• Journal of the Korean Society of Physical Medicine
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• v.18 no.2
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• pp.61-70
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• 2023

PURPOSE: This study evaluated an intrinsic foot strengthening exercise method for flat feet by comparing the effects of intrinsic exercises on a stable surface and intrinsic exercises on an unstable surface. METHODS: Twenty-four people with flat feet were divided into two groups. The control group performed short foot exercises and toe towel curl exercises on the stable support surface. The experimental group performed short foot exercises and toe towel curl exercises on an unstable support surface using Aerostep. The navicular drop test, and the static and dynamic balance were measured before and after the intervention. RESULTS: In the experimental and control groups, there was a significant difference in the navicular drop test and static balance before and after the intervention (p < .05). On the other hand, there was no significant difference between the two groups (p > .05). In the dynamic balance, the experimental group showed significant differences in all directions after the intervention (p < .05). The control group showed significant differences in the postero-lateral direction and posteromedial direction (p < .05). In particular, in the forward direction, the experimental group had a more significant change than the control group (p < .05). CONCLUSION: Intrinsic foot muscle strengthening exercises performed on unstable surfaces can be an effective clinical exercise method to improve the dynamic balance ability of people with flat feet.

• Anatomy and Cell Biology
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• v.56 no.4
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• pp.562-565
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• 2023

The muscles of the sole have been traditionally categorized into four layers, but it is more practical to divide them into peripheral and central groups. The peripheral groups include medial and lateral groups. The central plantar muscles are more numerous and divided into superficial and deep layers. During routine dissection in the Department of Anatomy, All India Institute of Medical Sciences Bibinagar, Hyderabad, variations are been observed in the plantar intrinsic muscle in the left foot & right foot of a 53-year-old male cadaver. This is the first cadaveric report of a combination of discrepancies especially the inter-tendinous connection between quadratus plantae and flexor digitorum brevis. Similar observations in the literature were not found by us. It is important to identify and study these dissimilarities of muscles of the sole for surgeons, anatomists, radiologists and orthopaedics as these muscles and tendons are used in foot reconstructive procedures, and for the treatment of some congenital anomalies.

• Physical Therapy Korea
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• v.16 no.2
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• pp.9-15
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• 2009

The purposes of this study were to compare abductor hallucis (AbdH) muscle activity during toe curl exercise according to position of interphalangeal joint (IPJ). Fifteen healthy subjects with neutral foot were recruit for this study. All subjects performed toe curl exercise with towel while maintaining the IPJ in flexion (condition 1) and extension (condition 2). Toe curl exercise with towel was perform three trials for five second periods in each condition. Surface electromyography (EMG) activities were recorded from three muscles (AbdH, tibialis anterior, peroneous longus) in each condition. EMG activity was normalized to the value of maximal voluntary isometric contraction (%MVIC). The EMG activities acoording to position of IPJ were compared using a paired t-test. This study showed that the EMG activity of AbdH during toe curl exercise with IPJ extension significantly increased compared to those during toe curl exercise with IPJ flexion (p<.05). However, the EMG activity of tibialis anterior and peroneus longus were not significantly different between the conditions (p>.05). These results suggest that toe curl exercise with towel must be performed with extension of IPJ in order to strengthen intrinsic muscle in subjects with overuse injuries related to excessive pronation.

• The Journal of Korean Physical Therapy
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• v.22 no.5
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• pp.57-61
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• 2010

Purpose: The purpose of this study was to identify the effect of active foot arch support on the muscles of lower extremity electromyographic activity during squat exercise in persons with pronated foot. Methods: The study subjects were 16 persons with pronated foot. They have no history of surgery in lower extremity and trunk and limitation of range of motion or pain when performing squat exercise. Each subject was measured the navicular drop (ND) to determine the pronated foot. And then the subjects were asked to perform three repetitions of a $90^{\circ}$ knee flexion squat in both conditions which are 1) preferred squat and 2) squat with active foot arch support. Results: Paired t-test revealed that squat with active foot arch support produced significantly greater EMG activities in abductor hallucis (p=0.00), proneus longus (p=0.03) and gluteus medius (p=0.04) than preferred squat. But the EMG activities of tibialis anterior, vastus medialis oblique and vastus lateralis were not showed significantly different between the both squat conditions. Conclusion: The findings of this study suggest that active foot arch support during squat increase the activities of lower extremity muscles which are the abductor hallucis, proneus longus and gluteus medius. Also, the abductor hallucis which is one of the planter intrinsic muscle and peroneus longus play a role in support of the foot arch and active foot arch support induced the increase of the activity of gluteus medius. Therefore active foot arch support can change the lower extremity biomechanics as well as passive foot support such as foot orthotics and taping.

