• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.62-68
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• 2001

Purpose: to investigate the etiology and the results of surgical treatment of the symptomatic accessory navicular in adults. Materials and Methods: Between 1996 and 2000, 17 cases in 16 adult patients who were older than 20 years were diagnosed as painful accessory na vicular. 11 patients could recall a twisting injury of the ankle, and 8 of them were inversion sprain. 4 patients had tibialis posterior tendon lesions. 13 feet of 12 patients were treated by resection of accessory navicular, the synchondrosis, the medial portion of the navicular and reattachment of tibialis posterior tendon without transposition. 9 feet in 8 patients were followed for more than one year after surgery. In 4 patients with tibialis posterior tendon lesions, additional procedures were performed according to the state of the lesion. Results: All were type II accessory navicular bone which had synchondroses. There was gross motion of the synchondrosis in 'the operating field in all feet. Of the 9 feet which were followed for more than one year after surgery, results were excellent in five and good in four. Conclusion: The painful accessory navicular in adult might be closely associated with inversion ankle sprain, and also with the tibialis posterior tendon lesions. Satisfactory result could be obtained without transposition of the tibialis posterior tendon to the undersurface of the navicular and immediate postoperative weight bearing does not have harmful effect on the result.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.71-75
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• 2004

Purpose: The purpose of this study was to evaluate retrospectively the clinical results of closed reduction and percutaneous screw fixation for unstable injuries on stress radiographs in subtle injuries of Lisfranc joint. Materials and Methods: From June 1997 to March 2003, 6 cases of unstable injuries on stress radiograph in subtle injuries of Lisfranc joint were treated by percutaneous cannulated screw fixation after closed reduction. All cases were injuried by indirect force (twisting injury). The average diastasis between the 1st and 2nd metatarsal base was 3 mm (2-4 mm) on initial nonweight bearing AP radiograph. The average follow-up period was 20 months. Clinical evaluation was assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score. Results: The AOFAS midfoot score was average 86 (80-90) points. The average diastasis between 1st and 2nd metatarsal base was 2 mm (1-3 mm) on weight bearing AP radiograph in final follow up. The final diastasis was increased slightly than diastasis in initial postoperative radiographs. But the clinical results were good. There was no correlation between the degree of diastasis and the clinical results. On weight bearing lateral radiograph, the average difference with normal foot in the distance between plantar aspect of 5th metatarsus and medial cuneiform was 2 mm (0-3 mm). One case had mild arthritic change on the radiographs. Conclusion: When the Lisfranc injuries, especially in the subtle injuries were suspicious, the stress views are helpful to assess stability of the Lisfranc injuries and planning of treatment. For unstable injuries on stress radiographs in subtle injuries of Lisfranc joint, closed reduction and percutaneous screw fixation is useful method to expect good clinical results.

• Korean Journal of Applied Biomechanics
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• v.20 no.4
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• pp.469-477
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• 2010

The purpose of this study was to evaluate the effects of insole-equipped ankle-foot-orthoses (AFO) on gait. 10 healthy males who had no history of injury in the lower extremity participated in this study as the subjects. The foot of each subject was first scanned, and the insole fit to the plantar was made using BDI-PCO(Pedcad Gmbh, Germany). The subject then was made to walk on a treadmill under four experimental conditions: 1) normal walking, 2) walking wearing AFO, 3) walking wearing AFO equipped with the insole, 4) walking wearing pneumatic-ankle-foot-orthosis (pAFO) equipped with the insole. During walking, foot pressure data such as maximum force, contacting area, peak pressure, and mean pressure was collected using Pedar-X system (Novel Gmbh, Germany) and EMG activity of lower limb muscles such as gastrocnemius medial head, gastrocnemius lateral head, and soleus was recorded using MP150 EMG module (BIOPAC System Inc., USA). Collected data was then analyzed using paired t-test in order to investigate the effects of the insole. As a result of the analysis, when insole was equipped, overall contacting area was increased while both the highest peak pressure and the mean pressure were significantly decreased, and EMG activity of the lower limb muscles was decreased. On the contrary, the cases of wearing AFO showed the decreased contacting area and the increased pressures. Therefore, the AFO equipped with a proper insole fit well to the foot can help comfortable walking by spreading the pressure over the entire plantar.

