Citations
Citations
Citations
Citations
Citations
Citations
Citations
Citations
To investigate the differences in biomechanical parameters measured by gait analysis systems between healthy subjects and subjects with plantar fasciitis (PF), and to compare biomechanical parameters between ‘normal, barefooted’ gait and arch building gait in the participants.
The researchers evaluated 15 subjects (30 feet) with bilateral foot pain and 15 subjects (15 feet) with unilateral foot pain who had a clinical diagnosis of PF. Additionally, 17 subjects (34 feet) who had no heel pain were recruited. Subjects were excluded if they had a traumatic event, prior surgery or fractures of the lower limbs, a leg length discrepancy of 1 cm or greater, a body mass index greater than 35 kg/m2, or had musculoskeletal disorders. The participants were asked to walk with an arch building gait on a treadmill at 2.3 km/hr for 5 minutes. Various gait parameters were measured.
With the arch building gait, the PF group proved that gait line length and single support line were significantly decreased, and lateral symmetry of the PF group was increased compared to that of the control group. The subjects with bilateral PF displayed significantly increased maximum pressure over the heel and the forefoot during arch building gait. In addition, the subjects with unilateral PF showed significantly increased maximum pressure over the forefoot with arch building gait.
The researchers show that various biomechanical differences exist between healthy subjects and those with PF. Employing an arch building gait in patients with PF could be helpful in changing gait patterns to normal biomechanics.
Citations
To see how people think about their own feet, and evaluate whether there are correlations among self-awareness of the participants and clinical examination findings.
Adult twins and their families who participated in the Healthy Twin study from May 2008 to April 2010 were recruited. Participants were asked whether they thought their feet were normal, flat, or cavus. The lateral talometatarsal angles were measured on foot X-rays to determine the foot arch height. Using the podoscopic footprints taken with the podobaroscope, the Staheli arch index was also measured. Kappa statistics were used to calculate degree of agreement among the three measurement methods.
Self-awareness and radiographic findings were significantly different (Pearson chi-square test, p=0.000) and only slightly agreed (kappa measure of agreement=0.136, p=0.000). Self-awareness and podoscopy results revealed a significant difference (Pearson chi-square test, p=0.000), with only slight agreement (kappa measure of agreement=0.072, p=0.000).
There is significant disagreement between patients' perception of their feet and actual test results. Many people may have an incorrect assumption about their own foot conditions that may be reflected in improper management. Dissemination of accurate information about foot disorders by foot clinicians would be helpful.
Citations
To clarify the relationship of the initial radiologic and a biomechanical parameter at first clinical visit, and define the effectiveness of modified insole, following insole fitting in children with flexible flatfoot.
Children aged less than 13 years with flexible flatfoot were enrolled. The total number of subjects was 66 (33 boys, 33 girls). The subjects were divided into 5 subgroups, based on age: 1–2, 3–4, 5–6, 7–9, and 10–12 years. The mean time period between the initial & final examination for their resting calcaneal stance position angle (RCSPA) was 24 months. Radiography quantified the deformity by measuring angles, including the talometatarsal angle, the metatarsal angle, and the calcaneal pitch angle.
From the angles measured on radiographs, only the talometatarsal angle showed a statistically significant correlation to the initial RCSPA (r=-0.578 for right side, r=-0.524 for left side; p<0.01). The mean RCSPA improved in all subgroups of subjects following insole fitting. Moreover, in children younger than 7 years, the improvement in RCSPA from the insole fitting was greater compared to children aged 7 years and older.
The insole has additionally beneficial effects in all populations younger than 13 years. However, there might exist a hidden effect of normal structural pedal alignment during growth accompanied with bony maturation and developmental process. To date, it is controversial whether the treatment of flexible flatfoot is necessary in the vast majority of cases, or simple observation and advice to parents would suffice.
Citations
To assess the effectiveness of the resting foot splint to prevent ankle contracture.
We performed a randomized controlled trial in 33 patients with brain injury with ankle dorsiflexor weakness (muscle power ≤grade 2). Both groups continued conventional customized physical therapy, but the patients in the foot splint group were advised to wear a resting foot splint for more than 12 hours per day for 3 weeks. The data were assessed before and 3 weeks after the study. The primary outcome was the change in ankle dorsiflexion angle after 3 weeks.
