• Anatomy and Cell Biology
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• v.56 no.1
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• pp.137-140
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• 2023

Tibialis anterior (TA) muscle originates from the lateral surface of tibia and its tendon attaches to the medial cuneiform and base of the first metatarsal. The TA muscle is responsible for both dorsiflexion and inversion of the foot. We present a case of bilateral TA muscle variations that diverge slightly from the current classification systems of this muscle. Recognizing variations such as these may be important for anatomists, surgeons, podiatrists, and physicians. Following routine dissection, an accessory tendon of the TA muscle was found on both sides. Accessory tendons of the extensor hallucis longus and extensor hallucis brevis joined to form a common tendon on both sides. We believe that this unique case will help further the classification systems for the tendons of the TA and also be informative for clinical anatomists as well as physicians treating patients with pathology in this region.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.146-150
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• 2005

Purpose: We made a radiological comparison between $60^{\circ}$ distal Chevron osteotomy with short armed two parts and $40^{\circ}$ distal Chevron osteotomy with long armed one part performing operation in cases of hallux valgus angle of less than $40^{\circ}$, intermetatarsal angle of less than $15^{\circ}$. Materials and Methods: 12 cases with $60^{\circ}$ distal Chevron osteotomy and 12 cases with $40^{\circ}$ distal Chevron osteotomy were selected from October 2000 to March 2005. We have analysed the hallux valgus angle, 1-2 intermetatarsal angle, metatarsal length, distal metartarsal articular angle and angulation at osteotomy site on lateral view in each radiological films taken at preoperative, postoperative and 3 months after operation presuming bone union. All cases were women, both sides were 9 cases and average age was 52.3 years old. Results: Data taken at preoperative, postoperative and 3 months follow up films in $60^{\circ}$ distal Chevron osteotomy were as follows; the hallux valgus angles were $32.1^{\circ}$, $10.9^{\circ}$, $13.8^{\circ}$, the 1-2 intermetatarsal angles were $13.6^{\circ}$, $8.5^{\circ}$, $8.4^{\circ}$, the metatarsal length were 60.6 mm, 58.8 mm, 58 mm, the distal metartarsal articular angles were $13^{\circ}$, $6^{\circ}$, $6.6^{\circ}$ and 3 cases were over $3^{\circ}$ angulation at lateral view. In $40^{\circ}$ distal Chevron osteotomy, the hallux valgus angles were $34.5^{\circ}$, $11.6^{\circ}$, $15.3^{\circ}$, the 1-2 intermetatarsal angles were $12.7^{\circ}$, $8.2^{\circ}$, $7.8^{\circ}$, the metatarsal length were 59.2 mm, 56.9 mm, 55.9 mm, the distal metartarsal articular angles were $12^{\circ}$, $7.3^{\circ}$, $7.3^{\circ}$ and there were no case with angulation over $3^{\circ}$ at lateral view. Conclusion: In comparison between $60^{\circ}$ distal Chevron osteotomy and $40^{\circ}$ distal Chevron osteotomy measuring at postoperative and follow up, most of all data were similar, but 3 cases over $3^{\circ}$ angulation at lateral view happened in $60^{\circ}$ Chevron osteotomy. This result showed that $40^{\circ}$ distal Chevron osteotomy fixing with screws through long armed one part may have benefit than $60^{\circ}$ distal Chevron osteotomy fixing with K-wires through short armed two parts in making rigid fixation, even though there is a personal difference of technigue.

• Korean Journal of Poultry Science
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• v.20 no.3
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• pp.133-140
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• 1993

A study was conducted to investigate the concentrations of Ca, P and ash in metatarsal bone of broiler chicks exposed to UV light in different Interval. Day-old Hubbard broiler chicks (199＝10 control＋3 irradiation interval $\times$ 9 elapsed time $\times$ 7 replicate) were fed vitamin D3 deficient diet for 3 wk in a windowless subdued-light room and exposed to 297 nm UVB light by 0.068 mJ/$\textrm{cm}^2$ three times In 0, 12 or 24 h interval. The metatarsal bones were taken at 0, 6, 12, 18, 24, 48, 96, 144 or 240 h after last irradiation, separated from adhering tissue, ether extracted, dried and ashed. The Ca concentration was measured by atomic absorption spectrophotometry and P by ammonium metavanadate colorimetry. When the birds were continuously exposed to UVB light for 30 min without interval, the Ca content in metatarsus increased gradually according to the time after irradiation and reached the highest value 16.75% at 240 h after exposure. The P content also increased gradually until 144 h, where it was 9.75%. The ash content in metatarsus increased continuously until 240 h, the final time in this research, where 42.75% was shown. As 10 min three times irradiation in 12 h interval was applied to the chicks, the metatarsal Ca presented a small peak(13.31%) at 12 h after irradiation and a large peak(16.91%) at 144 h. P content showed a small peak(7.18%) at 12 h and a large level(8.34%) at 240 h. Ash content increased continuously until 240 h, where it was 46.53%. The small peaks in Ca and P concentration were thought to be derived from preirradiation at 12 and 24 h before final irradiation for 10 min. When 24 h interval system was treated, the peak value of Ca content(24.18%) occurred earlier(96 h) than those in 0 and 12 h interval systems. P content also showed the maximum value at 96 h(7.29%). Ash content presented an increasing trend until 240 h, where 45.75% was appeared. In respecting the method of UVB irradiation, the peak value of Ca content in metatarsus appeared earlier in 24 h interval system than in other systems. Meanwhile the ash contents in metatarsus of birds exposed to UVB light in 12 and 24 h interval procedures were higher than those in 0 h interval one. Therefore, it was concluded that a daily 10 min irradiation of UVB light would be desirable for increasing the Ca and ash content in metatarsus of brolier chicks.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.547-556
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• 2019