• PNF and Movement
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• v.20 no.3
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• pp.431-441
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• 2022

Purpose: The purpose of this study was to compare the changes in the contact area, maximum pressure, maximum mean pressure, and maximum force of functional insoles and general insoles when walking. Methods: Foot pressure was measured by the ignition of functional insoles and general insoles on Company N shoes. The foot pressure was measured using a precision pressure distribution meter (Pedar - X mobile system, Novel, Germany). Each insole sensor contained 99 independent cells and was inserted between the foot and the shoe. A wireless Bluetooth-type program was used to measure the pressure detected by the measuring insoles. In order to eliminate adaptation and fatigue caused by wearing the guide during the experiment, sufficient rest was taken between each experiment, and the wearing order was randomly selected. Results: Functional insole significantly increased the forefoot and midfoot (medial, lateral) (p<0.05), while total foot, forefoot, and rearfoot peak pressure significantly decreased (p < 0.05) compared to the general insole. Conclusion: In the functional insole, a high contact area was measured inside, even in the middle of the foot, leading to a proper change in foot pressure. It was confirmed that the contact area was reduced and dispersion occurred well. In addition, it was found that the maximum pressure in the front and back of the entire foot was reduced, so the weight pressure dispersion in the functional insole was evenly distributed, and the maximum average pressure change was similar.

• Physical Therapy Korea
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• v.24 no.1
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• pp.9-18
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• 2017

Background: Short foot exercise (SFex) is often prescribed and performed in the sport and rehabilitation fields to strengthen intrinsic foot muscles. However, SFex is difficult to perform because of lack of feedback methods. Objects: The aim of this study was to compare the effects of SFex with and without electromyography (EMG) biofeedback on the medial longitudinal arch (MLA) of healthy individuals who maintained a static standing position. Methods: All participants (14 males and 12 females) were randomly divided into two groups (biofeedback and non-biofeedback groups). The EMG activity of the abductor hallucis (AbdH) and tibialis anterior (TA) and the MLA angle on the dominant leg side were measured with the participant in the standing position in the pre- and post-intervention conditions. The intervention session consisted of 15 minutes of SFex with (biofeedback group) or without (non-biofeedback group) EMG biofeedback. The groups were compared using two-way repeated measures analysis of variance. Results: The post-intervention activities of the AbdH muscle (p<.05) and the AbdH/TA ratio (p<.05) were significantly greater in the biofeedback group than in the non-biofeedback group. The activity of the TA (p<.05) and the MLA angle (p<.05) in the biofeedback group were significantly lower in the post-intervention condition than in the pre-intervention condition. Conclusion: The present findings demonstrate that the combination of SFex and EMG biofeedback can effectively facilitate the muscle activity of the AbdH and strengthen the medial longitudinal arch.

• PNF and Movement
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• v.16 no.3
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• pp.441-449
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• 2018

Purpose: This study aimed to compare the impact of proprioceptive neuromuscular facilitation leg patterns emphasizing hallux abduction (PNF-LPHA) on the intrinsic foot muscles of participants with hallux valgus (HV) using the toe-spread-out exercise (TSO). Methods: The present study recruited 12 individuals with HV. All the participants voluntarily agreed to participate in the study after hearing explanations of its purpose and process. All participants performed the TSO, PNF-LPHA 1, and PNF-LPHA 2. The participants' abductor hallucis (AbH), adductor hallucis (AdH), extensor hallucis longus (EHL), and flexor hallucis brevis (FHB) activity was measured, and the ratio of AbH:AdH was measured during the three interventions using electromyography. Additionally, the participants' AbH thickness was measured by ultrasonography. An intraclass correlation coefficient (ICC) was used to verify the intra-rater reliability of ultrasonography at rest and during contraction. Results: The intra-rater reliability was excellent at rest and during contraction ($ICC_{3,1}=0.90$ and $ICC_{3,1}=0.83$, respectively). There were no statistically significant differences in the activity of the AbH, the ratio of AbH: AdH, and the thickness of AbH between the TSO and PNF-LPHA2 groups. Additionally, EHL activity was significantly higher in the PNF-LPHA2 group than in the TSOgroup. Conclusion: PNF-LPHA 2 can be recommended as a method to optimize AbH and EHL activity, the ratio of AbH:AdH, and the thickness of AbH in individuals with HV.

