366 pissn : 1226-2102, eissn : 2005-8918 Original Article J Korean Orthop Assoc 2014; 49: 366-373 http://dx.doi.org/10.4055/jkoa.2014.49.5.366 www.jkoa.org 소아의유연성편평족환아에서족저압검사방법의유용성과방사선검사와의관련성 설영준 정성택 양현기 이근배 오창선 정영주 조행난 전남대학교의과대학정형외과학교실 Diagnostic Availability of Pedobarography and Correlation of Radiographic and Pedobarographic Measurements in Pediatric Flexible Flatfoot Young-Jun Seol, M.D., Sung-Taek Jung, M.D., Hyun-Kee Yang, M.D., Keun-Bae Lee, M.D., Chang-Seon Oh, M.D., Young-Ju Jung, M.D., and Hang-Nan Cho, M.D. Department of Orthopaedic Surgery, Chonnam National University Medical School, Gwangju, Korea Purpose: The purpose of this study was to analyze the diagnostic availability and to examine the co-relation between pedobaragraphy and radiography of pediatric flexible flatfoot. Materials and Methods: Seventeen patients and ten normal children were studied. In radiographic evaluation, the talo-1st metatarsal angle was measured on anteroposterior radiographs; and the talo-1st metatarsal angle, the talo-horizontal angle, the calcaneal pitch, and the talocalcaneal angle were measured on lateral radiographs. In pedobarography, foot pressures were subdivided into eight areas for measurement of contact time, ratio of measured area and to investigate the relation between the degree of the medial deviation of the Center of pressure line and the radiographic measurements. Results: Flat foot group and normal group showed statistically significant difference in every angle measured in lateral radiographs. The foot pressure ratios of the lateral sides in forefoot and the medial and lateral sides of midfoot and the medial side of hindfoot between the flexible flatfoot group and normal group showed statistically significant difference in pedobarography and ratio of contact area in forefoot and hindfoot showed significant change in statistics but no changes in contact time. The relation between pedobarography and radiography was investigated: foot pressure of the medial and lateral side of forefoot and the talocalcaneal angle showed significant relation in statistics and foot pressure of the medial and lateral side of mid foot and every angle measured in lateral radiographs showed significant relation in statistics. Contact time of midfoot and every radiographic value measured in lateral radiograph showed significant relation in statistics and contact area of forefoot and midfoot showed significant relation with every radiographic value measured in lateral radiographs. In addition, medial deviation of center of pressure line showed significant relation in statistics with talus-first metatarsal angle measured on anteroposterior radiographs and talo-horizontal