Before the study, there were no differences between groups in gender, age, time post-injury, brain injury type, initial edema, spasticity, passive range of ankle dorsiflexion, Fugl-Meyer score (FMS), or Functional Ambulation Classification. A significant improvement in ankle dorsiflexion angle, and FMS was found after 3 weeks in both groups. The splint group showed more spasticity than the control group after 3 weeks (p=0.04). The change of ankle dorsiflexion angle, foot circumference, spasticity, and FMS after adjusting initial value and spasticity were not significantly different between the 2 groups.
Wearing a resting foot splint for 3 weeks did not affect joint mobility in patients with subacute brain injury regularly attending personalized rehabilitation programs. Further studies of larger sample sizes with well controlled in spasticity are required to evaluate the effects of the resting foot splint.
Citations
To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis.
A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic technique to control foot overpronation. Pain questionnaire was used to obtain pain sites, degree, and frequency. Balancing ability was determined using computerized posturography. These evaluations were performed prior to custom-molded foot orthoses, 1 month, and 3 months after fitting foot orthoses.
Of 24 children with symptomatic flexible flat feet recruited for this study, 20 completed the study. Significant (p<0.001) improvements in pain degree and frequency were noted after 1 and 3 months of custom-molded foot orthoses. In addition, significant (p<0.05) improvement in balancing ability was found after 3 months of custom-molded foot orthoses.
Short-term use of custom-molded foot orthoses significantly improved foot pain and balancing ability in children with symptomatic flexible flat foot.
Citations
To investigate differences in plantar pressure distribution between a normal gait and unpredictable slip events to predict the initiation of the slipping process.
Eleven male participants were enrolled. Subjects walked onto a wooden tile, and two layers of oily vinyl sheet were placed on the expected spot of the 4th step to induce a slip. An insole pressure-measuring system was used to monitor plantar pressure distribution. This system measured plantar pressure in four regions (the toes, metatarsal head, arch, and heel) for three events: the step during normal gait; the recovered step, when the subject recovered from a slip; and the uncorrected, harmful slipped step. Four variables were analyzed: peak pressure (PP), contact time (CT), the pressure-time integral (PTI), and the instant of peak pressure (IPP).
The plantar pressure pattern in the heel was unique, as compared with other parts of the sole. In the heel, PP, CT, and PTI values were high in slipped and recovered steps compared with normal steps. The IPP differed markedly among the three steps. The IPPs in the heel for the three events were, in descending order (from latest to earliest), slipped, recovered, and normal steps, whereas in the other regions the order was normal, recovered, and slipped steps. Finally, the metatarsal head-to-heel IPP ratios for the normal, recovered, and slipped steps were 6.1±2.9, 3.1±3.0, and 2.2±2.5, respectively.
A distinctive plantar pressure pattern in the heel might be useful for early detection of a slip event to prevent slip-related injuries.
Citations
To analyze the differences in the vertical ground reaction force (GRF) variables of hemiplegic patients compared with a control group, and between the affected and unaffected limbs of hemiplegic patients using foot scans.
Patients (n=20) with hemiplegia and healthy volunteers (n=20) underwent vertical force analysis. We measured the following: the first and second peak forces (F1, F2) and the percent stances at which they occurred (T1, T2); the vertical force impulse (VFI) and stance times. The GRF results were compared between the hemiplegic patients and control individuals, and between the affected and unaffected limbs of hemiplegic patients. Additionally, we analyzed the impulse of the unaffected limb according to the motor assessment scale (MAS), Brunnstrom stage, and a Timed Up and Go Test.
The F1s and F2s of the affected and unaffected limbs were significantly less than those of the normal control individuals (p<0.05). The T1s of both the affected and unaffected limbs of the patients were greater than control individuals, whilst the T2s were lower (p<0.05). Greater impulses and stance times were recorded on both sides of the patients than in the limbs of the control individuals (p<0.05). The MAS, Brunnstrom stage and Timed Up and Go Test results were significantly correlated with the VFI of the unaffected limbs (p<0.05).
The high impulse values of the unaffected limb were associated with complications during gait rehabilitation. Therefore, these results suggest that unaffected limbs should also be taken into consideration in these patients.
Citations
To investigate the correlation between the Foot Posture Index (FPI) (including talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, talonavicular bulging, congruence of the medical longitudinal arch, and abduction/adduction of the forefoot on the rare foot), plantar pressure distribution, and pediatric flatfoot radiographic findings.