• Fashion & Textile Research Journal
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• v.15 no.4
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• pp.613-619
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• 2013

This study compares the gait characteristics of elderly women during barefoot walking and walking with sneakers. We measured foot angles, max foot pressure, peak plantar pressure of each plantar region, velocity of Center of Pressure(COP), and axis shifting of COP with an RS-scan system. Elderly women's foot angles were narrower when walking with sneakers than when barefoot walking. We found that the subtalar joint angle (representing ankle joint flexibility) affected walking stability. Regarding the peak plantar pressure of each foot region, pressures were high in the medial regions and the pressures greatly varied depending on the region measured during barefoot walking. The COP moved significantly faster when walking with sneakers than barefoot walking and suggests that elderly women walked faster in sneakers. Axis shifting of the COP decreased during walking with sneakers and indicated that gait balance improved when walking with sneakers. The findings of the present study can be utilized as foundational data for elderly women's gait characteristics as well as data for the production of functional footwear. Future research that focuses on various types of shoes, age groups, and gender are recommended for the development of more functional footwear for stable gaits.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.166-172
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• 2019

Purpose: This study evaluated the clinical and radiological results after reinforcement of the weakened medial joint capsule using Internal Brace (Arthrex) for treating severe hallux valgus. Materials and Methods: This study reviewed 56 cases of 50 patients that were followed-up postoperatively for at least 12 months, from September 2017 until August 2018. An extended distal chevron osteotomy combined with a distal soft-tissue release was performed by a single surgeon to treat severe hallux valgus. Internal Brace was applied in 12 cases (group A) who had weakened medial joint capsules, and capsulorrhaphy was performed in 44 cases (group B), and these two groups were compared postoperatively for the clinical and radiological results. The postoperative complications were also investigated. Results: No significant differences at 1-year follow-up on the Manchester-Oxford Foot Questionnaire and the patients' satisfaction scores were found between the two groups (p=0.905 and p=0.668, respectively). For the radiology, the changes of the values between before surgery and at 1-year follow-up according to the group showed no significant differences in the hallux valgus angle, intermetatarsal angle, and the hallux interphalangeal angle (p=0.986, p=0.516, p=0.754, respectively). Recurrence of hallux valgus was reported in two cases in group A, and in three cases in group B. Transfer metatarsalgia occurred in 4 cases in group B. Conclusion: Based on these results, we recommend the capsule reinforcing technique using Internal Brace as a successful operative option for treating a weakened medial capsule in patients with severe hallux valgus.

• 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.9 no.1
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• pp.9-12
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• 2005

Purpose: This study is to compare the medial longitudinal arch between heel pain group and normal painless group. Materials and Methods: Heel pain group 242 feet and normal group 140 feet were evaluated through the radiographic images of standing foot-ankle lateral view. Four radiographic indices, talo-1stmetatarsal angle (TMA), calcaneal-1st metatarsal angle (CMA), calcaneal pitch angle (CPA), and arch ratio (AR), were used as well as BMI. Results: There was no difference between heel pain group and normal group in the TMA, CMA, CPA, and AR. But in the BMI, heel pain group showed $1.7\;kg/m^2$ (p=0.0002) higher than normal group. To eliminate the sexual error, male and female were evaluated separately. Male heel pain group showed 2.9 degrees more dorsiflexion (p=0.001) in the TMA, 3.1 degrees greater (p=0.007) in the CMA, 0.01 lower (p=0.028) in the AR, and $1.0\;kg/m^2$ greater (p=0.033) in the BMI than normal male group. There were no difference in the CPA. Female heel pain group showed 3.6 degree greater (p=0.035) in the CMA, and $1.9\;kg/m^2$ greater (p=0.002) in the BMI than normal female group. But other indices demonstrated no differences. Conclusion: talo-$1^{st}$ metatarsal angle, calcaneal-$1^{st}$ metatarsal angle and arch ratio were radiographic indices related with heel pain.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.144-149
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• 2006