angle and talus-first metatarsal angle measured on lateral radiographs. Conclusion: The results of this study showed correlation between radiologic methods and pedobarography in diagnosis of pediatric flexible flatfoot and pedobarography is an useful tool in quantitative and qualitative analysis of the degree of foot deformity and medial deviation of center of pressure line. Key words: flexible flatfoot, pedobarography, radiography Received August 14, 2013 Revised February 11, 2014 Accepted June 25, 2014 Correspondence to: Sung-Taek Jung, M.D. Department of Orthopaedic Surgery, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea TEL: +82-62-227-1640 FAX: +82-62-225-7794 E-mail: stjung@chonnam.ac.kr 서론 편평족은 2 세무렵소아의약 97% 에서발견되고 10 세에는 4% 정 도로감소하는흔한질환이나대부분무증상이며유연성이있는 The Journal of the Korean Orthopaedic Association Volume 49 Number 5 2014 Copyright 2014 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
367 족저압검사의유용성및방사선검사와의관련성 것으로보고되고있다. 1) 편평족의병리는전족부, 중족부, 후족부사이에복합적인변형이동반된다. 2) 대부분거종관절 (talocalcaneal joint), 설상중족관절 (cuneiform-metatarsal joint) 부분에서내측세로궁이소실되어내측세로궁의높이가감소하고후족부외반및전족부외전, 외측거골하관절의아탈구가일어날수있다. 3) 그중에서소아유연성편평족은내측세로궁과족부의지방조직이정상적으로잘발달하는 5세이후부터진단하기에용이하며 4) 진단방법에는증상의유무, 체중부하시또는비체중부하시내측세로궁모양의비교, 비정상적보행의유무및방사선검사등이이용되고있다. 이중특히방사선검사는편평족의해부-병리적변형정도를평가하여치료방향결정에단서를제공한다고알려져있지만, 소아의경우다른연령에비해족부에연부조직이풍부하고골자체가미성숙한상태이며계속적인성장단계에있으므로방사선검사를통하여얻는정보의제한이있는실정이다. 이러한방사선검사의단점을극복하기위해최근족저압검사가많이이용되고있다. 4) 따라서본연구에서는소아유연성편평족환자에서단순방사선검사와족저압검사를시행하여족부의변형정도를파악하고두검사간의연관성및족저압검사의유용성을알아보고자하였다. 환자중신경적이상증상이있거나, 티눈이나압박종등다른병변이존재한경우, 족부및족관절에수술을받은과거력이있는환자를제외한 17명, 34예의족부와정상소아 10명, 20예의족부를정상군으로선정하여연구를시행하였다. 유연성편평족환자군은남자 9명, 여자 8명이었으며평균연령은 8.2 세 (5.0-11.0 세 ), 평균몸무게는 27.9 kg (11.4-35.6 kg), 평균신장은 138.8 cm (89.0-166.8 cm) 이었다. 정상군에서남자는 7명, 여자는 3명이었으며평균연령은 9.0 세 (5.0-11.0 세 ), 평균몸무게는 34.2 kg (21.0-42.2 kg), 평균신장은 139.9 cm (120.0-152.6 cm) 였고편평족환자군과정상군간의통계적유의성은없었다. 2. 연구방법 1) 단순방사선검사 (plain radiography) 단순방사선사진촬영시환자는양하지를신전, 중립위로위치한후체중부하상태에서전후면및측면사진을촬영하였다. 족부의전후면사진에서는거골- 제1 중족각 (talo-1st metatarsal angle) 을측정하였으며족부의측면사진에서는거골- 제1 중족각 (talo-1st metatarsal angle), 종골- 수평각 (calcaneo-pitch angle), 거종각 (talocalcaneal angle), 거골- 수평각 (talo-horizontal angle) 을측정하였다 (Fig. 1). 대상및방법 1. 대상 2011 년 3월부터 2012 년 7월까지보행이상과이학적검사및단순방사선검사상유연성편평족이의심되어족저압검사를실시한 2) 족저압검사 (pedobarography) 모든환자에서시행한족저압검사는 EMED-at 25/D system (Novel GMBH Inc., Munich, Germany) 을이용하였다. EMEDat 25/D system 은 360 190 mm 2 의센서가내장된발판 (sensor platform) 에약 1,400 개의센서 (sensor) 가있는장치로족저압검사 Figure 1. Radiographic indices in a flatfoot. (A) Anteroposterior view: talo-1st metatarsal angle. (B) Lateral view: talo-1st metatarsal angle. (C) Lateral view: calcaneal pitch. (D) Lateral view: talocalcaneal angle. (E) Lateral view: talo-horizontal angle.