Nineteen children with flatfoot (age, 9.32±2.67 years) were included as the study group. Eight segments of plantar pressure were measured with the GaitView platform pressure pad and the FPI was measured in children. The four angles were measured on foot radiographs. We analyzed the correlation between the FPI, plantar pressure characteristics, and the radiographic angles in children with flatfoot.
The ratio of hallux segment pressure and the second through fifth toe segment pressure was correlated with the FPI (r=0.385, p=0.017). The FPI was correlated with the lateral talo-first metatarsal angle (r=0.422, p=0.008) and calcaneal pitch (r=-0.411, p=0.01).
Our results show a correlation between the FPI and plantar pressure. The FPI and pediatric flatfoot radiography are useful tools to evaluate pediatric flatfoot.
Citations
To evaluate the therapeutic effect of botulinum toxin A (BTX-A) injection on spastic gastrocnemius (GCM) and tibialis posterior muscles (TPo) by using the foot pressure measurement system (FPMS).
Eighteen ambulatory CP patients were recruited in this study. BTX-A was injected into the GCM at a dose of 6-12 units/kg and TPo at a dose of 4-9 units/kg according to the severity of equinus and varus deformity. Foot contact pattern, pressure time integral (PTI), coronal index using the FPMS and Modified Ashworth Scale (MAS), and visual inspection of gait pattern were used for evaluation of the therapeutic effect of BTX-A injection. Clinical and FPMS data were statistically analyzed according to the muscle group.
A significant decrease in the MAS score of the GCM and TPo was observed, and spastic equinovarus pattern during gait showed improvement after injection. The GCM+TPo injection group showed a significant decrease in forefoot, lateral forefoot pad, and lateral column PTI, and a significant increase in hindfoot PTI and coronal index. In the GCM only injection group, forefoot PTI and lateral column PTI were significantly decreased and hindfoot PTI was significantly increased. The TPo only injection group showed a significant decrease in lateral column PTI and a significant increase in the coronal index. Change in PTI in the hindfoot showed a significant correlation with the change in MAS score of the GCM. Change in PTI of the lateral column and coronal index showed a significant correlation with the change in MAS score of the TPo.
The FPMS demonstrated the quantitative therapeutic effect of BTX-A on abnormal pressure distribution in equinovarus foot in detail. The FPMS can be a useful additional tool for evaluation of the effect of BTX-A injection.
Citations
To identify the effects of a custom-made rigid foot orthosis (RFO) in children over six years old with pes planus.
The medical records of 39 children (mean age, 10.3±4.09 years) diagnosed with pes planus, fitted with RFOs, and had who more than two consecutive radiological studies were reviewed. The resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle (APTCA), lateral talocalcaneal angle (LTTCA), the lateral talometatarsal angle (LTTMA), and calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. After diagnosis, children were fitted with a pair of RFOs and recommended to walk with heel strike and reciprocal arm swing to normalize the gait pattern. A follow-up clinical evaluation with radiological measurements was performed after 12-18 months and after 24 months of RFO application. Post-hoc analysis was used to test for significant differences between the radiological indicators and RCSP.
With RFOs, all radiological indicators changed in the corrective direction except LTTCA. RCSP and CP in the third measurement showed significant improvement in comparison with the second and baseline measurements. Additionally, APTCA and LTTMA revealed improvements at the third measurement versus the baseline measurements.
This study revealed that radiological indicators improved significantly after 24 months of RFO application. A prospective long-term controlled study with radiographical evaluation is necessary to confirm the therapeutic effects of RFOs and to determine the optimal duration of wear in children with pes planus.
Citations
To evaluate the therapeutic effect of a Tibia Counter Rotator (TCR) with toe-out gait plate (GP) upon tibial internal torsion by a comparative analysis of transmalleolar angle (TMA) and gait analysis with GP alone.
Twenty participants with tibial internal torsion were recruited for this study. Each 10 participants were included in group A with TCR and GP application and in group B with GP application only. The TMA and the kinematic results were used for the evaluation of the therapeutic effects of orthoses.
Within each group, TMA showed a significant increase after treatment. Group A showed a continuous improvement up to six months, however, group B showed an improvement up to five months only. Group A showed a significantly higher correction effect than group B after treatment. Regarding kinematic data, both groups showed a significantly decreased mean ankle adduction angle after treatment. However, group A showed a significantly lower mean ankle adduction angle than group B after six months.
