• 한국운동역학회지
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• 제19권2호
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• pp.197-204
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• 2009

It bas been hypothesized that foot ulceration might be internally initiated. Current instruments which merely allow superficial estimate of plantar loading acting on the foot, severely limit the scope of many biomechanical/clinical studies on this issue. Recent studies have suggested that peak plantar pressure may be only 65% specific for the development of ulceration. These limitations are at least partially due to surface pressures not being representative of the complex mechanical stress developed inside the subcutaneous plantar soft-tissue, which are potentially more relevant for tissue breakdown. This study established a three-dimensional and nonlinear finite element model of a human foot complex with comprehensive skeletal and soft-tissue components capable of predicting both the external and internal stresses and deformations of the foot. The model was validated by experimental data of subject-specific plantar foot pressure measures. The stress analysis indicated the internal stresses doses were site-dependent and the observation found a change between 1.5 to 4.5 times the external stresses on the foot plantar surface. The results yielded insights into the internal loading conditions of the plantar soft-tissue, which is important in enhancing our knowledge on the causes of foot ulceration and related stress-induced tissue breakdown in diabetic foot.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.15-21
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• 1999

Soft tissue defect on heel area of the foot present difficult problems particularly because of anatomic property of plantar surface of the foot. There is a paucity of available local tissue in the foot for coverage. In addition to having little expandable tissue, the foot's plantar surface has a unique structure, making its replacement especially challenging. Plantar skin is attached to the underlying bone by fibrous septa, preventing shear of the soft-tissue surfaces from the underlying skeleton. Plantar surface of foot is in constant contact with the environment. Protective sensibility also would be maintained or restored in the ideal reconstruction. So the ideal flap for reconstruction of the heel should include thin, durable hairless skin with potential for reinnervation. The aim of this article is to present a clinical experience of free lateral arm neurosensory flap for reconstruction of the heel. From March 1995 to December 1997, a total 16 lateral arm free flaps were performed to soft tissue defects on the weight-bearing area of the hindfoot. we used tibial nerve as recepient nerve in 11 and calcaneal branch of tibial nerve in 5 for restoration of sensibility of flap. All cases survived completely. A static two-point discrimination of 14 to 34mm was detected in the flap. Radial nerve palsy which was caused by hematoma in donor site occured in one case, but recorverd in 3 weeks later completely. In conclusion, the lateral arm free flaps are versatile, reliable and sensible cutaneous flap and especially indicated for soft tissue defect on plantar surface of the hindfoot which are not good indications for other better-known flaps.

• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.153-161
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• 2002

Purpose : Plantar surfaces, calcaneal area, and region of Achilles insertion, which are extremely related with weight-bearing area and shoes application, must be reconstructed with glabrous and strong fibrous skin. Numerous methods of reconstructing defects of these regions have been advocated, but the transfer of similar local tissue as a cutaneous flap with preservation of sensory potential would best serve the functional needs of the weight-bearing and non-weight-bearing surfaces of this region. Therefore it is recommended to use the limited skin of medial surface of foot that is similar to plantar region and non-weight-bearing area. In this paper we performed the medial plantar flap transfered as a fasciocutaneous island as one alterative for moderate-sized defects of the plantar forefoot, plantar heel, and area around the ankle in 25 cases and report the result, availability and problem of medial plantar flap. Materials and methods : We performed proximally based medial plantar flap in 22 cases and reverse flow island flap in 3 cases. Average age was $36.5(4{\sim}70)$ years and female was 3 cases. The causes of soft tissue defect were crushing injury on foot 4 cases, small bony exposure at lower leg 1 case, posterior heel defect with exposure of calcaneus 8 cases, severe sore at heel 2 cases, skin necrosis after trauma on posterior foot 4 cases, and defect on insertion area of Achilles tendon 6cases. Average follow up duration was 1.8(7 months-9.5 years) years. Results: Medial plantar flaps was successful in 22 patients. 18 patients preserved cutaneous branches of medial plantar nerve had sensation on transfered flap but diminished sensation or dysesthesia. At the follow up, we found there were no skin ulceration, recurrence of defect or skin breakdown in all 18 patients. But there was one case which occurred skin ulceration postoperatively among another 4 cases not contained medial plantar nerve. At the last follow up, all patients complained diminished sensation and paresthesia at medial plantar area distally to donor site, expecially with 4 patients having severe pain and discomfort during long-time walking. Conclusion : Medial plantar island flap based on medial plantar neurovascualr pedicle have low failure rate with strong fibrous skin and preserve sensibility of flap, so that it is useful method to reconstruct the skin and soft tissue defect of foot. But it should be emphasized that there are some complications such like pain and paresthesia by neuropraxia or injury of medial plantar nerve at more distal area than donor site. We may consider that medial plantar flap have limited flap size and small arc of rotation, and require skin graft closure of the donor defect and must chose this flap deliberately.