368 설영준 정성택 양현기외 4 인 Figure 2. Pedobarographic result. (A) Foot pressure data. (B) Contact time data. (C) Contact area data. ROP, roll of process. 를시행할환자와보호자에게충분한설명을한다음맨발로보행하는동적인상태에서발판을밟는순간 25 Hz로족저압 (peak pressure), 접촉면적 (contact area), 접촉시간 (contact time), 최대힘 (maximum force) 등을측정하였다. 동일방법으로총 3회시행하여각각의평균값을측정하였다. EMED-at 25/D system 을이용하여양측족부를각각전족부, 중족부, 후족부, 족지부의 4구역으로나누었으며족저압, 접촉시간, 접촉면적을측정하였다. 또한 4구역을두번째발가락과뒤꿈치중심을잇는선을기준으로하여내측면과외측면으로구분하여총 8구역으로세분화하였으며각구역의족저압및각각의값이전체에해당하는비율을구하였고, 전족부, 중족부, 후족부의전체족부에대한접촉시간및접촉면적의비율은막대그래프로표시하였다 (Fig. 2). 또한보행하는동안의족저압중심 (center of pressure) 의이동에대한평가는족저압중심이동경로의전후길이와족부전체의전후길이의비인전후지수 (anteroposterior index) 와족저압중심이동경로의최대외측편향길이와족부의최대좌우길이비인족부외측편향지수 (center of pressure excursion index) 를측정하였다 (Fig. 3). 5) 위의내용을바탕으로얻은결과값의통계적인검증은 PASW Statistics ver. 18.0 (IBM Co., Armonk, NY, USA) 을이용하였다. 먼저단순방사선검사와족저압검사의환자군과정상군을비교하였으며족저압검사와단순방사선검사의연관성을알아보았다. 환자군과정상군사이의족저압비율, 접촉면적, 접촉시간결과값차이는독립분석 t-test 를시행하였고족저압결과값과단순방사선결과값사이의관련성및압력중심축의내측편향정도는단순상관분석방법을시행하였으며유의수준은 p<0.05 로하였다. Figure 3. Anteroposterior index (B/A) and center of pressure excursion index (D/C). A, anteroposterior length of the foot; B, anteroposterior length of the path of the center of pressure; C, maximum width of the foot; D, lateral deviation of the center of pressure from the construction. 1. 방사선검사 결과 편평족환자군의단순방사선검사에서족부의전후면사진상거 골 - 제 1 중족각은 20.7 o (2.6 o -45.2 o ) 로측정되었으며, 족부의측면 사진상에서는거골 - 제 1 중족각은 11.4 o (4.2 o -45.2 o ), 거골 - 수평각 은 41.1 o (22.0 o -49.8 o ), 종골 - 수평각은 11.9 o (4.0 o -21.5 o ), 거종각은 53.2 o (35.1 o -64.1 o ) 로측정되었다. 정상군의단순방사선검사에서 족부의전후사진상에서는거골 - 제 1 중족각은 18.3 o (6.8 o -29.4 o ) 로 측정되었으며, 족부의측면사진상에서는거골 - 제 1 중족각은 5.7 o (1.2 o -9.9 o ), 거골 - 수평각은 26.8 o (18.3 o -38.6 o ), 종골 - 수평각은 16.1 o
369 족저압검사의유용성및방사선검사와의관련성 Table 1. Radiographic Measurement Flatfoot ( o ) Normal ( o ) Reference ( o )* p-value Anteroposterior talo-1st metatarsal angle 20.7 (2.6 45.2) 18.3 (6.8 29.4) 0 15 0.502 Lateral talo-1st metatarsal angle 11.4 (4.2 45.2) 5.7 (1.2 9.9) 0 5 0.001 Lateral calcaneo-pitch angle 11.9 (4.0 21.5) 16.1 (9.8 21.3) 15 20 0.001 Lateral talocalcaneal angle 53.2 (35.1 64.1) 46.6 (37.9 50.3) 35 50 0.004 Lateral talo-horizontal angle 41.1 (22.0 49.8) 26.8 (18.3 38.6) 20 25 0.001 Values are presented as median (range). Independent t-test was used. *Normal range of radiologic measurement is from Duk Yong Lee s Pediatric orthopaedics, 3rd edition. Statistically significant. (9.8 o -21.3 o ), 거종각은 46.6 o (37.9 o -50.3 o ) 로측정되었다. 그결과편평족환자군에서측면사진상의거골- 제1 중족각 (p=0.001), 거골- 수평각 (p=0.001) 과거종각 (p=0.004) 이정상군에비해통계적으로유의하게증가하였고측면사진상의종골- 수평각 (p=0.016) 이통계적으로유의하게감소하였다 (Table 1). 그러므로단순방사선검사를통해유연성편평족환자군에서족부의변형을진단할수있고특히전후면사진보다는측면사진의결과값이정상군과의차이를더욱잘반영하므로유연성편평족환자에서의진단시유용할것으로생각된다. 2. 족저압검사 1) 족저압비율정상군과족저압결과값을비교한결과유연성편평족환자군에서전족부의외측 (p=0.027), 후족부의내측족저압비율 (p=0.046) 값이감소하였고, 중족부의내측 (p=0.001), 외측 (p=0.002) 족저압비율값이크게증가하였다. 2) 접촉면적비율유연성편평족환자군에서의접촉면적비율은정상군과비교한결과전족부 (p=0.035) 는감소하였으며, 중족부 (p=0.006) 는증가하였다. 3) 접촉시간비율접촉시간비율은유연성편평족환자군과정상군에서통계적으로유의한차이는없었다. 이러한결과는유연성편평족환아에서보행시상대적으로내측세로궁이감소하면서중족부의족저압, 접촉면적이정상군에비해증가하게되어정상적인족부의운동역학에변화가올수있음을확인할수있었다 (Table 2). 4) 압력중심축의내측편향압력중심축의내측편향정도는유연성편평족환자군의전후지수 (anteroposterior index) 는평균 0.81 이고정상군은 0.84 로통계 Table 2. Comparison of Pedobarographic Results between Flatfoot and Normal Foot Foot pressure ratio (%) 적으로유의한차이를보이지않았으며외측편향지수 (center of pressure excursion index) 역시유연성편평족환자군은평균 0.11 이고정상군은 0.15 로통계적으로유의한차이를보이지않았다 (Table 2). 3. 방사선검사와족저압검사의관련성 Flatfoot Normal p-value Forefoot lateral 32.5 44.3 0.027 Midfoot medial 22.0 6.2 0.001 Midfoot lateral 22.3 14.0 0.002 Hindfoot medial 29.8 37.4 0.046 Contact area ratio (%) Forefoot 33.1 38.2 0.035 Midfoot 27.3 20.5 0.006 Center of pressure Excursion index 0.11 0.15 0.39 Anteroposterior index 0.81 0.84 0.40 Independent t-test was used. 유연성편평족환자군의단순방사선검사결과값과족저압검 사결과값사이의관련성을단순상관분석방법을이용하여알 아본결과보행도중에측정한전족부의내측, 외측족저압비율 은방사선검사중측면상의거종각과유의한관련성이있었고 중족부의내측, 외측족저압비율은측면에서측정한모든방사 선결과값 ( 거골 - 제 1 중족각, 종골 - 수평각, 거종각, 거골 - 수평각 ) 과유의한관련성이있었고전족부와중족부의접촉면적역시 모든측면상의방사선결과값과유의한관련성이있었다. 그리고 중족부의접촉시간은모든측면상의방사선결과값과유의한 관련성이있었고전족부와중족부의접촉면적역시모든측면상 의방사선결과값과유의한관련성이있었다 (Table 3). 또한압력중심축의내측편향정도와단순방사선검사값과
