• 대한족부족관절학회지
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• 제18권2호
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• pp.62-67
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• 2014

Purpose: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. Materials and Methods: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. Results: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from $27.5^{\circ}$ to $46.7^{\circ}$. In radiographic measurements, calcaneal pitch angle improved from $19.1^{\circ}$ to $15.8^{\circ}$, Meary angle from $13.0^{\circ}$ to $9.3^{\circ}$, Hibb's angle from $44.3^{\circ}$ to $37.0^{\circ}$, and tibio-calcaneal axis angle from varus $17.5^{\circ}$ to varus $1.5^{\circ}$ Conclusion: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

• 대한족부족관절학회지
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• 제17권3호
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• pp.225-233
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• 2013

Purpose: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. Materials and Methods: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. Results: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. Conclusion: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.

• 대한족부족관절학회지
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• 제8권2호
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• pp.126-130
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• 2004

Purpose: In this study, we tried to develop the technique of osteotomy for hallux valgus. The new modified technique of osteotomy was accomplished with even more greater stability, accurate correction of the deformity and more effective than 'chevron' osteotomy in terms of correction of the deformity. Materials and Methods: Between March 1998 and December 2001, 55 cases of new modified osteotomy for hallux valgus were performed for 39 patients, 16 of whom underwent operation of both feet. Operations were made for 34 women and 5 men whose average age was 46 years old (range, $20{\sim}71$ years). Average follow up period was three years (range, $2{\sim}5$ years), and during the follow up, the patients underwent physical examination and assessment with use of the American Orthpaedic Foot and Ankle Society's hallux-metatarso-phalangealinterphalangeal scale and standard foot radiographic measurements. Results: 37 patients (53 cases) out of 39 patients (55 cases) had no pain, good cosmesis, and all of the patients were satisfied with the results of the operation. Two had occasional mild discomfort. The average score according to the hallux-metatarso-phallangeal-interphalangeal scale was 93.2 points (range, $78{\sim}100$ points). The average preoperative intermetatarsal angle was $14.4^{\circ}$, which was decreased to $7.9^{\circ}$ after the osteotomy with an average correction of $6.5^{\circ}$ and The average preoperative hallux valgus angle was $34.1^{\circ}$, which was decreased to $11.1^{\circ}$ after the osteotomy with an average correction of $23^{\circ}$. This new modified technique would prevent the angulation or shortening at the osteotomy site and it was also even more stable at osteotomy site, and could do even more effective and accurate correction of the deformity than conventional Chevron osteotomy. Conclusion: New modified chevron osteotomy for the treatment of symptomatic hallux valgus was done in 55 cases, and the results were satisfactory in all cases. This method was more stable at the osteotomy site than conventional Chevron osteotomy and was also possible to do more accurate and more effective correction of the deformity. It was also easy to control the distal fragment of first metatarsal bone.

• 대한족부족관절학회지
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• 제8권2호
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• pp.121-125
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• 2004

Purpose: We try to retrospectively evaluated the amount of dorsal angulation angle of the first metatarsal commonly occurring as the complication of proximal dome osteotomy for hallux valgus. Materials and Methods: Between January 2004 and March 2004, 34 patients who underwent proximal dome osteotomy for moderate to severe hallux valgus. Two of 34 patients were male, and thirty-two were female. The average age was 57.6 years. We measured and compared hallux valgus angle, 1st-2nd intermetatarsal angle, dorsal angulation angle of 1st metatarsal on preoperative, postoperative, postoperative 3 weeks', postoperative 3 months' X-ray. Results: Osteotomy sites were completely united on plane X-ray in all cases. The hallux valgus angle averaged $41.2^{\circ}$ ($30{\sim}60^{\circ}$) at preoperative, $4.3^{\circ}$ ($-10{\sim}20^{\circ}$) at postoperative, $5.5^{\circ}$ ($-1{\sim}20^{\circ}$) at 3 weeks after operation, $7.8^{\circ}$ ($-2{\sim}20^{\circ}$) at 3 months after operation. The 1st-2nd intermetatarsal angle averaged $17.1^{\circ}$ ($12{\sim}24^{\circ}$) at preoperative, $6.3^{\circ}$ ($0{\sim}13^{\circ}$) at postoperative, $7.2^{\circ}$ ($0{\sim}15^{\circ}$) at 3 weeks after operation, $8.7^{\circ}$ ($0{\sim}18^{\circ}$) at 3 months after operation. The dorsal angulation angle averaged $0.4^{\circ}$ ($0{\sim}3^{\circ}$) at postoperative, $1.6^{\circ}$ ($0{\sim}7^{\circ}$) at 3 weeks after operation, $2.1^{\circ}$ ($0{\sim}8^{\circ}$) at 3 months after operation. There were no statistically correlation between increase of dorsal angulation angle of the distal segment of the first metatarsal and increase of hallux valgus angle or 1st-2nd intermetatarsal angle. Conclusion: Our results shows that the dorsal angulation of distal fragment occurring after the proximal dome osteotomy in the treatment of hallux valgus may be minimized with meticulous surgery and patient's education.

