Achilles tendon rupture is a common sports injury encountered in younger populations. Various treatment methods are used for acute and chronic rupture. Several treatments for each condition are available, each having their advantages and disadvantages. In an acute rupture, surgical treatment may be a priority for younger patients or those wishing a quick return to play, but the long-term functional outcome is similar to non-surgical treatment. In addition, the re-rupture rate shows a slight difference between the two treatments. The clinical outcomes are similar regardless of the surgical treatment, but an accelerated rehabilitation program should be accompanied by good results. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment. Treatments are chosen based on the size of the tendon defect. This article reviews the current updates in the treatment of Achilles tendon rupture that will help clinicians choose the appropriate treatment.

Purpose: This retrospective study reports the intermediate-term clinical outcomes including the practical function in daily and sports activities after total ankle arthroplasty for end-stage rheumatoid arthritis, as well as the effects of modification of perioperative anti-rheumatic medications. Materials and Methods: Twelve patients were followed for a minimum of 2 years after total ankle replacement for end-stage rheumatoid arthritis. Perioperative anti-rheumatic medications in all patients were modified based on a specific guideline. Clinical evaluations consisted of American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores. Periodic radiographic evaluation was conducted to detect changes in ankle alignment and postoperative complications. Results: Mean AOFAS, FAOS, and FAAM scores improved significantly from 37.5 to 81.2, 39.1 to 72.4, and 33.8 to 64.0 points at final follow-up, respectively (p<0.001). Functional outcomes in daily and sports activities at final follow-up were found to be 76.5 and 55.8 points for the FAOS and 70.5 and 57.5 points for the FAAM, respectively. As early postoperative complications, there was one case of local wound necrosis, one case of medial malleolar fracture, and one case of deep peroneal nerve injury. Radiological evaluation revealed two cases of asymptomatic heterotopic ossification and one case of progressive arthritis in the talonavicular joint. Reoperation was performed in only one patient (8.3%) with a medial soft tissue impingement at a mean of 35.6 months follow-up. Conclusion: Total ankle arthroplasty appears to be an effective surgical option for end-stage rheumatoid arthritis. Practical functions in daily and sports activities were significantly improved at intermediate-term follow-up. Modification of perioperative anti-rheumatic medications can be one of the solutions to reduce the postoperative complication rate.

Purpose: This study examined the clinical outcomes and assessed the average time to return to play following a peroneal tendon repair in Korean athletes. Materials and Methods: Between March 2004 and February 2017, a total of 30 athletes underwent peroneal tendon repair for a peroneal tendon tear. The indications of surgical treatment were chronic pain or intractable symptoms after a previous ankle sprain affecting sports activity refractory to conservative treatment for at least six months. The patient underwent tubulization for a longitudinal tendon rupture. Peroneus longus to peroneus brevis tenodesis was performed when tendon repair was impossible due to total rupture or multiple longitudinal rupture. Results: Twenty patients not included in this study were as follows: insufficient follow-up, previous surgery, and additional bone surgery. All 10 patients had a previous ankle sprain history, tenderness and swelling on the retromalleolar area. In the 10 patient population, there were five peroneus brevis tendon tears, three peroneus longus tendon tears, one peroneus longus and brevis tendon tear, and one peroneus brevis and superior peroneal retinaculum tear. In the 10 patients, six cases of peroneal brevis tendon repair and four cases of peroneal longus to brevis tenodesis were performed. The preoperative American Orthopaedic Foot and Ankle Society score was improved from a mean of 60.6 (standard deviation [SD], 8.64) to a mean of 90.2, postoperatively (SD, 4.4; p<0.012). The preoperative visual analogue scale was improved from a mean of 5.43 (SD, 1.2) to 0.5 (SD, 0.16), postoperatively (p<0.023). The mean length of time to return to play was 12.2 weeks (range, 8~16 weeks). Conclusion: Peroneal tendon tear can occur due to sports injuries. If there is tenderness at the retromalleolar area, the surgeon should consider a peroneal tendon lesion. Surgical repair of the peroneal tendon can be an effective treatment to help athletes to return to play.