• Annals of Clinical Neurophysiology
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• v.13 no.2
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• pp.87-92
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• 2011

Background: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy that occurs in the ankle. Previous studies reported that this disease was due to physiologic factors and structural lesions in the ankle or foot. The authors investigated the causative factors of TTS and their frequency via operative findings. The diagnostic value of MRI was also evaluated based on the concordance between the operative findings and the MRI findings. Methods: This study was performed in retrospective by using medical record of the patients who underwent operations with TTS from August 2003 to May 2010. Physical examination, nerve conduction study, and MRI were conducted on patients who visited department of neurology or orthopedic surgery due to pain and sensory abnormality of their ankle and foot. Results: 34 patients underwent the operation. Ganglion accounted for the largest portion of the operative findings. In addition, varicose veins, intrinsic foot muscle hypertrophy, tenosynovitis, and fascia thickening were mainly observed. Of the 34 patients, 33 patients underwent pre-operative MRI, of whom 18 patients showed MRI findings consistent with the operative findings. Conclusions: Space-occupying lesions accounted for the majority of the causative factors in TTS patients who underwent the surgical treatment. In this study, the MRI appeared useful for identifying causes of TTS.

• PNF and Movement
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• v.20 no.3
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• pp.409-416
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• 2022

Purpose: This study compared and analyzed the contractility of the abductor hallucis (AbdH), an intrinsic foot muscle, between flat feet and normal feet during a movement control test (single-leg small knee band test) using ultrasonography. Methods: A total of 23 subjects with (n = 11) and without (n = 12) flatfoot were included in the study. Each subject performed the short foot exercises (SFE) with a single-leg small knee bend (SLSKB) test, which is a functional movement. An ultrasound device was used to collect data regarding the changes in the contractility of the AbdH. Results: Intergroup comparison showed that dorsoplantar thickness was significantly reduced at baseline and during the SFE with SLSKB in the flatfoot group (p < 0.05). Intragroup comparison showed that the cross-sectional area significantly improved when the SFE was performed with SLSKB in the control group (p < 0.05). Conclusion: In this study, it was observed that the AbdH had inadequate contractility during the SLSKB test in subjects with flatfoot; therefore, it is important to train the contraction of the AbdH via functional movements during clinical interventions for subjects with flatfoot.

• PNF and Movement
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• v.18 no.1
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• pp.97-106
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• 2020

Purpose: This study aimed to determine the most effective way to facilitate the abductor hallucis muscle during PNF leg pattern-emphasized hallux abduction. Methods: The study recruited 18 healthy adults. All participants agreed voluntarily to take part in the study following an explanations of its purpose and procedures. They randomly performed the PNF leg pattern-emphasized hallux abduction variations in a hook-lying or sitting position. Activation of the abductor hallucis (AbH), adductor hallucis (AdH), extensor hallucis longus (EHL), and tibialis anterior (TA) muscles, and the ratio of AbH/AdH, were measured during PNF exercises using electromyography. One-way repeated ANOVA was used to compare the activation of foot intrinsic and extrinsic muscles during the four PNF exercises. Results: PNF leg pattern-emphasized hallux abduction using normal timing was significantly higher in TA compared to PNF leg pattern-emphasized hallux abduction using timing for emphasis, regardless of the starting position. The PNF leg pattern-emphasized hallux abduction using timing for emphasis in the hook-lying position was significantly higher in AbH than in other exercises. Although there was no statistically significant difference in the ratio of AbH/AdH, it was higher in the hook-lying position. Conclusion: PNF leg pattern-emphasized hallux abduction using timing for emphasis in the hook-lying position can be recommended as a method to optimize the activation of AbH and the ratio of AbH/AdH.