The group with TCR and GP showed a significantly better outcome and continued correction force compared to the group with GP only. Our results suggest that TCR with GP may be useful therapeutic orthoses for children with tibial internal torsion.
Citations
To evaluate the effects of heel-opened ankle foot orthosis (HOAFO) on hemiparetic gait after stroke, especially on external foot rotation, and to compare the effects of HOAFO with conventional plastic-AFO (pAFO) and barefoot during gait.
This cross-over observational study involved 15 hemiparetic patients with external rotation of the affected foot. All subjects were able to walk independently, regardless of their usual use of a single cane, and had a less than fair-grade in ankle dorsiflexion power. Each patient was asked to walk in three conditions with randomized sequences: 1) barefoot, 2) with a pAFO, and 3) with an HOAFO. Their gait patterns were analyzed using a motion analysis system.
Fifteen patients consisted of nine males and six females. On gait analysis, hip and foot external rotation were significantly greater in pAFO (-3.35° and -23.68°) than in barefoot and HOAFO conditions (p<0.05). Wearing an HOAFO resulted in significant decreases in hip (0.78°, p=0.04) and foot (-17.99°, p<0.01) external rotation compared with pAFO; although there was no significant difference between HOAFO and barefoot walking. Walking speed and percentage of single limb support were significantly greater for HOAFO than in barefoot walking.
HOAFO was superior to pAFO in reducing hip and foot external rotation during the stance phase in patients with post-stroke hemiparesis. HOAFO may, therefore, be useful in patients with excessive external rotation of the foot during conventional pAFO.
Citations
In herpes zoster infection, neurological complications may be overlooked because pain is a more prominent symptom and because peripheral polyneuropathy associated with weakness is rare. A 57-year-old male visited our hospital, complaining of pain and skin eruptions on the right flank. He was diagnosed as having herpes zoster and the symptoms were alleviated by administration of acyclovir for a week. After three weeks, the herpes zoster relapsed. He was re-admitted and diagnosed with chronic myeloid leukemia (CML), and imatinib mesylate was prescribed for five weeks. Ten weeks after the onset of herpes zoster, bilateral foot drops and numbness of the right foot dorsum developed. Through an electrodiagnostic study, he was diagnosed as having peripheral polyneuropathy that was suspected to be caused by neural invasion by varicella zoster virus. After administration of famciclovir, not only the pain but also the neurologic symptoms improved. We herein report a case of peripheral polyneuropathy that was supposed to be related to herpes zoster.
Citations
Lateral plantar foot pain can be caused by various entities, and the painful os peroneum syndrome should be considered in the differential diagnosis. Recent developments in musculoskeletal ultrasonography are very useful for initial diagnosis. We discuss a 69-year-old female who experienced lateral plantar foot pain for over one month. Through physical examination, radiography, ultrasound and magnetic resonance imaging, she was diagnosed with the painful os peroneum syndrome with a chronic fatigue fracture of multipartite os peroneum and peroneus longus tenosynovitis, for which she underwent surgery. We herein report this rare condition and reviewed the relevant literature.
Citations
To investigate the characteristics of foot deformities in patients with Charcot-Marie-Tooth (CMT) disease compared with normal persons according to severity of disease.
Sixty-two patients with CMT disease were recruited for this study. The normal control group was composed of 28 healthy people without any foot deformity. Patients were classified into a mild group and a moderate group according to the CMT neuropathy score. Ten typical radiological angles representing foot deformities such as pes equinus and pes varus were measured. The CMT group angles were compared with those of the normal control group, and those of the mild group were also compared with those of the moderate group.
The lateral (Lat.) talo-first metatarsal angle, anteroposterior talo-first metatarsal angle, Lat. calcaneal-first metatarsal angle, Lat. naviocuboid overlap, Lat. calcaneal pitch, Lat. tibiocalcaneal angle, and Lat. talocalcaneal angle in the CMT group showed a significant difference compared to the normal control group (p<0.05). These findings revealed CMT patients have pes cavus, forefoot adduction, midfoot supination and pes varus deformity. Compared to the mild group, the moderate group significantly showed an increased Lat. calcaneal pitch and decreased Lat. calcaneal-first metatarsal angle, Lat. tibiocalcaneal angle, Lat. talocalcaneal angle, and Lat. talo-first metatarsal angle (p<0.05). These findings revealed that the pes cavus deformity of CMT patients tend to be worse with disease severity.