370 설영준 정성택 양현기외 4 인 Table 3. Association between Pedobarographic Measurement and Radiographic Measurement of Flatfeet in Children Pressure ratio (%) Anteroposterior talo-1st metatarsal angle Lateral talo-1st metatarsal angle Lateral calcaneopitch angle Lateral talocalcaneal angle Lateral talohorizontal angle Midfoot medial 0.282 0.001* 0.001* 0.003* 0.012* Midfoot lateral 0.260 0.001* 0.002* 0.001* 0.011* Forefoot medial 0.078 0.114 0.099 0.019* 0.105 Forefoot lateral 0.163 0.240 0.117 0.009* 0.274 Contact time ratio (%) Midfoot 0.123 0.001* 0.004* 0.001* 0.007* Contact area ratio (%) Forefoot 0.052 0.002* 0.001* 0.002* 0.007* Midfoot 0.074 0.017* 0.003* 0.001* 0.008* Bivariate correlation analysis was used. *Statistically significant. Table 4. Association between Center of Pressure and Radiographic Measurement Angle 의관련성을알아본결과족부의전후지수가전후면방사선검 사에서의거골 - 제 1 중족각 (p=0.023) 과측면영상에서의거골 - 제 1 중족각 (p=0.031) 및거골 - 수평각 (p=0.030) 이통계적으로유의하 였다 (Table 4). 이와같이이제까지유연성편평족진단에주로이 용되고있는단순방사선검사와족저압검사결과값은여러부 분에서서로관련성이많은것을알수있으며또한족저압검사 결과를통해유연성편평족환자중족부에족압, 접촉시간, 접촉 면적의증가정도를객관적으로분석할수있고체중부하가중 족부로더실리게되어운동역학에변화가생겨여러가지임상 증상을유발할수있음을유추할수있었다. 고찰 Center of pressure index Excursion index (p) Anteroposterior index (p) Anteroposterior talo-1st metatarsal angle 0.059 0.023* Lateral talo-1st metatarsal angle 0.079 0.031* Lateral calcaneo-pitch angle 0.098 0.180 Lateral talocalcaneal angle 0.103 0.192 Lateral talo-horizontal angle 0.065 0.030* Bivariate correlation analysis was used. *Statistically significant. p, the significance level. 편평족은내측세로궁이소실되어족저부가편평하게되는변형 의총칭으로, 소아에게흔한질환이다. 내측세로궁의형성이나 이, 성별, 관절의과운동성, 후족부의배열등을포함한많은요소 에의해영향을받는다는것이 Mickle 등 4) 에의해밝혀졌다. 이러한내측세로궁의변화는방사선검사를통해가장정확하게발견할수있다. 그러므로편평족은주로임상적양상과함께방사선검사를통하여진단하는데편평족환자에서방사선측정결과는족부의전후면사진상거골- 제1 중족각의증가, 측면사진상거골- 제1 중족각, 거골- 수평각, 거종각은증가하고, 종골- 수평각은감소한다고보고되었는데 6) 이번연구에서유연성편평족환자군의방사선검사에서도이와비슷한양상으로측정되어이를바탕으로임상적검사와함께소아유연성편평족환자와정상소아를분류하여연구하였다. 하지만방사선검사는환자가기립하여체중부하후정지한상태에서시행하므로족부의상태가동적이지못하고환자의보행시족저압의변화를제대로반영하지못한다고할수있다. 