• 대한족부족관절학회지
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• 제6권2호
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• pp.217-220
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• 2002

Although osteochondromas are common bone lesions, extraosseous osteochondromas are rare. The most common sites of involvement are the hand, knee, and foot. The authors experienced a case of soft tissue osteochondroma in the plantar aspect of the left foot. The patient complained of a palpable mass for 5 years. The mass grew slowly and had been asymptomatic until 5 months prior to admission when the patient developed slight pain on ambulation and numbness distal to the mid foot. Radiologic studies demonstrated well-circumscribed, lobulated, ossified mass in the plantar aspect of the mid foot. Histological examination confirmed a osteochondroma of soft tissue origin.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.129-136
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• 2010

Purpose: Anatomically, the foot is provided with insufficient blood supply and is relatively vulnerable to venous congestion compared to other parts of the body. Soft tissue defects are more difficult to manage and palliative treatments can cause hyperkeratosis or ulcer formation, which subsequently requires repeated surgeries. For weight bearing area such as the heel, not only is it important to provide wound coverage but also to restore the protective senses. In these cases, application of flaps for hind foot reconstruction is widely recognized as an effective treatment. In this study, we report the cases of soft tissue reconstruction for which various types of flaps were used to produce good results in both functional and cosmetic aspects. Methods: Data from 37 cases of hind foot operation utilizing flaps performed between from June 2000 to June 2008 were analyzed. Results: Burn related factors were the most common cause of defects, accounting for 19 cases. In addition, chronic ulceration was responsible for 8 cases and so forth. Types of flaps used for the operations, listed in descending order are radial forearm free flap (18), medial plantar island flap (6), rotation flap (5), sural island flap (3), anterolateral thigh free flap (2), lattisimus dorsi muscular flap (2), and contra lateral medial plantar free flap (1). 37 cases were successful, but 8 cases required skin graft due to partial necrosis in small areas. Conclusion : Hind foot reconstruction surgeries that utilize flaps are advantageous in protecting the internal structure, restoring functions, and achieving proper contour aesthetically. Generally, medial plantar skin is preferred because of the anatomical characteristics of the foot (e.g. fibrous septa, soft tissue for cushion). However alternative methods must be applied for defects larger than medial plantar skin and cases in which injuries exist in the flap donor / recipient site (scars in the vicinity of the wound, combined vascular injury). We used various types of flaps including radial forearm neurosensory free flap in order to reconstruct hind foot defects, and report good results in both functional and cosmetic aspects.

• 대한정형도수물리치료학회지
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• 제23권2호
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• pp.27-32
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• 2017

Background: The purpose of this study was to compare the effects of IASTM and static stretching techniques on ankle joint range of motion (ROM), static foot pressure. Methods: Twenty four subjects with gastrocnemius shortness participated in this study. The subjects were assigned randomly to one of two groups: The soft tissue mobilization technique (IASTM) group received intervention using a IASTM instrument for two minutes, and the stactic stretching group performed self stretching for 30 seconds, four times. The ROM of the ankle joint was measured by active ankle dorsi-flexion test, and a TPScan was utilized to collect the plantar foot pressure. This experiment was performed by two physical therapists. The significant level was set at ${\alpha}=.05$. Results: The results were as follows: 1) The ROM of the ankle joint and was significantly increased in both groups. 2) Plantar foot pressure was no significant in both groups. 3) There were no significant differences between the IASTM group and static stretching group for any variable. Conclusions: The results of this study suggest that static stretching is an effective and easy technique for restoring proper muscle length in subjects with gastrocnemius shortness. We recommend that static stretching technique be used for treat gastrocnemius shortness in clinical setting and home program.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.110-113
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• 2000