The characteristic equinovarus foot deformity patterns in CMT patients were revealed and these deformities tended to be worse with disease severity. Radiographic measures may be useful for the investigation of foot deformities in CMT patients.
Citations
To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements.
Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0.
The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively.
Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.
Citations
To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot.
Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physician's rating scale (PRS).
The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (p<0.001), while the BTX-A injection-only group improved until 6 weeks following injection (p<0.05). The combined group showed a significantly greater increase in the degree of dorsiflexion compared to the BTX-A injection-only group at post-injection weeks 6 and 12 (p<0.05). Three children (11.5%) suffered from foot ulcers as a complication caused by the serial casting.
Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.
Citations
Objective: The purpose of this study was to know the correlation between resting calcaneal stance position (RCSP) and height-length (H/L) ratio of foot.
Method: Both feet of 173 persons who visited the Department of Rehabilitation Medicine, Chungnam National University Hospital were included in the study. Their mean age was 23.6 years old. H/L ratio, RCSP and navicular angle of 346 feet were measured. All people were divided into 3 groups, such as, normal foot (2o≤RCSP≤2o), rear foot valgus (RCSP＜2o) and rear foot varus (RCSP＞2o) according to the angle of RCSP. And the relationship between RCSP and H/L ratio were evaluated. Independent T-test, ANOVA and Pearson correlation of SPSS was used for statistical data processing.
Results: The mean H/L ratio of rear foot valgus was 0.2206, noraml foot 0.2440 and rearfoot varus 0.2625. H/L ratio and navicular angle showed significant increase in each RCSP groups in order of rear foot angle.
Conclusion: H/L ratio and RCSP showed strong positive correlation and the value of H/L ratio in normal group was 0.2440⁑0.0114 (Mean⁑S.D.). H/L ratio is easily acceptable parameter in human mechanics or orthotic field of rehabilitation. (J Korean Acad Rehab Med 2002; 26: 591-597)
Innervation anomalies are well-known sources of erroneous interpretation in motor nerve conduction studies. The extensor digitorum brevis (EDB) muscle is supplied by the deep peroneal nerve and is commonly used as recording point in peroneal motor conduction study. If the compound muscle action potentials (CMAPs) are not evoked with EDB muscle recording without any symptoms or signs of peroneal neuropathy, we should lead one to consider either technical pitfall or anomalous innervation. We experienced an anomalous innervation in a woman in whom the bilateral EDB muscles were innervated exclusively by the tibial nerve. This was proved using a monopolar needle electrode for recording in extensor digitorum brevis (EDB) and flexor digitorum brevis (FDB) muscles, which encoded acceptable shape of CMAPs on tibial nerve stimulation. To avoid erroneous interpretation of electromyographic and nerve con
Flatfoot is a common foot disorder. Some modifications by orthotic shoes for the flatfoot have been prescribed, however their effectivenesses are not fully proven yet. We have tried to validate the effectivenesses of conventional orthotic shoes for the flatfoot patients. We assessed the static and dynamic pressure, dynamic pressure-time integral, and relative impulse with and without wearing orthotic shoes. Thirteen subjects with the flatfoot were included in this study. The results showed the positive effects of orthotic shoes for the subjects. Especially the dynamic pressure-time integral values revealed the significantly reduced values at the medial side of midfoot, which meant the functional improvement of flatfoot status. We have concluded that the use of conventional orthotic shoes for the flat foot patients would be effective for properly selected patients, if there is no other associated abnormality.
Objective: The purpose of this study were to investigate the temporospatial, kinematic data and energy consumption in hemiplegic patients according to the types of ankle-foot orthosis (AFO), and to determine the most effective type of AFO for gait training.
Method: A prospective study was performed for 10 patients with hemiplegia who was able to walk independently at indoor level. The temporospatial, kinematic data and energy consumption were compared in each five different conditions: 1) barefoot, 2) donning AFO with posterior leaf spring (PLS), 3) donning PLS with the distal part of metatarsal head trimmed off (PLS-C), 4) donning hinged PLS (HPLS), 5) donning hinged PLS with the distal part of metatarsal head trimmed off (HPLS-C).