반면족저압검사는방사선검사시감수해야하는방사선조사에대한위험성이전혀없어아무런부작용없이반복적인측정이가능하며보행시족저압의분산을역동적으로측정할수있어 7) 수술후의변화나족부변형이시간이지남에따라변하는양상을정량적및정성적으로측정할수있는유용한검사방법으로알려져왔다. 8,9) 또한족저압검사에서는보행시족저압의변화를내측부와외측부로구분하여측정할수있고이값들을비교함으로써보행시족부의내반- 외반변형도예측할수있다. 실제로유연성편평족에대한진단및치료를위해내원한환자들중에는오랜보행이나달리기등체중부하상태에서활동한후에증상을호소하기도하므로환자가역동적으로보행중인상태에서검사를해야만더욱유연성편평족의병태생리를잘반영한다고할수있다. 더군다나소아편평족진단에족저압을측정하여정량화한후족부질환병리에대한연구는족저압측정법이개선됨에따라임상적, 과학적유용성이증가하고있다. 3) 과거의연구는 Harris foot plate 를이용하여신발을신지않은상태에서보행
371 족저압검사의유용성및방사선검사와의관련성 주기중한순간만을포착하여족압을평가한것이었으나신발안에장착할수있는얇고유동적인탐색자의개발로최근에들어보행중에나타나는족저압의변화에대한연구의관심이높아지고있는실정이다. 3,7,8) 또한, 족부의병적인상태가없는정상인에서도족부통증과족저압사이의관계에대한다양한연구가진행중이다. 10) 이중편평족을동반한뇌성마비환자에서외측종골연장술후치료결과를알아보기위한방법으로족저압검사를시행한결과편평족을동반한뇌성마비환자에서족부변형의첫번째병인은거골두의이탈이고족저부의중간부분의압력이증가하며동시에뒤꿈치부위의족저압은아킬레스건혹은가자미근의단축등으로인해감소하는것으로알려져있다. 11) 이러한족부의구조적변형은방사선측정값에영향을미치며아울러족부와지면사이의반응관계를정량화할수있는족저압검사에도영향을끼친다는것을확인할수있었다. 이번연구결과에서도정상군에비해상대적으로족저압, 접촉면적, 접촉시간은중족부에서증가하고전족부와후족부는전반적으로감소하는경향을보이며압력중심축이내측으로기울어지게측정되는것으로보아내측세로궁소실과후족부의외반및전족부외회전변형이동반될수있음을확인할수있었다. 이전족저압검사는대부분뇌성마비환자들이나다른여러가지원인및족부의변형으로인해보행및족부에심각한장애가있어수술적치료가필요한소아나성인만을대상으로시행되어왔기때문에연구대상이매우적고병적변형이상당히진행된족부에국한되어있는실정이었다. 12) Kadhim 등 13) 은전신적인대이완성을동반한소아에서편평외반족의수술적치료후족저압검사를통해의미있는족저압변화및접촉부위분포가향상됨을알수있다고보고하였다. 하지만이번연구에서는다른질환이나변형이동반되지않은일반적인소아유연성편평족환자를대상으로하였으며족저압과방사선검사의관련성뿐만아니라족저압검사결과접촉면적및접촉시간도통계적으로정상군에비해유의하게변화하였다고증명하였다. 또한족저압검사는방사선조사등의부작용이없고검사하는방법자체가매우간단하며실제환자가보행하는상태에서의족압, 접촉면적및시간등을정량적및정성적으로측정할수있어족부의전반적인변화를알아보는데매우유용한검사방법이라는것을확인할수있었다. 이번연구를통해소아편평족환자에서방사선검사와족저압검사사이에관련성이있음을알수있었으나몇가지제한사항이있다. 첫째이번연구의대상은평균나이 8.2 세의어린환자였고가장어린환자는 5세의남아환자로검사시검사자의설명과지시사항을정확하게이행하기가쉽지않고경우에따라서는보호자의도움이필요했다. 둘째 EMED-at 25/D system 으로족저압측정시환자는자신의보폭및발의딛는순서를 platform 에맞춰 걸어야하기때문에 platform 을딛는순간에는부자연스러운자세로보행하게되는경우가많았다. 물론측정하기전실험자가충분한설명및여러차례교육및연습을실시하고측정하였지만어느정도의자세불안정및부자연스러운보행을완전히배제할수는없었다. 그리고이번연구에서는소아유연성편평족환자 17명, 34예의족부와본과외래진료후외래추시결과나방사선검사결과가정상인소아 10명, 20예의족부를정상군으로선정하여비교하여결론을도출하였다. 만약더많은수의환자군과정상소아에서족저압검사결과값을도출한다음이번연구결과를비교분석하였으면더욱의의있는결론도출이가능하였을것이다. 본연구를통해족저압검사의유용성을증명하였으므로먼저유연성편평족의심하에내원한소아들의족부병변및변형에대해정확한이학적, 방사선검사를시행하여야하며추가적으로비교적간단하게시행할수있는족저압검사를하여소아의유연성편평족을보다쉽고정확하게진단할수있도록해야할것이다. 