lunge test were recruited in this study. They were divided into three groups: (FDM, FR, and SS), and underwent each intervention for five minutes. Before and after the intervention, the ankle dorsiflexion ROM in the supine (the open-) and standing (the closed-kinetic chain) of the subjects were tested. The changes in the ROM between pre- and post-intervention and among the groups were analyzed. Results: All groups showed increased ankle dorsiflexion ROM after the intervention in both positions. In the position of the open kinetic chain, the changes in the ROM between pre- and post-intervention had significant differences among the groups, and the FDM was higher than the FR and SS. In the position of the closed kinetic chain, the ROM after the interventions and the changes in the ROM had significant differences among the groups, and FDM was higher than the FR (ROM after the intervention, the change in ROM) and SS (the change in ROM). Conclusion: These findings showed that FDM had more efficiency than the FR and SS as FDM had a stronger effect on increasing ankle dorsiflexion in a short, limited time. Clinicians who have limited time to treat their patients, particularly trying to increase ankle dorsiflexion ROM, should consider the application of FDM.

• Korean Journal of Applied Biomechanics
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• v.25 no.4
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• pp.401-412
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• 2015

Objective : The purpose of this study is to evaluate the effects of hip joint exercises and orthotics on RCSP, ankle's range of motion, and core muscle strength of middle school students with pes planus. Method : Out of the original pool of 200 students, 60 students with pes planus (RCSP < -2) were selected for the study. The selected 60 students were then divided into four groups. The first group was a combined orthotics and exercise group (12 students), the second was the orthotics-only group (9 students), the third was the exercise-only group (8 students), and the last was the control group (10 students). Exercise groups worked out twice a week for 60 minutes per session over 8 weeks. The independent variables were corrective hip joint exercises and orthotics. The dependant variables consisted of kinematic and kinetic variables. The kinematic variables were RCSP, and ankle's range of motion (dorsiflexion and plantarflexion). The kinetic variables were muscles forces that consist in core muscle strength, which are hip joint adduction, abduction, and flexion muscles forces. Statistical analysis was performed via SPSS 18.0 with multivariate analysis of covariance (MANCOVA) and a paired t-test was used. Results : The left foot was more responsive to the treatments, both exercise and orthotics, than the right foot. RCSP improved significantly in the left foot for the first and third groups. Only the first group significantly improved hip joint adduction, abduction, and flexion muscles' strengths. As for the ankle's range of motion of the left foot, plantarflexion showed improvement when treated with exercise, orthotics, or both. Conclusion : This study found that exercise is more effective in correcting RCSP and foot orthotics is more effective in reinforcing core muscle strength. Future studies should expand on these results to examine the relationship between the ankle, hip, and pelvis.

• Physical Therapy Rehabilitation Science
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• v.4 no.2
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• pp.66-72
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• 2015

Objective: The aim of this study was to investigate the effect of balance training with plantar flexor stretching on ankle dorsi flexion range of motion (ROM), balance, and gait ability in stroke patients. Design: A randomized controlled pilot trial. Methods: Thirty stroke patients volunteered to participate in this study. The subjects were randomly allocated to two groups: the experimental group (n=15) received the neurodevelopment therapy plus balance training with plantar flexor stretching for 20 minutes in one session. The control group (n=15) received the same neurodevelopment therapy plus plantar flexor static stretching for 20 minutes in one session. Both groups underwent sessions four times a week, for a total of 4 weeks. Measurements included passive range of motion (PROM), active range of motion (AROM) of ankle dorsiflexion using a goniometer, timed up and go (TUG), the functional reaching test (FRT), and the 10 m walk test (10 MWT). Results: There were significant improvements in AROM and PROM of ankle dorsiflexion, TUG, and FRT scores after the intervention in the experimental group (p<0.05). However, the control group showed no statistically significant differences except for PROM of ankle dorsiflexion. The experimental group showed a significant improvement in PROM, TUG, and FRT scores compared to the control group (p<0.05). Conclusions: Balance training with plantar flexor stretching improves ankle dorsiflexion ROM and balance ability in patients with stroke. Therefore, this therapeutic intervention will be effective for rehabilitation of stroke patients in the clinical setting.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.21 no.2
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• pp.53-62
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• 2015