Results: With four types of PLS, maximal ankle plantar flexion was significantly decreased, however we didn't find any difference in kinematic data of the pelvis and hip as compared with barefoot and with PLS, HPLS, HPLS-C and maximal knee extension angle was significantly decreased compared with barefoot. With HPLS-C, cadence and walking speed significantly increased and double support time and oxygen cost significantly decreased as compared with barefoot.
Conclusion: This study showed increased walking speed, decreased energy cost and improved
The purpose of this study is to evaluate the effectiveness of intramuscular botulinum toxin A injection in cerebral palsy with foot deformities using roentgenogram. We have studied 26 children with cerebral palsy(age 3 to 13 years old). They were twenty spastic diplegias, three hemiplegias and three mixed types(spasticity and athetosis). The botulinum toxin A was injected into gastrocnemius or peroneous muscles with an electromyographic guidance. Before injections, passive joint angles of the ankle were assessed by the goniometric measurements. A plantar-flexion angle of talus, dorsiflexion angle of calcaneous, and talar-calcaneal divergence angle were measured using the lateral and anterior-posterior roentgenograms of the foot with weight- bearing for the assessment of equinovalgus of ankle. Follow-up assessments were performed at 1 and 3 months after the injection. At 1 month after the injection into gastrocnemius muscle, there was an increased range of passive ankle joint motion, decreased plantar-flexion angle of talus, and increased dorsiflexion angle of calcaneous. These changes were still significant at 3 months after the injection. After the injection into peroneous muscle, the talar-calcaneal divergence angle was significantly decreased. This study provides the evidence that the treatment with botulinum toxin A improves the ankle joint motion in cerebral palsy with feet deformities by reducing hypertonicity, spasticity and dynamic contracture. In addition, the lateral and anterior- posterior roentgenograms of the foot with weight bearing seems to be the simple and objective methods to evaluate the effectiveness of intramuscular botulinum toxin A injection in cerebral palsy with foot deformities.
Objective: This study was aimed to demonstrate definite diagnostic radiologic criteria between normal and flatfoot.
Method: Sixty healthy subjects and fifty two flatfoot cases were evaluated by radiologic measurements. We evaluated criteria for longitudinal arch curve by measuring of calcaneal pitch, talocalcaneal angle, talometatarsal angle, metatarsal angle and navicular height I and II.
Results: Over 10 years old, there was significant correlation between normal group and flatfoot in calcaneal pitch, talocacaneal angle, difference angle, metatarsal angle, navicular height I and II. But below 10 years old, there was difference in only talometatarsal angle and metatarsal angle. Therefore talometatarsal angle and metartarsal angle are valuable in diagnosis of flatfoot in all age group.
Conclusion: In diagnosis of flatfoot, variable radiologic measurement are clinically significant.
The posterior tibial muscle is considered a plantar flexor as well as an invertor of the foot, which acts as a key muscle to the medial longitudinal arch by locking the talar joints in normal gait. Rupture of the posterior tibial tendon can cause a valgus deformity of the hindfoot and an abduction deformity of the forefoot which produces a typical flat foot and a talar dislocation in severe cases.
The tendon of posterior tibial muscle can be ruptured spontaneously after the age of 40 from chronic stress at the ankle joint, or by sports injury and trauma. Severe foot deformity which can be prevented by early diagnosis and appropriate treatment often occurs from misdiagnosis as a chronic ankle sprain or a congenital flat foot.
We report two cases of foot deformities caused by spontaneous and traumatic rupture of posterior tibial tendons with their clinical manifestations and MRI findings.
Objective: The purpose of this study is to investigate the incidence and ratio of biphalangeal toes in Korean adult and to investigate whether this finding correlates with the evolution of human toes.
Method: The materials used in this study consisted of 1,290 radiographs of the human feet obtained from 645 adults with foot symptom and complete osseous growth. The 1,290 radiographs consisted of anteroposterior weightbearing radiographs and nonweightbearing oblique radiographs. Those were retrospectively reviewed and carried out of detailed macroscopic examinations.
Results: Biphalangeal toe was observed for the 5th toe in 934 cases (72.40%), for the 4th toe in 161 cases (12.48%), for the 3rd toe in 7 cases (0.54%), and for the 2nd toe in 1 case (0.08 %). Bilaterality of biphalangeal and triphalangeal toes for each toe was observed over 97.1%.
