• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.69-73
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• 2005

Purpose: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. Materials and Methods: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. Results: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. Conclusion: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.74-80
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• 2005

Purpose: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. Materials and Methods: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). Results: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). Conclusion: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.87-93
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• 2005

Purpose: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. Materials and Methods: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. Results: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was $23.8^{\circ}$ and $6.6^{\circ}$, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. Conclusion: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.15 no.3
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• pp.149-152
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• 2011

Purpose: The Akin osteotomy which is a closing wedge osteotomy of the proximal phalanx widely used for the correction of hallux valgus has several methods of fixation. we tried to report the effects of the fixation using an absorbable suture material during the Akin osteotomy for the hallux valgus. Materials and Methods: This study was based on 448 cases of 346 patients who were able for follow-up more than 12 months among the patients who had an Akin osteotomy together with the surgery of hallux valgus between March of 2006 and May of 2010. Absorbable suture material had been used in all cases. Radiologically displacement and union of osteotomy site were observed after the surgery, and clinically postoperative complication such as skin irritation, pain and satisfaction were investigated. Results: Radiologically all cases had showed complete union and no case had the loss of an correction due to loss of fixation. Also, any case had no skin irritation due to a knot. Three cases had a medial cortical breakage due to a strong knot, and the initial one case among them had additionally fixed the osteotomy site for four weeks using K-wire, and the remaining two cases had fixed a suture on an articular surface without any fixation of an additional wire. If a medial cortical bone was lost by carrying out an ostectomy due to proximal protrusion of proximal phalanx, three cases could show union through the fixation of suture on an articular surface. Conclusion: This study considers that the fixation of the osteotomy site using an absorbable suture material in an Akin osteotomy was effective method and the advantage of this procedure was unnecessity of the material removal and no skin irritation.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.134-139
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• 2008

Purpose: The purpose of this study was to evaluate the radiological and clinical results of modified scarf osteotomy for hallux valgus with lesser metatarsalgia. Materials and Methods: Total 19 patients (24 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 46.4 years. The mean follow-up time was 14.8 months. We modified original scarf osteotomy by adding the procedure of closing wedge osteotomy at the medial side of distal fragment for achieving of the supination of the first metatarsal head. Additionally, Akin osteotomy of the first proximal phalanx was done in 16 patients (20 feet) and no lesser metatarsal operation was done. First-second intermetatarsal, hallux valgus and distal metatarsal articular angles were analyzed radiologically before and after the operation. And 3-dimensional CT was used to evaluate the supination of the first metatarsal head. Clinical results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score and persistence of lesser metatarsalgia. Results: First-second intermetatarsal and hallux valgus angles were reduced from the mean pre-operative values of $14.2^{\circ}$ and $32.5^{\circ}$ to $8^{\circ}$ and $12.5^{\circ}$, respectively, 12 months after the operation. And the supination of the first metatarsal head was confirmed by 3-dimensional CT. The mean AOFAS score improved from 41.4 points pre-operatively to 87.2 points at follow-up. Lesser metatarsalgia still remained in 2 patients (2 feet). Conclusion: Modified scarf osteotomy would be an effective surgical procedure, especially, for achieving downward displacement and supination of the first metatarsal head in hallux valgus with lesser metatarsalgia.

• Journal of Korean Foot and Ankle Society
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• v.17 no.2
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• pp.121-129
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• 2013

Purpose: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. Materials and Methods: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, $1^{st}-2^{nd}$ intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of $1^{st}-2^{nd}$ metatarsal declination angle and distance between the $1^{st}-2^{nd}$ metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). Results: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the $2^{nd}$ metatarsal and distance between the $1^{st}-2^{nd}$ metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). Conclusion: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length, metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.238-241
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• 2006

Purpose: The purpose of this study was to figure out the appropriate and systemic insurance charge for the hallux valgus operations. Materials and Methods: 5 Hospitals for hallux valgus operations were analyzed how they have been charging the national health insurance corporation for their operation fees and how to use the estimated guide and authoritive interpretation through the guide book of health insurance medical treatment grant expense and the guide book of Health insurance medical treatment. Results: There are nothing for guiding principle of hallux valgus operations in both books but a guide of Mcbride operation which is approved 'JA-93-KA and JA-31' for operation fee. So majority of hospitals have charged operation fee depending on their own interpretations they like. According to the guide books, there was a authoritive interpretation that simultaneous operation of osteotomy and tendon transfer for cerebral palsy and flat foot can be eatimated as 'osteotomy+JA-93-NA'. Conclusion: Distal soft tissue procedure should be approved as 'JA-93-NAx100%+JA-31x50%' according to the the estimated guide and authoritive interpretation if transected adductor hllucis is transfered to first metatarsal head. So distal chevron osteotomy could be 'JA-30-1-RAx100%+JA-31x50%', proximal metatarsal osteotomy could be 'JA- 93-NAx100%+JA-31-50%+JA-30-1-RAx50%', first metatarsocuneiform joint arthrodesis could be 'JA-93-NAx100%+ JA-31x50%+JA-73-RAx50%'.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.47-54
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• 2003

