• Korean Journal of Applied Biomechanics
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• v.31 no.2
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• pp.79-86
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• 2021

Objective: The purpose of this study was to identify the effect of reduced plantar cutaneous sensation on gait kinematics during walking with and without CAI. Method: A total of 20 subjects involved in this study and ten healthy subjects and 10 CAI subjects participated underwent ice-immersion of the plantar aspect of the feet before walking test in this study. The gait kinematics were measured before and after ice-immersion. Results: We observed a before ice-immersion on plantar cutaneous sensation, CAI subject were found to reduced ankle dorsiflexion, knee external rotation, hip adduction, and internal rotation compared to control subject. After ice-immersion, CAI subjects were found to reduce knee external rotation, hip adduction. However, no significant ankle joint kinematics. Conclusion: While walking, gait pattern differences were perceived between groups with and without plantar cutaneous sensation. The results of the study may explain the abductions in the hip angle movements in CAI patients at initial contact compared to healthy subjects in the control group when plantar cutaneous sensation was reduced. A change in proximal joint kinematics may be a conservative strategy to promote normal gait patterns in CAI patients.

• Korean Journal of Applied Biomechanics
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• v.29 no.1
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• pp.33-41
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• 2019

Objective: This study aimed to investigate the effect of diminished plantar sensation in Y-balance test between chronic ankle instability (CAI) patients versus Healthy individuals. Method: A total of 90 subjects and CAI group (N=45) (age: $24.49{\pm}2.52yrs$, height: $173.53{\pm}8.20cm$, weight: $69.62{\pm}12.92kg$) and healthy group (N=45) (age: $24.85{\pm}2.70yrs$, height: $170.27{\pm}7.70cm$, weight: $66.04{\pm}11.60kg$) participated in this study. Participants were tested on the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the Y-Balance Test before and after a 10-minute of plantar cutaneous sensation application using ice ($2^{\circ}C$). Normalized reach distances were measured 3 times each direction. Results: We observed a decrease in reach-distance scores for the reach directions after diminished plantar cutaneous sensation in all reach directions (p<.01). Also, we observed a decrease in reach-distance scores for the PL, and PM reach directions between groups (p<.05). Conclusion: Our results indicated that dynamic postural control was adversely affected immediately after diminished plantar cutaneous sensation between CAI group and healthy group. Future research may suggest that determine the studies involving more realistic dynamic movement, such as walking or running, landing.

• The Journal of Korean Physical Therapy
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• v.24 no.5
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• pp.306-312
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• 2012

Purpose: The purpose of this study was to examine the effect of changes in foot cutaneous sensation on plantar pressure distribution during gait. Methods: Sixteen healthy young subjects participated in this experiment. All subjects performed two trials of walking under three somatosensory conditions induced by a normal facilitatory insole that provides increased plantar sensory stimulation, and application of lidocaine cream to the plantar surface of the foot to reduce the sensitivity of the soles. Semmes-Weinstein monofilaments were used for evaluation of reduced plantar sensation. The Pedar system was used for measurement of pressure distribution at the plantar surface of the foot. Results: Pressure in the lateral midfoot area showed an increase with increasing and decreasing sensory inputs. When sensory input was increased, plantar pressure showed a decrease in the forefoot area. When sensory input was decreased, plantar pressure showed an increase in the lateral forefoot area and a decrease in the hallux area. Conclusion: By altering sensory feedback, plantar pressure distribution is changed during gait. Plantar cutaneous afferents play an important role in plantar distribution.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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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.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.53-62
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• 2002

Several investigators have reported clinical experience of medial plantar septo-cutaneous flap for reconstruction for soft tissue defect of the hand and digits. Jayme and Hamilton first described the anatomy of superficial branch of medial division of the medial plantar artery used in this flap through cadavaric study in 1997. But, they had a few cases for this flap and there was no anatomic study in Korean. We experienced the reliability of medial plantar septo-cutaneous flap for reconstruction for soft tissue defect of hand and digits through an anatomic study (20 fresh specimens dissected) and clinical application (17 patients). An anatomic study revealed that there were differences in diameter and length of the vessels between Korean and Caucasian. The diameter of vessels in Korean is larger than Caucasian one in each area. Based on this anatomic knowledge, we could harvest this flap safely, and have performed reconstruction on 17 patients with soft tissue defects of hand and digits using a thin, flexible medial plantar septo-cutaneous flap similar to the volar aspect of the hand and digits in anatomical characteristics of the skin and subcutaneous tissue covering. The vessels used for this flap were superficial branches of medial division of the medial plantar artery and vena comitants, or the subcutaneous veins. The mean size of the flap was $2.82cm{\times}4.15cm$. All the flaps survived without significant complications. A medial plantar septo-cutaneous flap possesses several advantages : (1) It is very thin in comparison with other standard free flap; (2) it has two draining venous pathways; (3) it provides a good color and texture match for hand and finger; (4) a good recovery of protective sensation is achievable.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.