Effects of Biomechanical Foot Orthoses on the Resting Calcaneal Stance Position Angle in Flatfoot Patients

박동휘,전광옥,우성호,구원모,김종민,이병주,주선영,어효신 대한임상통증학회 2023 Clinical Pain Vol.22 No.2

Objective: Flatfoot is a very common condition in pediatric rehabilitation that can cause various symptoms. Therefore, objective evaluation and effective management of flatfoot is important. The resting calcaneal stance position (RCSP) angle has been widely used as an indicator of flatfoot. This study followed up the RCSP angle in children with flatfoot who were prescribed biomechanical foot orthoses (BFOs), to determine whether BFOs significantly improved flatfoot. Methods: We included 77 children who were diagnosed with flatfoot and prescribed BFOs. We followed up and compared the RCSP angle using the paired t-test. In addition, the patients divided into two groups according to RCSP angle improvement to determine whether any significant indicators were present in the group with greater improvement. Results: The mean age of 77 children was 11.05 years, with 50 boys and 27 girls. The RCSP angle improved by 3.25 and 2.78 degrees on the right and left sides, respectively, with the paired t-test showing a significant improvement in the RCSP angle (p≤0.001). 40 and 37 exhibited an RCSP angle improvement of more and less than 4 degrees, respectively, with the paired t-test also confirming a significant improvement in the RCSP angle (p≤0.001). However, independent t-tests revealed no significant differences in all indicators between the two groups. Conclusion: This study confirmed that wearing BFO in children with flatfoot can improve the RCSP angle. Our findings showed that RCSP angles improved regardless of other factors. Further studies providing more data and including a control group are needed.

편평족의 진단

이태훈,최서우,김학준,Lee, Tae Hoon,Chay, Suh Woo,Kim, Hak Jun 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.1

Flatfoot is defined as loss of medial arch with hindfoot valgus, but normal condition is obscure due to wide individual variance. Loss or decreasing of medial longitudinal arch with radiographic image is clinically diagnosed as flatfoot. Flatfoot without symptoms is not an indication for treatment. The etiologies of flatfoot are congenital cause, hypermobility, tarsal coalition, neuromuscular disease, post-traumatic deformity, Charcot arthropathy, and posterior tibial tendon dysfuction. The flatfoot is classified as congenital and acquired, flexible, and rigid. The diagnosis is made by physical examination and radiographic findings. In particular, the posterior tibial tendon dysfunction is known as adult acquired flatfoot.

Correlation of Foot Posture Index With Plantar Pressure and Radiographic Measurements in Pediatric Flatfoot

이정수,김기범,정진욱,권나연,정상미 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.1

Objective 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. Methods 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. Results 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). Conclusion Our results show a correlation between the FPI and plantar pressure. The FPI and pediatric flatfoot radiography are useful tools to evaluate pediatric flatfoot.

Plantar Pressure Distribution During Level Walking, and Stair Ascent and Descent in Asymptomatic Flexible Flatfoot

Jeong-ah Kim,One-bin Lim,Chung-hwi Yi 한국전문물리치료학회 2013 한국전문물리치료학회지 Vol.20 No.4

The first purpose was to identify the plantar pressure distributions (peak pressure, pressure integral time, and contact area) during level walking, and stair ascent and descent in asymptomatic flexible flatfoot (AFF). The second purpose was to investigate whether peak pressure data during level walking could be used to predict peak pressure during stair walking by identifying correlations between the peak pressures of level walking and stair walking. Twenty young adult subjects (8 males and 12 females, age 21.0±1.7 years) with AFF were recruited. A distance greater than 10 ㎜ in a navicular drop test was defined as flexible flatfoot. Each subject performed at least 10 steps during level walking, and stair ascent and descent. The plantar pressure distribution was measured in nine foot regions using a pressure measurement system. A two-way repeated analysis of variance was conducted to examine the differences in the three dependent variables with two within-subject factors (activity type and foot region). Linear regression analysis was conducted to predict peak pressure during stair walking using the peak pressure in the metatarsal regions during level walking. Significant interaction effects were observed between activity type and foot region for peak pressure (F=9.508, p<.001), pressure time integral (F=5.912, p=.003), and contact area (F=15.510, p<.001). The regression equations predicting peak pressure during stair walking accounted for variance in the range of 25.7% and 65.8%. The findings indicate that plantar pressures in AFF were influenced by both activity type and foot region. Furthermore the findings suggest that peak pressure data during level walking could be used to predict the peak pressure data during stair walking. These data collected for AFF can be useful for evaluating gait patterns and for predicting pressure data of flexible flatfoot subjects who have difficulty performing activities such as stair walking. Further studies should investigate plantar pressure distribution during various functional activities in symptomatic flexible flatfoot, and consider other predictors for regression analysis.