• 대한족부족관절학회지
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• 제13권2호
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• pp.113-117
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• 2009

Purpose: To evaluate the short-term results of medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot deformity. Materials and Methods: Twenty four patients (25 feet) who had undergone medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot between July 2004 and May 2007 were included. The mean age was 43.6 years (16~78 years). The mean follow-up was 26 months (14~50 months). Clinical outcomes were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Six radiographic parameters were measured from weightbearing radiographs to assess the difference between preoperative and postoperative radiographs. Results: The mean AOFAS score improved from 57.9 points preoperatively to 89.2 points at latest follow-up (p=0.000). The mean VAS improved from 62 points preoperatively to 23 points at latest follow-up (p=0.000). The mean talonavicular coverage angle on anteroposterior (AP) view changed from 20.2 degrees to 16.0 degrees (p=0.002). The mean calcaneal pitch angle on lateral view changed from 12.6 degrees preoperatively to 14.5 degrees at latest follow-up (p=0.001). Regarding these radiographic parameters, the difference between interobserver measurements was larger than that between pre- and post-operative measurements. The calcaneus was transferred medially by average 11.8 mm (p=0.003), which was 27.9% of the width of calcaneal tuberosity (p=0.000). The mean talo-first metatarsal angle on AP and lateral views, and navicular height on lateral view were not significantly changed. Conclusion: Medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot could lead to improve the clinical outcomes, although the restoration of medial longitudinal arch was not clinically significant.

• 대한족부족관절학회지
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• 제19권2호
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• pp.51-57
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• 2015

Purpose: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. Materials and Methods: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. Results: The mean hallux valgus angle measured at preoperation was $37.7^{\circ}$ and $15.9^{\circ}$ at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were $15.2^{\circ}$ and $8.3^{\circ}$. The mean distal metatarsal articular angle changed from $12.6^{\circ}$ at preoperation to $7.8^{\circ}$ at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was $37^{\circ}$ and 13o, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. Conclusion: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under $37^{\circ}$ and distal metatarsal articular angle under $13^{\circ}$ can lead to good clinical results without recurrence.

• 대한족부족관절학회지
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• 제19권3호
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• pp.102-106
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• 2015

Purpose: We wanted to compare the results between cadaveric and radiological measurements of calcaneus. Materials and Methods: Sixty three calcaneus of 33 cadavers donated between December 2012 and December 2014 were actually measured. Computed tomography (CT) images of 244 calcaneus in 122 patients of the same age group with cadavers were radiologically measured. Maximum length, maximum width, maximum height, $B{\ddot{o}}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were measured. Results: In cadaveric measurement, the mean maximal height, length, and width were $41.8{\pm}3.3mm$, $73.3{\pm}3.4mm$, and $40.7{\pm}2.2mm$, respectively. In radiological measurement, the mean maximal height, length, and width were $38.5{\pm}4.3mm$, $74.0{\pm}5.7mm$, and $44.7{\pm}1.4mm$, respectively. In cadaveric measurement, the mean $B\ddot{o}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were $32.1^{\circ}{\pm}6.2^{\circ}$, $110.8^{\circ}{\pm}8.1^{\circ}$, $55.8^{\circ}{\pm}6.8^{\circ}$, and $59.7^{\circ}{\pm}4.6^{\circ}$, respectively. In radiological measurement the mean $B{\ddot{o}}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were $32.6^{\circ}{\pm}3.8^{\circ}$, $113.7^{\circ}{\pm}5.7^{\circ}$, $62.2^{\circ}{\pm}3.9^{\circ}$, and $61.6^{\circ}{\pm}6.3^{\circ}$, respectively. The mean maximal height was significantly higher in the cadaveric measurement group (p<0.001) and the mean maximal length and width were significantly higher in the radiologic measurement group (p<0.001, p<0.001). The mean Gissane angle, Fowler-Philip angle, and $B{\ddot{o}}hler$ angle were significantly higher in the CT group (p=0.001, p<0.001, p=0.016, respectively). There was no significant difference in the mean tala-articular angle (p=0.352). Conclusion: Significant differences in length parameters were observed between the cadaveric measurement group and the radiologic measurement group. However, no significant differences in angular measurements were observed between the two groups. The authors carefully conclude that radiological measurement values may be different from actual values in the calcaneus.