Purpose: This study evaluated the results of surgical treatment for residual or recurrent deformity after the conservative treatment of idiopathic clubfoot. Materials and Methods: Fifty-one cases (32 patients), who were followed up to skeletal maturity, were reviewed retrospectively. The mean age at the last follow-up was 18.7 years. The surgical options included selective or comprehensive soft tissue release, tendon lengthening and transfer, and various types of osteotomy. The radiology measurements included the talocalcaneal angle and talo-first metatarsal angle in the anteroposterior (AP) view, and the talocalcaneal angle and calcaneal pitch in the lateral view. The radiology measurements were compared with the normal values for adults. The clinical evaluations were made using the ankle-hindfoot score and the midfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS): excellent (>85), good (71-85), pair (56-70), and poor (<56). Results: At the last follow-up, the percentages of the 51 cases, whose parameter values fell within the normal ranges were as follows: in the AP view, 41.2% (talocalcaneal angle); and 90.2% (talo-first metatarsal angle). In the lateral view, the percentage was 84.3% (talocalcaneal angle). For the calcaneal pitch, the percentages were 61%. The mean AOFAS score was 88.1±10.7 on the ankle-hindfoot score and 86.7±11.5 on the midfoot score. Conclusion: The long-term outcome of patients with idiopathic clubfoot, who underwent surgical treatment after conservative treatment, was found to be 43%-90% of the normal range of radiographic indices. Clinically, the mean AOFAS scores were "excellent". Therefore, a satisfactory result can be obtained by analyzing the elements of deformity more accurately and then using the selective operation method, even if the non-surgical correction method fails.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.59-66
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• 2019

Purpose: Several radiologic reference lines have been used to evaluate individuals with a clubfoot but there is no consensus as to which is most reliable. The aim of this study was to identify which radiologic parameters have relevance to the predictability of additional surgery after Ponseti casting on clubfoot and the effect of clubfoot treatments that contain Ponseti casting and additional surgery. Materials and Methods: A total of 102 clubfeet (65 patients, 37 bilateral) were reviewed from 2005 to 2013. The patients were divided into two groups (Group A, those for whom the result of the Ponseti method was successful and did not require additional surgery; and Group B, those for whom the result of the Ponseti method was unsuccessful and required additional surgery), and the following parameters were measured on the plain radiographs: i) talo-calcaneal angle on the anteroposterior and lateral view, ii) talo-1st metatarsal angle on the anteroposterior view, and iii) Tibio-calcaneal angle on the lateral view with the ankle full-dorsiflexion state. Each radiograph was reviewed on two separate occasions by one orthopedic doctor to characterize the intra-observer reliability, and the averages were analyzed. Next, 20 cases were chosen using a random number table, and two orthopedic doctors measured the angle separately to characterize the interobserver reliability. Results: Groups A and B included 73 clubfeet (71.6%) and 29 clubfeet (28.4%), respectively. The initial talo-calcaneal angle and tibiocalcaneal angle in the lateral view were significantly different among the groups. In addition, inter- and intra-observer biases were not detected. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view were significantly different after treatment in both groups. Conclusion: Congenital clubfeet treated with the Ponseti method showed successful results in more than 70% of patients. The initial talocalcaneal angle and tibio-calcaneal angle on the lateral view were the radiologic parameters that could predict the need for additional surgical treatments. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view could effectively evaluate the changes in clubfoot after treatment.