Purpose: To compare the efficacy between cast immobilization and functional treatment using an ankle brace as a treatment for acute lateral ankle sprain. Materials and Methods: This study reviewed the medical records of 157 acute ankle sprain patients who were treated between 2009 and 2014. A total of 101 cases were included in this study except for cases with a combined injury, and could not be followed up for eight weeks after the first visit. The patients were divided according to the treatment modality: a cast immobilization group (64 cases) and functional treatment group (37 cases). The clinical outcomes were assessed retrospectively based on the medical records of each group. The residual symptoms, such as pain, swelling, and instability, at three weeks after the primary treatment and at the last visit were compared. Results: The residual pain and instability were significantly common in the functional treatment group at three weeks. Five cases (7.8%) of pain and one case (1.6%) of instability were in the cast group whereas nine cases (24.3%) of pain and six cases (16.2%) of instability in functional treatment group (p=0.021, p=0.014). On the other hand, there was no meaningful difference at the last follow-up. Residual pain, swelling, and instability at the last visit were noted in three (4.7%), six (9.4%), and four cases (6.3%) in the cast group, and three (8.1%), three (8.1%), and three (8.1%) were observed in the functional treatment group. Six patients refused cast immobilization. Conclusion: Although there was no significant difference at the last follow-up, cast immobilization appears to be more effective than a functional brace in terms of early pain relief and early restoration of ankle stability as a treatment for acute ankle lateral sprain in this study.

Purpose: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. Materials and Methods: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. Results: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. Conclusion: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

Purpose: This study evaluated the clinical and radiological results of 6.5 mm full threaded cancellous bone screw fixation of calcaneal fractures. Materials and Methods: Thirty seven patients diagnosed with Sanders type II or III calcaneal fractures, who underwent open reduction and internal fixation with a 6.5 mm full threaded cancellous bone screw between August 2014 and August 2017, were analyzed. Both the preoperative and postoperative Böhler angle and Gissane angle were measured radiographically. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were also assessed. Results: The mean age of the patients was 52.7 years and the mean follow-up period was 29.5 months. In the Sanders classification, type II and III were 16 and 24 cases, respectively. The Böhler and Gissane angles improved from 21.2° and 122.6° preoperatively to 21.6° and 120.3°, respectively, in the postoperative radiographs. All cases achieved bony union, and the AOFAS ankle-hindfoot scale was 90.7 and 91.3 in Sanders type II and III, respectively, at the final follow-up. Conclusion: The treatment of calcaneal fractures using a 6.5 mm full threaded cancellous bone screw can reduce the complications with minimally invasive surgery and achieve firm fixation.

Purpose: To investigate the spatial distribution of diabetes-related lower limb amputations and analyze the relationship between the spatial distribution of diabetes-related lower limb amputations and regional factors. Materials and Methods: This study was performed based on the data from the Korean Health Insurance Review and Assessment Service, in 2016. The unit of analysis was the administrative districts of city·gun·gu. The dependent variable was the age- and sex-adjusted incidence of diabetes-related lower limb amputations and the regional variables were selected to represent two aspects: socioeconomic factors, and health and medical factors. Along with traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for spatial analysis. Results: The age- and sex-adjusted incidence of diabetes-related lower limb amputation varied according to region. OLS regression showed that the incidence of diabetes-related lower limb amputation had significant relationships with the health and medical factors (number of healthcare institution and doctors per 100,000 population). In GWR, the effects of regional factors were not consistent. Conclusion: The spatial distribution of the incidence of diabetes-related lower limb amputations and the effects of regional factors varied according to the regions. The regional characteristics should be considered when establishing health policy related to diabetic foot care.

Stiff-person syndrome is a rare disorder, and the natural history of the syndrome has not been completely ascertained. The symptoms range from mild to severe and can progress over time: the final result can be significant disability. However, this syndrome is often misdiagnosed due to a lack of understanding of the clinical manifestations. We report the case of a patient who presented with slowly progressing gait disturbance and lower extremity pain and was later diagnosed as suffering from stiff-person syndrome. The patient experienced symptomatic improvement after the administration of benzodiazepines. No recurrence of symptoms has been reported. If the characteristic clinical features and electromyography findings of the syndrome are accurately interpreted, diagnosis of patients with abnormal muscle tension can be effectively done.

According to a recent systemic review, hallux valgus deformity has a prevalence rate of about 23% among adults aged 18 to 65 years. To date, more than 100 operative methods have been reported for the correction of hallux valgus deformity. For young female with mild to moderate hallux valgus deformity, minimally invasive surgery can be considered for aesthetic demands. Here, we report a case of a young female patient with mild hallux valgus deformity treated by minimally invasive surgery using intramedullary low profile plate fixation. This can be the favorable method for secure fixation of the osteotomy site and prevention of medial skin irritation symptoms derived from a sharp osteotomy margin.

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving the synovial membranes. Complete excision with a total synovectomy is important for diffuse type PVNS because of its high recurrence rate. In the ankle, complete excision of diffuse type PVNS is difficult due to the anatomical structure of the ankle joint. This paper reports the author's experience of surgical treatment with combined open and arthroscopic synovectomy. In this manner, it is expected that the complications of the open procedure and the recurrence rate of arthroscopic procedure can be reduced.