Introduction: Painful plantar callosities under the second and third metatarsal heads are not uncommonly associated with hallux valgus and there have been controversies concerning its treatment modalities. We performed the Weil osteotomy in patients with painful callosities under the second and third metatarsal head associated with hallux valgus, and evaluated the outcome clinically & radiologically. Materials and Methods: From November 2000 through November 2001, out of 51 patients diagnosed with hallux valgus, the Weil osteotomy was performed in 5 women associated with painful callosities under the second and third metatarsal heads. The mean age was 53.4 years (range, 31-66) with a minimum follow-up period of 12 months(range, 12-16). Results: The mean AOFAS lessor metatarso-phalangeal-interphalngeal Scale(LMIS) improved from 61.2 points preoperatively to 88.8 points postopertively. Mean decreases in length of the second and third metatarsal after surgery were 3.2mm and 3mm. Conclusion: We experienced improvement of metatarsalgia in 80% of patients by Weil osteotomy and all patients were symptom-free at last follow-up, suggesting that the Weil osteotomy is an effective procedure in treating painful plantar callosities under the second and third metatarsal heads associated with hallux valgus.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.115-118
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• 2003

Purpose: We are going to present a report from clinical and radiographic results of hallux valgus done only by soft-tissue procedure, when intermetatarsal joint is totally unfit under mild to moderate deformity. Materials and Methods: As a retrospective study, among all the patients who went under the surgery for hallux valgus, and of those who were possible to follow up,(excluding those whose intermetatarsal joint is fit) it was done over 28 cases (18 patients). the soft-tissue procedure was all done by Modified Mc Bride. Results: Hallux valgus angle and intermetatarsal angle each showed correction of $19.4^{\circ}$ and $5.2^{\circ}$, and from the final follow up, they were each decreased by $5.1^{\circ}$ and $1.5^{\circ}$. 21% (6case) were recurred, in one case, the intermetatarsal angle decreasing 120 and the other 5 case all decreased by $13^{\circ}$. Conclusion: when the intermetatarsal joint is unfit and there is no degenerative change, and, if the intermetatarsal angle is not large, moderate hallux valgus can show a good result, just by the distal soft-tissue procedure. a critical indication and a well through out preparation can reduce unneccessary surgeries.

• Journal of Korean Foot and Ankle Society
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• v.1 no.2
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• pp.95-101
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• 1997

Hallux valgus has been characterized by a valgus deformity of the great toe at the metatarsophalangeal joint, along with medial deviation of the first metatarsal, and by three components. First, there is a valgus angle more than $20^{\circ}$ at the first, metatarsophalangeal joint. Second, there is a greater angle than $9^{\circ}$ between the first. and second metatarsals. Third, there is bursal hypertrophy at the medial eminence of the first metatarsals head. The etiology is multifactorial and many procedures have been reported in the treatment of hallux valgus. Most of the procedures are directed towards pain relief, correction of deformity, and preservation of dorsiflexion in the first metatarsophalangeal joint. One such treatment is the Modified chevron osteotomy. It is technically simple, and provides greater stability than a standard osteotomy, and allows early ambulation after surgery. We a reviewed 19 cases with 13 patients of hallux valgus deformity. They were all treated with the Modified chevron osteotomy at the Department of Orthopedic Surgery, Choong ang Gil Hospital, between June 1988 and May 1994. The results of the study were as follows; 1. The mean age was 36 years. Three patients(5 case) were male and ten patients(14 cases) were female. 2. The mean value of the hallux valgus angle was $34.1^{\circ}$, and the first to second intermetatarsal angle was $12.1^{\circ}$, preoperatively. These angles were corrected to $15.8^{\circ}$ and $8.5^{\circ}$, respectively. 3. The metatarsalgia subsided in 17 cases (89.5%). avascular necrosis, non union, and dorsal angulation complicatious were nonexistant. Early bone healing occurred in all cases. 4. The Modified chevron osteotomy is technically simple. It provides excellent pain relief, early ambulation, increased mechanical stability, and many avoids many complications such as AVN, non-union, and dorsal angulation.