• 대한족부족관절학회지
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• 제12권1호
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• pp.20-25
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• 2008

Purpose: The purpose of this study is comparison of radiological and clinical outcomes between proximal metatarsal osteotomy and distal chevron osteotomy for the correction of hallux valgus. Materials and Methods: In this retrospective study, we included subjects who underwent the correction of hallux valgus in our institution between March 2001 and August 2006, with a minimum follow-up of 12 months. The group of proximal metatarsal osteotomy was 23 patients (34 feet); the group of distal chevron osteotomy was 20 patients (26 feet). The group of proximal metatarsal osteotomy was composed of 26 severe cases (76.5%) and 8 moderate cases (23.5%); the group of distal chevron osteotomy was composed of 13 severe cases (50.0%) and 13 moderate cases (50.0%). Results: Compared to preoperative values, the hallux valgus angle, the first-second intermetatarsal angle and the distance of first-fifth metatarsal head were significantly decreased in two groups (p<0.05). In each parameter, the hallux valgus angle was decreased 66.3% (proximal metatarsal osteotomy) versus 49.6% (distal chevron osteotomy), which were significant (p=0.037). The first-second intermetatarsal angle and the distance of first-fifth metatarsal head were not significant. Mayo clinic forefoot scoring system (FFSS) score was significantly improved in two groups (p<0.05). The ratio of improvement was not significant (p=0.762). In severe group, hallux valgus angle and the first-second intermetatarsal angle was significantly decreased in proximal metatarsal osteotomy group compared to distal chevron osteotomy group (p<0.05), but the difference of the distance of first-fifth metatarsal head and FFSS score was not significant in both groups. In moderate group, the difference of all parameters was not significant in both groups. Conclusion: Although both proximal metatarsal osteotomy and distal chevron osteotomy showed satisfactory result in FFSS, proximal metatarsal osteotomy was more proper operative technique than distal chevron osteotomy in severe group, because of superiority of correction in radiological parameters.

• 대한족부족관절학회지
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• 제12권1호
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• pp.26-30
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• 2008

Purpose: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. Results: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was $3.21{\pm}1.7$ and group B $1.76{\pm}1.0$. Preoperative mean AOFAS score of group A was $45.61{\pm}8.3$, group B $44.41{\pm}8.9$, the final mean score of group A was $88.87{\pm}8.3$ and group B $92.47{\pm}4.4$. Preoperative mean HVA was $30.82{\pm}6.6$ degrees in group A and $32.88{\pm}14.5$ degrees in group B, the final mean angle of group A was $14.89{\pm}8.3$ degrees and group B $17{\pm}4.4$ degrees. The preoperative mean IMA of group A was $13.69{\pm}3.6 $degrees and group B $12.35{\pm}5.2$, the final mean angle of group A was $9.26{\pm}3.6$ degrees and group B $12.35{\pm}5.8$ degrees. Conclusion: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.

• 대한족부족관절학회지
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• 제12권1호
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• pp.93-99
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• 2008

Purpose: To evaluate the result of the early exercise and rehabilitation after limited posterior operative treatment of the calcaneal fractures. Materials and Methods: Between May 2005 and December 2007, 43 cases with intraarticular calcaneal fractures were treated by open reduction with K-wires and Steinmann pins. Mean age and mean follow-up period were 42.5 years old and 15 months. All patients were treated with the same postoperative protocol, the early exercise of subtalar joint without short leg splint and cast was began after postoperative 1 day, non-weight bearing crutch ambulation did after 2 weeks, partial-weight bearing crutch ambulation did after 6 weeks, without crutch ambulation did after 10 weeks. The fractures was classified by Essex-Lopresti and Sanders classification using radiographs and the functional outcomes were evaluated by circle draw exercise, AOFAS score. Results: By Essex-Lopresti classification, the tongue type was 6 cases (14%), the joint depression type was 15 cases (35%), the combined type was 22 cases (51%). By Sanders classification, type II were 10 cases (23%), type III were 15 cases (58%), and type IV were 8 cases (19%). By AOFAS functional evaluation, the mean preoperative scores were 70.3 and 70.5 respectively, mean postoperative scores were 83.7 and 86.9 respectively. There were satisfactory results in 40 cases but 3 cases were unsatisfactory including on case of lateral impingement and 2 cases of traumatic arthritis of subtalar joint. Conclusion: We obtained satisfactory result of the early exercise of subtalar joint without short leg splint and cast and rehabilitation after limited posterior operative treatment of the calcaneal fractures.