Background: This study was to investigate the effect of 8-weeks medical exercise therapy on ankle pain, range of motion, stress symptom after traumatic injury, and depression, in a 51 years old stroke patient with right ankle joint inflammation. Method: The 8-weeks medical exercise therapy program was applied to 4 grades of Dosage 1 (1-3 weeks), Dosage 2 (4-5 weeks), Dosage 3 (6-7 weeks), and Dosage 4 (8 weeks) on right ankle joint inflammation in a female with right hemiplegia admitted to D hospital located in Gyeonggi-do. Result: The findings showed that visual analogue scale (VAS) scores improved from 8 to 0-1 scores, passive range of motion (ROM) increased to 5 degrees more than before, Korean-version impact of event scale-revised (IES-R-K) scores increased from 61 to 31 scores, and Korean-version beck depression inventory II (BDI-II-K) scores decreased from 51 to 17 scores. As such, the 8-week medical exercise therapy program may decrease the pain, increase ROM, improve stress after traumatic injury, and improve depression symptom. Conclusion: The presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms. It is possible to apply the medical exercise therapy for modulating pain experience and treating pain. Also, it may be effective methods to treat the psychological aspects of pain.

• Physical Therapy Korea
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• v.21 no.1
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• pp.55-62
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• 2014

For professional drivers, there is a possibility to have musculoskeletal disorders on ankle joint due to repetitive pedaling operation. Therefore, this study have focused to examine ankle active range of motion (AROM), dorsiflexor strength, and pressure pain threshold (PPT) of tibialis anterior muscle (TA) in taxi drivers compared to a age-matched control group. Thirty male taxi drivers with at least 10 years of driving experience and thirty male sedentary workers were evaluated for ankle AROM, dorsiflexor strength, and PPT of TA. Multiple independent t-tests were used to identify significant differences between two groups. For the results, taxi drivers had significantly less AROM in dorsiflexion and greater AROM in external tibial rotation compared to the control group. Also, dorsiflexor strength and PPT of TA in taxi drivers was significantly lower than in the control group. This study indicates that the repetitive ankle movements associated with driving have an effect on ankle AROM, dorsiflexor strength, and PPT of TA and may lead to work-related musculoskeletal disorders on ankle. Professional drivers may need to be educated to prevent a potential musculoskeletal disorders associated with repetitive movement.

• Journal of Korean Foot and Ankle Society
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• v.21 no.1
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• pp.21-26
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• 2017

Purpose: To evaluate the clinical outcome of an operation with early rehabilitation from ankle fracture in accordance with the injury type. Materials and Methods: A total of 136 patients (70 males and 66 females) who underwent surgery and early rehabilitation for ankle fractures between December 2008 and December 2013 were retrospectively reviewed. The average age was 47.9 years, with a range of 18~79 years. The mean follow-up period was 28.7 months, with a range of 24~102 months. All patients were classified in accordance with the Lauge Hansen classification and anatomic fracture site. Moreover, the presence of ligament injuries were documented. A short-leg cast was applied postoperatively for two weeks; thereafter, patients began the range-of-motion exercises after cast removal. Full weightbearing was allowed at 2 weeks postoperatively. Each patient was assessed radiologically and clinically based on the OlerudMolander score, visual analogue scale (VAS) for pain, joint stiffness, and capability of single heel raising. Results: Seventeen patients (12.5%) complained of postoperative pain (VAS score 1~3), and the incidence was higher in patients with trimalleolar fractures or associated ligament injuries. Twenty-three patients (16.9%) complained of postoperative ankle stiffness. The mean Olerud-Molander score was 75.4/80 (range, 55~80). Olerud-Molander scores were lower in patients with ligament injuries than in those with fracture alone. There was no nonunion or fracture displacement even after early weightbearing walking. Conclusion: In this retrospective series, early rehabilitation after surgical restoration of ankle mortise by anatomical reduction and stabilization was shown to be successful. Earlier motion exercise and weightbearing walking can minimize fracture complications like joint stiffness or weakness in ankle fracture.