Conclusion: Our results are in agreement with Nakashima and it is likely that over 70% of the Asian population have only two phalanges in their fifth toes, and it seems to be an example of microevolution or genetic adaptation to bipedalism. (J Korean Acad Rehab Med 2002; 26: 193-197)
The purpose of this study was to determine the effects of high heeled shoes on plantar pressure and muscle fatigue. The subjects were 36 women who were divided into three groups, i.e., high heel, middle heel and low heel. The mean height of each heel was over 7 cm, 5 cm and below 2 cm respectively. The plantar pressure was measured by F scan system.
The fatigue of subjects was evaluated with endurance time and voluntary maximal contraction that was measured by Cybex 6000 system and the degrees of foot pain and fatigue by visual analogue scale.
With high heeled shoes, the plantar pressure was shifted from hindfoot to forefoot, and from the lateral part to the medial part in forefoot. With all shoes, the plantar pressure was generally increased in the forefoot after 8 hours. Especially the pressure of medial and middle parts of forefoot was significantly increased on high heeled shoes. Voluntary maximal contraction and endurance time was significantly decreased in subjects with high heeled shoes for 8 hours. The degrees forefooot pain and fatigue by visual analogue scale were very significantly increased in subjects with high heeled shoes. With low heeled shoes, the fatigue was the least degree and the middle heeled shoes are recommendable for cosmetic needs and lesser fatigue and pain.
In conclusion, when women were in high heeled shoes for a long time, the pressure of forefoot and foot pain and fatigue were increased. Therefore, these effects of high heeled shoes on the plantar pressure and fatigue should be considered in women with high heeled shoes.
Objective: The purpose of this study was to evaluate the correlation between each variable on occupational condition and foot deformity by Harris mat footprint.
Method: Subjects were 227 labors having no neurologic or musculoskeletal problems. They were evaluated by clinical history and Harris mat footprint. Three optional parameters of footprints were medial arch angle, metatatarsal arch grade, and hallux valgus angle.
Results: 1) Hallux valgus angles were significantly increased in group of female, above 39 years old, labor, and duration of duty more than 6 years. 2) Medial arch angles were signifi-
cantly decreased in female, above 39 years old, obese person, and labor. 3) Metatarsal arch grades were significantly increased in group of female, above 39 years old, and more than 20 numbers of conveyance, less than 6 years of duration of duty. Foot pain was not related to medial arch angle, metatatarsal arch grade, and hallux valgus angle, respectively.
Conclusion: These results suggest that deformity of foot were related to female, above 39 years old, obese person, position of duty, duration of duty, and standing time. So these peoples maybe helpful for weaning proper modified shoes. (J Korean Acad Rehab Med 2002; 26: 187-192)
Previous studies proved that, the high-heeled shoes caused postural changes, a loss of foot function, and deformities of foot. However the lumbar lordosis in gait is rarely measured. The purposes of this study were to compare kinematics and kinetics between high-heeled and high-forefoot gait by skin markers, and to find the influence of heel height to lumbar vertebral alignment. We used the Vicon 370 three-dimension Gait Analysis System.
In the present study, the lower extremity biomechanics in high-heeled and high-forefoot shoes were examined in 20 Korean female subjects. Results showed that the double support phase increased in high-forefoot gait in linear parameters. In sagittal plane kinematics, the lumbar lordosis slightly increased in high-forefoot gait, but that did not increase in high-heeled gait. The knee flexion and ankle plantarflexion increased in high-heeled gait, but ankle pantar flexion reduced in high-forefoot gait. Clinically the change of ankle motion was not significantly influenced to the lumbar lordosis. However, high-heeled shoe users with low back pain are probably influenced by the overstress of paraspinal muscles and vertebral ligments. Further studies are required for more precise analysis of high-heeled and high-forefoot gaits.
Objective: To evaluate outcomes of treatment of hallux valgus and its associated foot deformities with shoe and insole modification
Method: We present the short-term follow-up of 32 symptomatic hallux valgus deformities in 20 patients. The patients were all female and 32 to 77 years in age at the time of modification of shoe and insole. Twenty patients were evaluated on an average of 4 weeks following their shoe and insole modification. Hallux valgus angles and first-second intermetatarsal angle were evaluated as well as the range of motion of the first metatarsophalangeal joint and patient's satisfaction. Outcome was measured using changes in visual analogue scale (VAS) on twenty occasions during 4 weeks.