The reconstruction of soft tissue defects of the sole requires to stand the force of weight bearing, provide sensation and adequacy for normal foot-wear. Although certain local flaps have been described and used for resurfacing the foot, extensive injury requires distant or free flaps for coverage. There is no doubt that the ideal tissue for resurfacing the sole is the plantar tissue itself. The specialized dermal-epidermal histology and fibrous septa of the subcutaneous layer gives its unique property to stand the pressure and to absorb the shock upon gait. This paper presents a case of reconstructing the sole that involves about 70% of the weight bearing portion. The combined medial plantar and dorsalis pedis chimeric free flap based on the medial plantar artery and medial plantar nerve adds another dimension in resurfacing the weight bearing sole of moderate to large sized defects.

• Archives of Plastic Surgery
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• 제47권4호
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• pp.340-346
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• 2020

Background Adipofascial flaps covered with a skin graft address the challenges involved in reconstructing dorsal foot defects. The purpose of this study was to describe a large adipofascial flap based on the perforators of the dorsalis pedis artery for large foot defects. Methods Twelve patients aged 5-18 years with large soft tissue defects of the dorsal foot due to trauma were treated with an extended dorsalis pedis adipofascial flap from May 2016 to December 2018. The flap was elevated from the non-injured half of the dorsum of the foot. Its length was increased by fascial extension from the medial or lateral foot fascia to the plantar fascia to cover the defect. All perforators of the dorsalis pedis artery were preserved to increase flap viability. The dorsalis pedis artery and its branches were kept intact. Results The right foot was affected in 10 patients, and the left foot in two patients. All flaps survived, providing an adequate contour and durable coverage with a thin flap. Follow-up lasted up to 2 years, and patients were satisfied with the results. They were able to wear shoes. Donor-site morbidity was negligible. Two cases each of partial skin graft loss and superficial necrosis at the tip of the donor cutaneous flap occurred and were healed by a dressing. Conclusions The hinged multiperforator-based extended dorsalis pedis adipofascial flap described herein is a suitable method for reconstructing dorsal foot defects, as it provides optimal functional and aesthetic outcomes with minimal donor site morbidity.

• 한국운동역학회지
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• 제19권1호
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• pp.13-25
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• 2009

Existing footwear biomechanics studies rely on simplified kinetics and kinematics, plantar pressure and muscle electromyography measurements. Because of the complexity of foot-shoe interface and individualized subject response with different footwear, consistent results regarding the biomechanical performance of footwear or footwear components can yet be achieved. The computational approach can be an efficient and economic alternative to study the biomechanical interactions of foot and footwear. Continuous advancement in numerical techniques as well as computer technology has made the finite element method a versatile and successful tool for biomechanics researchdue to its capability of modelling irregular geometrical structures, complex material properties, and complicated loading and boundary conditions. Finite element analysis offers asystematic and economic alternative in search of more in-depth biomechanical information such as the internal stress and strain distributions of foot and footwear structures. In this paper, the current establishments and applications of the computational approach for footwear design and evaluation are reviewed.

• 대한의용생체공학회:의공학회지
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• 제21권2호
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• pp.213-218
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• 2000

Pressure distributions of the soft tissue are valuable for understanding and diagnosing the disease characteristics due to the mechanical loading. Our system measures dynamic pressure distributions in real-time under the general PC environment, and analyzes various foot disorders. Main features of the developed system are as follows: (1) With the resistive pressure sensor matrix of 40${\times}$40 cells, the data is sent to the PC with the maximum sampling rate of 40 frames/sec. (2) For each frame, contact area, pressure and force are analyzed by graphic forms. Thus, various biomechanical parameters are easily determined at specific areas of interests. (3) A certain stance phase can be chosen for the analysis from the continuous walking, and the detailed biomechanical analysis can be done according to an arbitrary line dividing anterior/posterior or medial/lateral plantar areas. (4) The center of pressure (COP) is calculated and traced from the pressure distribution data, and thus the movement of the COP is monitored in detail. A few experiments revealed that our system successfully measured the dynamic plantar distribution during normal walking.