• Journal of Yeungnam Medical Science
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• v.36 no.2
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• pp.92-98
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• 2019

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

• Journal of Korean Foot and Ankle Society
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• v.17 no.1
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• pp.64-67
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• 2013

Pigmented villonodular synovitis (PVNS) is a slowly, progressive, proliferative disorder of synovial tissue characterized by villous or nodular changes of synovial-lined joints, bursae, and tendon sheaths and most frequently affects the large joints, with the knee and hip. A few studies have been reported that occurred PVNS in small joint, but mainly in hands. It is a very rare condition that occurs in the small joints of the forefoot. We have experienced the case, which developed in small joint of the forefoot, and performed total synovectomy. After the operation, there was no recurrence. We report a case of PVNS in forefoot with a review of the literature.

• Korean Journal of Applied Biomechanics
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• v.24 no.2
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• pp.139-149
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• 2014

The purpose of this study was to evaluate the effect of angle change of forefoot's adhesive outsole on the electromyographic activity (EMG) of the erector spinae and selected lower limbs muscle during downhill walking over $-20^{\circ}$ ramp. Thirteen male university students (age: $25.4{\pm}3.9$ yrs, height: $176.2{\pm}5.1$ cm, weight: $717.4{\pm}105.0$ N) who have no musculoskeletal disorder were recruited as the subjects. To assess the myoelectric activities of selected muscles, six of surface EMG electrodes with on-site pre-amplification circuitry were attached to erector spinae (ES), rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), lateral gastrocnemius (LG), and medial gastrocnemius (MG). To obtain maximum EMG levels of the selected muscles for normalization, five maximum effort isometric contraction were performed before the experimental trials. Each subject walked over $0^{\circ}$ and $20^{\circ}$ ramp with three different forefeet's EVA outsole (0, 10, $20^{\circ}$) in random order at a speed of $1.2{\pm}0.1$ m/s. For each trial being analyzed, five critical instants and four phases were identified from the recording. The results of this study showed that the average muscle activities of MG and LG decreased in $20^{\circ}$ shoes compared to $0^{\circ}$ and $10^{\circ}$ ones in the initial double limb stance (IDLS). In initial single limb stance (ISLS) phase, the average muscle activities of ES increased with the angle of forefoot's adhesive outsole, indicating that the increment of shoes' angle induce upper body to flex anteriorly in order to maintain balance of trunk. In terminal double limb stance (TDLS) phase, average muscle activities of TA significantly increased in $20^{\circ}$ outsole compared to $0^{\circ}$ and $10^{\circ}$ ones. There was no external forces acting on the right foot other than the gravity during terminal single limb stance (TSLS) phase, all muscles maintained moderate levels of activity.

• Journal of Korean Foot and Ankle Society
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• v.17 no.1
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• pp.11-16
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• 2013

Freiberg's disease is a osteochondrosis of a metatarsal head that is recognized as primarily a disorder of the second metatarsal. It is seen more often in girls. Pain and limitation of motion of the affected joint is the predominant clincal feature. The radiographic appearance demonstrates from osteosclerosis in the early stage to osteolysis with collapse in the later stage. Conservative therapy may take the form of rest, a stiff shoe, and even a cast support to decrease the stress across the joint. Surgical intervention may also be of benefit. Surgery have been attempted either to modify the diseae process or to salvage the situation once the metatarsophalangeal joint develops degenerative changes. Metatarsophalangeal joint instability is common cause of forefoot pain that can develop in association with a traumatic episode and inflamatory tissue disorders as well as neighboring toe deformities. The second ray is by far the most frequently involved. The diagnosis can be made by clinical observation and physical examination including drawer test. Many surgical procedures have beem recommended when conservative treatment has failed. Procedures described range from soft tissue releases and tendon trasfer to the direct plantar plate repair combined with a Weil osteotomy.

• Korean Journal of Environmental Biology
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• v.37 no.4
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• pp.467-473
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• 2019

The amputation of body parts of wild animals can affect their activities in the wild and the behavior of mothers raising their cubs can cause behavioral characteristics in their offspring. In 2017, an Asiatic black bear was caught in a snare at the Jirisan National Park and had a right forefoot amputation. It was released into the wild the same year and gave birth to two cubs. The seasonal analysis of the behavioral rites of five females who gave birth in the same year as this individual showed specific home ranges, activity altitudes, and movement distances compared to other populations. Physical disabilities in the mother could lead to difficulties in food activity, hibernation, and cub-rearing, but the bear's maternal instincts helped to overcome difficulties in the wild and ensure the cubs' survival. It also became a special experience in the process of promoting the restoration of Asiatic black bears at Jirisan National Park. Although the Asiatic black bear's cubs, which grew up in difficult conditions compared to other populations, are not currently causing problems, continuous monitoring will help determine the success of the disabled mother cub-rearing study. Furthermore, these case studies will be used to establish long-term management directions and plans for conflicts with people from various perspectives.