보행 시 편평족에서 외적 무게 부하에 따른 족저압의 변화

장종성 ( Jong Sung Chang ),박지원 ( Ji Won Park ),김중선 ( Chung Sun Kim ) 대한물리의학회 2010 대한물리의학회지 Vol.5 No.4

Purpose:The study was designed to investigate the changes of plantar foot pressure by different loads during walking in flatfoot. Methods:Fifteen subjects with flatfoot were recruited along with their written informed consent. They were asked to walk on plate at a self-selected and comfortable speed with loads of 0, 5, 10, and 15㎏. Three walking trials were obtained and then averaged for data analysis. Foot pressure were measured from RS-Scan system (RS-Scan system, RS scan Ltd., German) and contact area, maximum force were analyzed. Results:There were significant increases on midfoot and decreases on forefoot in contact area. And there were significant increases in maximum force of foot pressure of 2nd metatarsal bone and midfoot. Conclusion:These findings revealed that flatfoot increases risk factors of metatarsal bone with different loads. Therefore, patients of flatfoot must be careful during walking with loads or activities of daily living.

Gait Analysis of Symptomatic Flatfoot in Children: An Observational Study

김하용,신혁수,고준혁,차용한,안재훈,황재연 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.3

Background: Flatfoot deformity is a lever arm disease that incurs kinetic inefficiency during gait. The purpose of this study was to measure the degree of kinetic inefficiency by comparing the gait analysis data of a flatfoot group with a normal control group. Methods: The patient group consisted of 26 children (21 males and 5 females) with symptomatic flatfoot. They were examined with gait analysis between May 2005 and February 2014. Exclusion criteria were patients with secondary flatfoot caused by neuromuscular disorders, tarsal coalition, vertical talus, or others. Patients’ mean age was 9.5 years (range, 7 to 13 years). The gait analysis data of the study group and the normal control group were compared. Results: The mean vertical ground reaction force (GRF) in the push-off phase was 0.99 for the patient group and 1.15 for the control group (p < 0.05). The mean ankle moment in the sagittal plane during the push-off phase was 0.89 for the patient group and 1.27 for the control group (p < 0.05). The mean ankle power in the sagittal plane during the push-off phase was 1.38 for the patient group and 2.52 for the control group (p < 0.05). The aforementioned results show that patients with pes planovalgus had a reduction of moment, power, and GRF in the push-off phase during gait. Conclusions: Symptomatic flatfeet had a moment inefficiency of 30% and power inefficiency of 45% during gait compared to feet with preserved medial longitudinal arches.

Effects of the Short Foot Exercise With Neuromuscular Electrical Stimulation on Navicular Height in Flexible Flatfoot in Thailand: A Randomized Controlled Trial

Namsawang, Juntip,Eungpinichpong, Wichai,Vichiansiri, Ratana,Rattanathongkom, Somchai The Korean Society for Preventive Medicine 2019 예방의학회지 Vol.52 No.4

Objectives: Flatfoot, or low medial longitudinal arch, contributes to back and lower extremity injuries and is caused by weak abductor hallucis (AbdH) muscles. The purpose of this study was to investigate the effects of short foot exercise (SFE) alone or with neuromuscular electrical stimulation (NMES) on navicular height, the cross-sectional area (CSA) of the AbdH muscle, and AbdH muscle activity in flexible flatfoot. Methods: Thirty-six otherwise healthy people with flexible flatfoot were randomly assigned to a group that received SFE with placebo NMES treatment (the control group) or a group that received both SFE and NMES treatment (the experimental group). Each group received 4 weeks of treatment (SFE alone or SFE with NMES). Navicular height, the CSA of the AbdH muscle, and AbdH muscle activity were assessed before and after the intervention. Results: No significant differences were found in navicular height or the CSA of the AbdH muscle between the control and experimental groups, while AbdH muscle activity showed a statistically significant difference between the groups ($SFE=73.9{\pm}11.0%$ of maximal voluntary isometric contraction [MVIC]; SFE with $NMES=81.4{\pm}8.3%$ of MVIC; p<0.05). Moreover, the CSA of the AbdH muscle showed a statistically significant increase after treatment in the SFE with NMES group ($pre-treatment=218.6{\pm}53.2mm^2$ ; $post-treatment=256.9{\pm}70.5mm^2$ ; p<0.05). Conclusions: SFE with NMES was more effective than SFE alone in increasing AbdH muscle activity. Therefore, SFE with NMES should be recommended to correct or prevent abnormalities in people with flexible flatfoot by a physiotherapist or medical care team.

Effects of the Short Foot Exercise With Neuromuscular Electrical Stimulation on Navicular Height in Flexible Flatfoot in Thailand: A Randomized Controlled Trial

Juntip Namsawang,Wichai Eungpinichpong,Ratana Vichiansiri,Somchai Rattanathongkom 대한예방의학회 2019 예방의학회지 Vol.52 No.4

