So-Young Ahn

Effects of Custom-Made Rigid Foot Orthosis on Pes Planus in Children Over 6 Years Old

Objective To identify the effects of a custom-made rigid foot orthosis (RFO) in children over six years old with pes planus. Methods The medical records of 39 children (mean age, 10.3±4.09 years) diagnosed with pes planus, fitted with RFOs, and had who more than two consecutive radiological studies were reviewed. The resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle (APTCA), lateral talocalcaneal angle (LTTCA), the lateral talometatarsal angle (LTTMA), and calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. After diagnosis, children were fitted with a pair of RFOs and recommended to walk with heel strike and reciprocal arm swing to normalize the gait pattern. A follow-up clinical evaluation with radiological measurements was performed after 12-18 months and after 24 months of RFO application. Post-hoc analysis was used to test for significant differences between the radiological indicators and RCSP. Results With RFOs, all radiological indicators changed in the corrective direction except LTTCA. RCSP and CP in the third measurement showed significant improvement in comparison with the second and baseline measurements. Additionally, APTCA and LTTMA revealed improvements at the third measurement versus the baseline measurements. Conclusion This study revealed that radiological indicators improved significantly after 24 months of RFO application. A prospective long-term controlled study with radiographical evaluation is necessary to confirm the therapeutic effects of RFOs and to determine the optimal duration of wear in children with pes planus.

The Effect of Different Foot Orthosis Inverted Angles on Plantar Pressure in Children with Flexible Flatfeet.

Although orthotic modification using the inverted technique is available for the treatment of flatfoot, empirical evidence for the biomechanical effects of inverted-angle foot orthoses (FOs) is lacking. The aim of this study was to evaluate the effects of different FO inversion angles on plantar pressure during gait in children with flatfoot. Twenty-one children with flexible flatfeet (mean age 9.9 years) were enrolled in this study. The plantar pressures were measured for the rearfoot; medial and lateral midfoot; and medial, central, and lateral forefoot as participants walked on a treadmill while wearing shoes only and shoes with the following 3 orthotic conditions: (i) orthosis with no inverted angle, (ii) orthosis with a 15° inverted angle, and (iii) orthosis with a 30° inverted angle. A one-way repeated measures analysis of variance (ANOVA) with the Bonferroni-adjusted post-hoc test was used to compare the mean values of each orthotic condition. Compared with the shoe only condition, the peak pressure decreased significantly under the medial forefoot and rearfoot with all FOs (p <0.05). However, no significant differences in the peak pressure under the medial forefoot and rearfoot were observed between the FOs. The peak pressure under the medial midfoot increased significantly with all FOs, and a maximal increase in the peak pressure was obtained with a 30° inverted angle orthosis. Furthermore, the contact area under the medial midfoot and rearfoot increased significantly with all FOs, compared with the shoe only condition (p <0.05). Again, no significant differences were observed between the FOs. For plantar pressure redistribution, a FO with a low inverted angle could be effective, accommodative, and convenient for children with flatfoot.

Recurrent cerebral infarction caused by mobile aortic arch thrombus refractory to warfarin therapy.

The mobile thrombus in the aortic arch is a rare condition, which becomes rarer when associated with cerebral infarction, resulting in disabling complications. Transesophageal echocardiography is useful for detecting the source of thrombi in the heart and aortic arch. Here, we report a case of a patient who suffered from recurrent cerebral infarction four times during the previous 18 months due to mobile thrombus in the aortic arch despite anticoagulant therapy. The thrombus with rocking motion (9.6 and 8 mm) was laid in the top of the aortic arch, and surgical resection was not allowed due to the location. We began anticoagulation therapy initially with heparin followed by a combination of warfarin, aspirin, and atorvastatin with an international normalized ratio between 2 and 3. The size of the aortic thrombi was significantly decreased by 3 mm and stabilized after 18 months.

Ultrasonographic Evaluation of Breast Cancer-related Lymphedema

Lymphedema is one of the most common complications after breast cancer surgery. There are many diagnostic tools for lymphedema, but no standard method yet exists. Progressive Resistance Exercise (PRE) is expected to improve lymphedema without additional swelling. This study showed the therapeutic effects of PRE on lymphedema by using ultrasonography to measure the change in thickness of the muscle and subcutaneous tissue. The thickness of subcutaneous tissue decreased more in the PRE group than in the non-PRE group. Ultrasonography is widely used in many clinics because of its easy accessibility, safety, and inexpensiveness. Ultrasound is one of the best tools for diagnosing and determining treatment efficacy on breast cancer-related lymphedema (BCRL).

The effects of talus control foot orthosis in children with flexible pes planus

Fourty children were participated in this study who had been diagnosed as flexible pes planus, and had more than two consecutive radiologic studies. The anteroposterior talocalcaneal angles (APTCA) and lateral talocalcaneal angles (LTTCA), the lateral talometatarsal angles (LTTMA) and the calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. Severe flexible pes planus was diagnosed when Beighton hypermobility score was greater than 4 points and when either of the feet had greater than 10 degrees valgus of resting calcaneal stance position angle and indicators showed greater than 55 degrees in APTCA and LTTCA, greater than 10 degrees in LTTMA, lesser than 10 degrees of CP. Twenty children with flexible flat foot were fitted with a pair of RFO and another 20 children were fitted with TCFO. They were recommended to put on orthosis more than 8 hrs a day, to walk with heel strike at initial contact and reciprocal arm swing to normalize gait pattern. The follow up clinical evaluation with radiologic study was done after 12 months. Result With TCFO, all radiologic indicators changed toward corrective direction than with RFO. There were statistically significant improvements in CP and RCSP in both groups. (p < 0.05) In TCFO group, APTCA, RCSP improved significantly compared with RFO group. Conclusion This study showed that TCFO is effective in the treatment of children with severe flexible pes planus than RFO. The evaluation with long term follow up of radiographic study would be necessary to confirm the therapeutic effect of TCFO in children with pes planus.