결론 본연구에서소아의편평족진단에족저압검사와방사선검사는여러결과값들에서연관성이있었다. 그리고족저압검사는보행상태를잘반영하는역동적인검사이며그결과값의분석을통해정상군에비하여보행중에중족부의다양한변화를알수있고압력중심이내측편향되는것을확인할수있었다. 또한이를바탕으로족저압검사는정량적및정성적인방법으로소아편평족진단에도움을줄수있을것이다. REFERENCES 1. Ananthakrisnan D, Ching R, Tencer A, Hansen ST Jr, Sangeorzan BJ. Subluxation of the talocalcaneal joint in adults who have symptomatic flatfoot. J Bone Joint Surg Am. 1999; 81:1147-54. 2. Brooks MH. Flat feet in children. BMJ. 1991;302:237. 3. Han SH, Jung M, Lee JW. Pedobarographic analysis in functional foot orthosis. J Korean Foot Ankle Soc. 2006;10:125-32. 4. Mickle KJ, Steele JR, Munro BJ. Is the foot structure of preschool children moderated by gender? J Pediatr Orthop. 2008;28:593-6. 5. Jameson EG, Davids JR, Anderson JP, Davis RB 3rd, Blackhurst DW, Christopher LM. Dynamic pedobarography for children: use of the center of pressure progression. J Pediatr Orthop. 2008;28:254-8.
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373 pissn : 1226-2102, eissn : 2005-8918 Original Article J Korean Orthop Assoc 2014; 49: 366-373 http://dx.doi.org/10.4055/jkoa.2014.49.5.366 www.jkoa.org 족저압검사의유용성및방사선검사와의관련성 소아의유연성편평족환아에서족저압검사방법의유용성과방사선검사와의관련성 설영준 정성택 양현기 이근배 오창선 정영주 조행난 전남대학교의과대학정형외과학교실 목적 : 유연성편평족소아에서족저압검사의유용성과방사선검사와의관련성을알아보았다. 대상및방법 : 환아 17명, 정상 10명을대상으로하여방사선검사를통해전후면거골- 제1 중족각, 측면상거골- 제1 중족각, 거골-수평각, 종골- 수평각, 거종각을측정하였다. 족저압검사는접촉시간과면적비율, 압력중심의편향정도및방사선과의연관성을알아보았다. 결과 : 방사선검사의모든측면각들이족저압검사에서전족부의외측, 중족부의내측과외측, 후족부의내측족저압비율이차이가났고, 전족부와중족부의접촉면적비율이차이가났으며접촉시간에서는차이가없었다. 그리고전족부의내측과외측족저압은거종각과관련성이있었고중족부의내측과외측족저압은모든측면각들과관련성이있었다. 중족부의접촉시간및전족부와중족부의접촉면적은모든측면상의방사선결과값과관련성이있었다. 또한압력중심의편향정도는전, 후면의거골- 제1 중족각과측면의거골- 제1 중족각및거골- 수평각과관련성이있었다. 결론 : 족저압검사와방사선검사는많은연관성이있고보행중의족부변형및역학적변화를정량적및정성적으로분석할수있는유용한검사방법이다. 색인단어 : 유연성편평족, 족저압검사, 방사선검사 접수일 2013 년 8 월 14 일수정일 2014 년 2 월 11 일게재확정일 2014 년 6 월 25 일책임저자정성택광주시동구제봉로 42, 전남대학교병원정형외과 TEL 062-227-1640, FAX 062-225-7794, E-mail stjung@chonnam.ac.kr 대한정형외과학회지 : 제 49 권제 5 호 2014 Copyright 2014 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.