• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.115-119
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• 2007

Avascular necrosis of the first metatarsal head is uncommon. It is most often seen following a distal metatarsal osteotomy for hallux valgus. Although many cases may be subclinical, it is a powerful cause of failure of bunion surgery. Avascular necrosis of the first metatarsal head results in a series of events that begins with phases of avascularity; revascularization, with or without collapse; and reossification. Collapse may result in degenerative change of the metatarsophalangeal joint. We have recently experienced a case of avascular necrosis of the first metatarsal head.

• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.43-47
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• 2014

Hallux valgus is a lateral deviation of the first phalanx and medial deviation of the first metatarsal at the first metatarsophalangeal (MP) joint. Its incidence has increased due to developing footwear. The etiologies include fashion footwear, genetic causes, anatomical abnormality around the foot, rheumatoid arthritis, and neuromuscular disorders. Physiologic alignment of the first MP joint is maintained by congruent and symmetric alignment of the articular surface of the first proximal phalanx and first metatarsal head, physiologic relationship of the distal first metatarsal articular surface and the first metatarsal shaft axis, and stable balance of soft tissue around the first MP joint and stable tarsometatarsal joint. Several factors have been associated with hallux valgus, including pes planus, hypermobility of the first tarsometatarsal joint, flattened shape of the first metatarsal head, increased distal metatarsal articular angle, and deformation of the medial capsular integrity. History and physical examination are very important to diagnosis of hallux valgus. Simple radiography provides information on deformity, particularly in weight-bearing anteroposterior and lateral radiographs. Understanding the etiologies and pathophysiology is very important for success in treatment of patients with hallux valgus.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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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.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.130-134
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• 2010

Purpose: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. Materials and Methods: We performed a dorsal closing wedge $1^{st}$ metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-$1^{st}$ metatarsal, calcaneus-$1^{st}$ metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. Results: Talo-$1^{st}$ metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of $21^{\circ}$ and $25^{\circ}$ to $12^{\circ}$ and $19^{\circ}$, respectively, at last followup. Also, calcaneus-$1^{st}$ metatarsal angle was increased from the mean $114^{\circ}$ to $114^{\circ}$. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. Conclusion: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.33-39
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• 1999

Brachymetatarsia of the first metatarsal is uncommon. It may occur as a congenital condition. Hallux varus is the name given to a medially deviated position of the first metatarsophalangeal joint with a nonpurchasing hallux in varus position. To have a patient with not only both hallux varus and brachymetatarsia, but for the brachymetatarsia to occur about the first metatarsal, is extremly rare. We experienced a case of the brachymetatarsia of the first metatarsal with hallux varus treated by callotasis. Excellent cosmetical and funtional outcome were obtained. So we reporting the case with a review of the literatures.

• Journal of Korean Foot and Ankle Society
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• v.4 no.2
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• pp.72-78
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• 2000

Purpose: To validate the major bony causes and postoperative results of the first metatarsal head plantar pain. Materials and Methods: We experienced one case of the fracture and non-union of the medial sesamoid treated by autogenous calcaneal bone graft, one case of the fracture and non-union and two cases of the hypoplasia of the medial sesamoid treated by excision of medial sesamoid, one case of the arthrosis between the first metatarsal head and the medial sesamoid treated by plantar 1/2 partial excision of the medial sesamoid, and two cases of the metatarsus primus nexus treated by basal metatarsal closing wedge osteotomy between October 1995 and September 1999. The mean follow-up period was 28 months. We evaluated the results by using of the clinical rating systems for the hallux and the radiographic findings. Results: An excellent results were achieved in all cases except one which was preoperatively diagnosed as metatarsus primus nexus. But, clinically this one case also satisfied with the postoperative result. Radiologically, We did not find the malunion or nonunion of the medial sesamoid treated by bone graft and of the metatarsus primus flex us treated by basal metatarsal closing wedge osteotomy. And also we did not find the postoperative fracture of the medial sesamoid treated by plantar 1/2 partial excision. There were no postoperative complications in all cases. Conclusion: We think that the good results may be achieved from the patients with the plantar pain of the first metatarsal head by the exact diagnosis and aggressive treatments.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.111-115
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• 2008

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation in the synovium. The cartilaginous nodules occur in the synovial membrane of a joint, bursa, or tendon sheath. It frequents large joints including knee, hip, and elbow. Synovial chondromatosis originating from the first metatarsal is extremely rare. We report a case of 37-year-old man with synovial chondromatosis of the first metatarsal.

• 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 the Korean Orthopaedic Association
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• v.54 no.2
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• pp.182-186
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• 2019

Giant cell tumor is a benign but locally aggressive tumor with common recurrence. Most cases occur around the knee joint. Giant cell tumor of the foot is rare and very few cases involving the first metatarsal have been reported. Its characteristics and treatment in adult patients remain unclear. This paper reports a case of recurrent giant cell tumor at the first metatarsal that was excised surgically and subsequently reconstructed with non-vascularized fibula graft.

• Journal of Korean Foot and Ankle Society
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• v.19 no.1
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• pp.18-22
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• 2015

Purpose: The purpose of this study is to evaluate the incidence and cause of reamputation with respect to the location of foot amputation. Materials and Methods: Eighty-six patients who received amputations below the ankle level from March 2002 to September 2012 with at least 1 year follow-up were enrolled in this study. We stratified the site of the initial amputation from first to fifth ray and into either the phalanx or metatarsal bone, and investigated the cause of reamputation. Results: The reamputation rate below the ankle level was 53.5%. It was highest (62.1%) in patients with first ray amputations without statistical significance. Rays were divided into two columns, first to third rays as the medial column and others as the lateral column, and reamputation was performed in 61.2% of patients with medial column amputation. Comparing the results between phalanx and metatarsal amputations, reamputation was performed in 62.1% of patients with metatarsal bone amputation. The rate of reamputation was statistically significant in both the medial column and metatarsal amputations. The most common reamputation site, in accordance to the initial site of amputation, was the adjacent ray (57.4%), which was without statistical significance. Moreover, the most common cause of reamputation was osteomyelitis and focal infection in all rays. Conclusion: This study showed that reamputation after amputation below the ankle level was relatively common with highest rate in medial column and metatarsal amputations. Hence, surgeons should be aware of the risk of reamputation and put more preventive effort during medial column and metatarsal amputations.