Objectives: Flatfoot, or low medial longitudinal arch, contributes to back and lower extremity injuries and is caused by weak abductor hallucis (AbdH) muscles. The purpose of this study was to investigate the effects of short foot exercise (SFE) alone or with neuromuscular electrical stimulation (NMES) on navicular height, the cross-sectional area (CSA) of the AbdH muscle, and AbdH muscle activity in flexible flatfoot. Methods: Thirty-six otherwise healthy people with flexible flatfoot were randomly assigned to a group that received SFE with placebo NMES treatment (the control group) or a group that received both SFE and NMES treatment (the experimental group). Each group received 4 weeks of treatment (SFE alone or SFE with NMES). Navicular height, the CSA of the AbdH muscle, and AbdH muscle activity were assessed before and after the intervention. Results: No significant differences were found in navicular height or the CSA of the AbdH muscle between the control and experimental groups, while AbdH muscle activity showed a statistically significant difference between the groups (SFE=73.9±11.0% of maximal voluntary isometric contraction [MVIC]; SFE with NMES=81.4±8.3% of MVIC; p<0.05). Moreover, the CSA of the AbdH muscle showed a statistically significant increase after treatment in the SFE with NMES group (pre-treatment=218.6±53.2 mm2; post-treatment=256.9±70.5 mm2; p<0.05). Conclusions: SFE with NMES was more effective than SFE alone in increasing AbdH muscle activity. Therefore, SFE with NMES should be recommended to correct or prevent abnormalities in people with flexible flatfoot by a physiotherapist or medical care team.

Preliminary Study on the Comparison of Calcaneus Taping and Arch Taping Methods for Flexible Flatfoot Subjects

Jinteak Kim,Byeongsoo Kim,Jongduk Choi 한국전문물리치료학회 2023 한국전문물리치료학회지 Vol.30 No.4

Background: The flexible flatfoot is characterized by a flattening of the foot arch due to excessive bodyweight. The use of shoe insoles or taping methods has been identified as effective in realigning the navicular or calcaneus bones and addressing supination in pronated feet. Objects: This study aimed to analyze the difference between the arch taping attachment method, introduced in a previous study, and a novel taping method designed to provide support to the inner aspect of the heel bone in cases of flexible flatfoot. Methods: A navicular drop test was performed to discriminate flexible flatfoot. To analyze the differences in pressure distribution during walking for each taping method, the subjects underwent testing in the barefoot state with no attachments. The procedure included a sequence of arch taping and heel taping. Subsequent analysis of pressure distribution during walking utilized the GaitRite® system (GAITRite Gold, CIR Systems Inc.). Results: Arch taping and calcaneus taping significantly reduced the integrated pressure over time and peak pressure on the medial side of the midfoot for both feet compared to the barefoot state. Conclusion: The findings of this study suggest that supporting the inside of the heel through calcaneus taping, without direct stimulation to the longitudinal arch and navicular bone, is an effective intervention for flexible flatfoot.

소아 유연성 편평족에서 Kalix® 족근동 기구를 이용한 거골하 관절 제동술

황석민,엄준상,이동오,이종수,김성욱,원태구,정홍근 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.6

Purpose: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. Materials and Methods: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. Results: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were -25.1° and -7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). Conclusion: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered. 목적: 소아의 유연성 편평족에 대한 거골하 관절 제동술의 방사선적 및 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2007년 3월부터 2012년 6월까지 건국대학교병원에서 편평족으로 진단 후 거골하 관절 제동술을 시행받은 10명, 14예의 환자를 대상으로 하였다. 방사선적으로는 측면 방사선 사진을 통하여 거골-제1 중족골 간 각, 거골 수평면각 및 종골 경사각을 측정하였다. 전후면 방사선 사진을 통하여 거주상골 피복각 및 거골-제1 중족골 간 각을 측정하였고, 후족부 정렬 사진을 통하여 경골-종골각을 측정하였다. 임상적 평가로는 수술 전후의 visual analogue scale (VAS) 통증 지수와 미국 정형외과 족부족관절학회(American Orthopaedic Foot and Ankle Society, AOFAS) 기능 점수를 조사하였다. 결과: 평균 추시 기간은 48.7개월(16-98개월)이었으며, 평균 연령은 11.6세(6-19세)였다. 방사선적 측면 족부 방사선 사진상에서 거골-제1 중족골 간 각은 술 전 평균 -25.1도에서 술 후 평균 -7.5도, 거골 수평면각은 술 전 평균 37.4도에서 술 후 평균 23.2도 및 종골 경사각은 술 전 평균 8.3도에서 술 후 평균 15.0도로 각각 향상 측정되었다. 전후면 방사선 사진에서 측정한 거주상골 피복각은 술 전 평균 23.0도에서 술 후 평균 11.9도로, 거골-제1 중족골 간 각은 술 전 평균 17.2에서 술 후 평균 9.0도로 감소하였다. 또한 후족부 정렬상 경골-종골 각은 술 전 평균 외반 17.4도에서 술 후 평균 외반 4.5도로 호전되었다. 임상적으로는 VAS 통증 점수는 술 전 5.8점에서 술 후 1.5점으로, AOFAS 점수는 술 전 61.8점에서 술 후 90.4점으로 향상되었다. 합병증으로는 족근동 통증이 5예(35.7%)에서 발생하였다. 결론: 소아의 유연성 편평족 환자에서 족근동 삽입물을 이용한 거골하 관절 제동술을 시행하여 방사선적 및 임상적으로 우수한 결과를 얻었고, 편평족 변형에 대해 만족스러운 교정을 얻을 수 있었다. 하지만 수술 후 체중 부하 시 족근동 통증의 높은 발생 가능성에 대해서는 유념하여야 할 것이다.