• Journal of Korean Physical Therapy Science
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• v.15 no.4
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• pp.27-34
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• 2008

Background: This study was designed to analyze Repetitive dorsiflexion exercises in ankles have effects on the active range of flexion and extension motion through lumbar, cervical spine and ankle, wrist joints. Methods: 30 female college students in their twenties who frequently wear high heels participated the number of the experimental group was 15 persons and the number of the control group was 15 persons. They did exercise at the physical therapy room in M college, from the 8th of March to the 11th of April 2007. The experimental group had used the model of dorsiflexion repetitive exercise three times per week, for 4 weeks, but the control group did not exercise at all. In the sagittal plane active ROM of the these spine and joints were measured before and after the experiment using a digital goniometer. The results of two groups were compared and analyzed using paired T-test. Results: The active range of flexion and extension motion of the vertebra(especially lumbar flexion) and distal joints were significantly different in exercise group(p<.05). Conclusion: The model of repetitive dorsiflexion exercise of the ankle joint had positive effects on improving the active range of flexion and extension motion of the lumbar vertebra and distal joints of limbs. The results suggest that the repetitive dorsiflexion exercise is useful and also effective therapy for improving motion in women usually wearing high-heel.

• Journal of International Academy of Physical Therapy Research
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• v.7 no.2
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• pp.1025-1030
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• 2016

The purpose of this study was to investigate the effects of combined wedge on the range of motion in ankle and knee joint, ankle eversion moment and knee adduction moment, and center of pressure excursion of foot for genu varus among adult men during gait. This study was carried out with 10 adult men for genu varus in a motion analysis laboratory in J university. The subjects of the experiment were measured above 5cm width between the knees on contact of both medial malleolus of ankle while standing. The width of their knees in neutral position was measured without the inversion or eversion of the subtalar joint by the investigator. The subjects of the experiment were ten who were conducted randomly for standard insole, insole with $10^{\circ}$ lateral on rear foot wedge, insole at $10^{\circ}$lateral on rear foot and $5^{\circ}$ medial on fore foot wedge. Before and after intervention, changes on the range of motion in ankle and knee joint, ankle eversion moment and knee adduction moment, and center of pressure excursion were measured. In order to compare analyses among groups; repeated one-way ANOVA and $Scheff{\acute{e}}$ post hoc test were used. As a result, combined wedge group was significantly decreased compared to control wedge group in terms of knee varus angle in mid-stance(p<.05). Combined wedge group was significantly decreased compared to lateral wedge group in terms of ankle eversion moment in whole stance(p<.05). Combined wedge group was significantly decreased compared to lateral wedge group in terms of knee adduction moment in whole stance(p<.05). Combined wedge group was significantly decreased compared to lateral wedge in terms of center of pressure excursion in whole stance(p<.05). The results of this study suggest that combined wedge for genu varus decreased ankle eversion moment and knee adduction moment upon center of pressure excursion. We hypothesize that combined wedge may also be effective in the protection excessive ankle pronation.

• Physical Therapy Korea
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• v.25 no.2
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• pp.22-29
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• 2018

Background: Deficits of both ankle dorsiflexion range of motion (DFROM) and dynamic balance are shown in persons with chronic ankle instability and the elderly, with the risk of falls. Objects: This study aims to investigate the relationship between DFROM and dynamic balance in elderly subjects and young adults. Methods: Fifty-nine subjects were divided into three groups: ankle stability young group (SY), ankle instability young group (IY) and ankle stability older group (SO). We recruited three old subjects with ankle instability, but excluded them during a pilot testing due to the safety issue. DFROM was measured by weight bearing lunge test (WBLT) and dynamic balance was measured via star excursion balance test (SEBT) in anteromedial, medial, and posteromedial directions. The group differences in WBLT and SEBT and each group's correlation between WBLT and SEBT were detected using the R statistical software package. Results: The dorsiflexion range of motion was significantly different between the SY, IY, and SO groups. The SO group showed the highest DFROM and IY group showed the lowest DFROM (SY: $45.88{\pm}.66^{\circ}$, IY: $39.53{\pm}1.63^{\circ}$, SO: $47.94{\pm}.50^{\circ}$; p<.001). However, the SO group showed the lowest dynamic balance score for all SEBT directions (SY: $87.24{\pm}2.05cm$, IY: $83.20{\pm}1.30cm$, SO: $77.23{\pm}2.07cm$; p<.05) and there was no relationship between the dorsiflexion range of motion and dynamic balance in any group. Conclusion: Our findings suggest that ankle DFROM is not a crucial factor for dynamic stability regardless of aging and ankle instability. Other factors such as muscle strength or movement coordination should be considered for training dynamic balance. Therefore, we need to establish the rehabilitation process by measuring and treating ROM, balance, and muscle strength when treating young adults with and without ankle instability as well as elderly people.