Purpose: To evaluate the clinical characteristics and the functional results of the osteochondral lesions of the talus (OLT) treated with arthroscopic osteochondroplasty. Materials and Methods: The study was based on 25 cases (25 feet) of osteochondral lesion of talus that were treated with arthroscopic osteochondroplasty from May 1997 to June 2005 with at least 1 year follow-up. Follow-up period was average 21.8 months. The average age was 37.2 years old. Male patients were 22 while female were 3. Postoperative evaluation was performed with American Orthopedic Foot and Ankle Society (AOFAS) Functional score, patient satisfaction and complications. Results: Ninety-two percent of patients had trauma history. Seventy-two percent of the lesions were located at the medial dome. As for the cartilage classification, 56% were fibrillation/fissure lesions while 44% were flap tears. Visual analogue scale (VAS) pain score improved from 6.8 points to 2.2 points, and AOFAS score improved from 71.3 points to 87.3 points. Eighty-eight percent of the patients were satisfied with the surgery and average period of returning to previous job was 6.5 weeks. Conclusion: We concluded that the arthroscopic osteochondroplasty is a viable surgical option for the osteochondral lesion of the talus.

• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.43-50
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• 1997

The tarsometatarsal joint complex is formed by articulation of the five metatarsal bases with the three cuneiform bones and the cuboid bone. Fracture-dislocation of tarsometatarsal area are difficult to recognize on standard radiographs. The exact diagnosis is occasionally delayed. As a result, improper treatment and late sequelae remains. We decided to make a study of patients with normal foot radiographs on 200 cases. Standard radiographic evaluation was used to study the normal variants of the foot and to evaluate the coincided alignment of the lisfranc joint. Accurate accessment on AP & lateral & $30^{\circ}$ oblique projection of radiographs are very adventageous & important, and next final outcome was detected. : 1. Coincided alignment below 1mm and unfolded lisfranc joint on AP projection was well visalized on 1st cuneiform-metatarsal lateral border and 2nd cuneiform-metatarsal medial border. 2. Coincided alignment below 1mm and unfolded lisfranc joint on oblique projection was well visualized on 2nd cuneiform-metatarsal lateral border and 3rd cuneiform-metatarsal medial border and 3rd cuneform-metatarsal lateral border. 3. More proximal location of 2nd lisfranc joint compared to another joint was 196 cases (98%). It is due to inceleration of 2nd metatarsal base between 3rd & 1st cuneiform. 4. 3rd lisfranc joint was volarward position compared to 2nd listranc on lateral projection at 191 cases (95.5%). It's due to anterior covexity of lisfranc joint. 5. Wide dorsal sided 2nd lisfranc is investigated at 189 cases (94.5%). Because of it. 2nd & 3rd lisfrances are mainly volar dislocated usually. 6. Notching on 5th metatarsal base is visible on 171 cases (85.5%). 7. 4th lisfranc joint had offset normally within $2\sim3mm$ at 98 cases (49%). 8. 5th Lisfranc joint had normally offset within $2\sim3mm$ at 99 cases (49.5%). 9. On lateral projection, slight dorsal location of cuneiform to metatarsal base is investigated at 82 cases (41%).

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.37-42
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• 2016

Purpose: Soft tissue coverage of the distal leg and ankle region represents a surgical challenge. Beside various local and free flaps, the perforator flap has recently been replaced as a reconstructive choice because of its functional and aesthetic superiority. Although posterior tibial artery perforator flap (PTAPF) has been reported less often than peroneal artery perforator flap, it also provides a reliable surgical option in small to moderate sized defects especially around the medial malleolar region. Materials and Methods: Seven consecutive patients with soft tissue defect in the ankle and foot region were enrolled. After Doppler tracing along the posterior tibial artery, the PTAPF was elevated from the adjacent tissue. The average size of the flap was $28.08{\pm}9.31cm^2$ (range, 14.25 to $37.84cm^2$). The elevated flap was acutely rotated or advanced. Results: Six flaps survived completely but one flap showed partial necrosis because of overprediction of the perforasome. No donor site complications were observed during the follow-up period and all seven patients were satisfied with the final results. Conclusion: For a small to medium-sized defect in the lower leg, we conducted the close-by islanded PTAPF using a single proper adjacent perforator. Considering the weak point of the conventional propeller flap, this technique yields much better aesthetic results as a simple and reliable technique especially for defects of the medial malleolar region.