Results: Hallux valgus was commonly associated with the lesser (2nd∼5th) toe deformity (21 cases, 65.5%), pes planus (12 cases, 37.5%), Achilles tightness (12 cases, 37.5%) and great toe pronation (10 cases, 31.5%). The result obtained was highly significant (p＜0.002), suggesting that the shoe and insole modification were as effective in reducing the level of pain due to hallux valgus and its associated foot deformities.
Conclusion: The shoe and insole modification can be an effective treatment of reducing pain of hallux valgus and its associated deformities.
Objective: To find out the characteristics of the foot pressure distribution and the path of center of pressure (COP) in the children with cerebral palsy, compared with normal control children.
Method: Twenty-four children with spastic cerebral palsy (CP) and 38 normal children were participated in this study. The parameters of foot contact, plantar pressure and COP were measured using F-scan system (Teksan Inc.) with pressure sensitive insoles inserted in the shoes.
Results: The total contact area, mid foot contact width and also the pressure of hallux and medial side of mid foot were significantly higher in the children with CP than in normal
controls. While the pressure of hind foot was significantly lower in the children with CP compared with normal controls. Anteroposterior distance and velocity of COP were significantly lowered in the cerebral palsied children. The paths of COP of both groups were directed inwardly without any significant differences between both groups.
Conclusion: We can identify the characteristics of the foot pressure distribution and the path of COP in the children with spastic CP using F-scan system. These quantitative data of foot scan may be useful for evaluating the foot pathology during the gait in the children with CP. (J Korean Acad Rehab Med 2002; 26: 127-132)
Objective: To investigate the effects of dynamic (hinged) and solid ankle-foot orthoses (AFO) on the gait characteristics in spastic cerebral palsied children and to find out which AFO has a more beneficial effect on correcting the abnormal gait pattern in those children.
Method: The subjects were 40 children with spastic cerebral palsy (CP) who were able to walk independently without walking aids. Their ages were ranging from 2 to 12 years. Children were randomly prescribed to dynamic or to solid AFO. Twenty-four children got solid AFO and 16 children got hinged AFO. Gait characteristics were evaluated by computer based kinematic gait analysis while they were walking with AFO and on barefoot. Gait characteristics on barefoot and with hinged AFO and with solid AFO respectively were compared.
Results: Temporospatial parameters while walking on barefoot were not significantly different from those while walking with AFOs. While walking with hinged AFO, the maximal knee extension angle during stance phase was decreased in comparison with that on barefoot (p＜0.05). Ankle dorsiflexion angle on hinged AFO was increased throughout the gait cycle (p＜0.05). While walking with solid AFO, ankle dorsiflexion angle at initial contact, at 98% of gait cycle and at maximal ankle dorsiflexion angle in stance phase were increased in comparison with that on barefoot (p＜0.05). There was no significant difference of changes after wearing orthoses between hinged and solid AFO.
Conclusion: Both types of AFOs exerted a positive effect on ankle motion, not in knee or hip joints in the children with spastic cerebral palsy. The gait characteristics during walking with both AFOs were not significantly different, even if the hinged type might be more effective in preventing knee hyperextension in stance phase and in improving maximal ankle dorsiflexion during the swing phase.
Objective: To find out the changes of the plantar pressure distribution of foot and the pathway of center of pressure (COP) in normal preschool children with age.
Method: Thirty-eight normal children aged 1 to 6 were participated in this study. We divided into three groups according to the age. Foot contact area, pressure of the foot and pathway of COP were measured using F-scan in-shoe measuring system (Tekscan Inc.) during the gait.
Results: The ratio of midfoot contact width to forefoot contact width was decreased with age (p＜0.05). And the relative pressure of the medial midfoot was decreased with age (p＜0.05). In the analysis of COP, the ratio of anteroposterior length of COP to total contact length was significantly increased (p＜0.05), and the ratio of mediolateral width of COP to forefoot contact width was tend to decrease.
Conclusion: We can identify the characteristics and changes of the foot pressure distribution and the pathway of COP in preschool children with normal foot using F-scan system. These quantitative data of foot scan are useful for evaluating the foot pathology in preschool children during the gait.
First
Prev