• Journal of Korean Foot and Ankle Society
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• v.21 no.3
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• pp.88-92
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• 2017

Purpose: The objective of this study was to confirm the results of the modified Lapidus procedure on moderate to severe hallux valgus patients with first tarso-metatarsal joint hypermobility. Materials and Methods: A retrospective study was conducted on 42 cases of 35 patients who underwent the modified Lapidus procedure between March 2006 and December 2014. A comparative analysis was performed on the preoperative and postoperative subjective satisfaction of patients and radiologic index. Moreover, the correlation between the follow-up time and patient's operative satisfaction, as well as between the proficiency of the operator and patient's operative satisfaction was analyzed. Complications were also evaluated. Results: Out of the total of 35 patients, 3 were male and 32 were female. The mean age was 61.3 years (range, 34~79 years), and the mean follow-up time was 22.1 months (range, 6~90 months). The overall satisfaction level was 67.6% and the mean hallux valgus angle improved from preoperative $40.5^{\circ}$ to postoperative $12.2^{\circ}$ (p<0.001). The mean 1, 2 intermetatarsal angle improved from preoperative mean of $16.9^{\circ}$ to postoperative mean of $7.6^{\circ}$ (p<0.001), and the sesamoid position improved significantly, from preoperative 2.7 to postoperative 0.9 (p<0.001). Furthermore, there was no correlation between the follow-up time and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux scale; also no correlation between the year the operation took place and the AOFAS hallux scale. In terms of complications, we observed screw irritation in 6 cases, hallux varus in 2 cases, and recurrence of hallux valgus and nonunion in one case. Conclusion: Contrary to our concerns, the level of complications was not high; however, the satisfaction level of patients was also not very high. Therefore, careful selecting of patients and sufficient consultation time is needed before surgery. In addition, since the causes of postoperative dissatisfaction still remain unclear, further studies are necessary.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.77-83
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• 1999

The skin on the dorsum of the foot is a source of the reliable thin and sensory cutaneous free tissue transplantation with or without tendon, bone and joint. A composite flap with attached vascularized tendon grafts for the combined loss of skin and tendon on the dorsum of the hand and foot offers an immediate one stage solution to this problem. The flap provides a very durable innervated tissue cover for the heel of the foot and the dorsum of the hand and an osteocutaneous transfer combined with the second metatarsal. The major dorsalis pedis artery is constant in size, but the first dorsal metatarsal artery is variable in size and location. The dorsal surface of the foot receives sensory innervation through the superficial peroneal nerve and the first web through the deep peroneal nerve. Authors had performed 5 dorsalis pedis free flap transplantation in the foot and hand at Department of Orthopedic Surgery, Chonbuk National University Hospital from August 1993 through August 1997 and followed up for the period of between 19 and 67 months until March 1999. The results were as follows 1. 5 cases dorsalis pedis free flap transfer to the foot(4 cases) and the hand(1 case) were performed and the recipient was foot dorsum and heel 2 cases each and hand dorsum 1 case. 2 All of 5 cases(100%) were survived from free flap transfer and recipient artery was dorsalis pedis artery(2 cases), anterior tibial artery(1 case), posterior tibial artery(1 case) and ulnar artery(1 case) and recipient veins were 2 in number except in the hand. 3. Long term follow up of the exterior and maceration was good and sensory recovery was poor 4. Donor site was covered with full thickness skin graft obtained from one or both inguinal areas at postoperative 3rd week and skin graft was taken good and no morbidity was showed.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.3
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• pp.2064-2072
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• 2015

The aim of this study is to identify the effects of the correction exercise program on femoral intercondylar distance, Q-angle and plantar pressure in undergraduate with genu varum. A experimental study with a randomized controlled trial design was used. Thirty subjects with genu varum were allocated in two groups: the experimental group (n=15) or the control group (n=15). The experimental group conducted correction exercise program for 30 minutes a day, 5 times a week, for 6 weeks, while the control group did not perform any exercise. The correction exercise program group showed a significant decreased femoral intercondylar distance, plantar pressure of M 4, M 5 (Metatarsal 4, 5). Also the correction exercise program group significantly increased Q-angle, plantar pressure of Toe 2-5 and M 1, M 2, M 3 (Metatarsal 1, 2, 3) (Rt, Lt) (p<.05). Thus, we suggested that the correction exercise program may be suitable intervention to improve normal alignment in undergraduate with genu varum.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.177-181
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• 2010

Purpose: The author evaluated the clinical and radiological results after wearing the medial arch supports in children. Materials and Methods: 103 patients who had symptomatic flat feet were evaluated from march, 2002 to may 2009. All patients wore the medial arch supports according to the symptoms. We measured parameters at weight-bearing radiographs before and after medial arch support were worn. We also evaluated the clinical scores using the AOFAS score. Results: Mean age of patients was 97 months (11-204 months), all foot of patients involved bilaterally. Mean talo-first metatarsal angle of right foot was $17.7{\pm}9.4$ and left foot was $19.96{\pm}9.5$ degrees at AP radiograph in pre-wearing state. Mean calcaneal pitch angle of right foot was $12.0{\pm}5.3$ and left foot was $11.9{\pm}5.8$ degrees at lateral radiograph in pre-wearing state. Mean talo-first metatarsal angle of right foot was $14.4{\pm}8.05$ and left foot was $13.1{\pm}8.77$ degrees at AP radiograph in post-wearing state. Mean calcaneal pitch angle of right foot was $16.4{\pm}5.75$ left foot was $16.5{\pm}5.6$ degrees at lateral radiograph in post-wearing state. The radiographic angles between pre-wearing and post-wearing state were statistically significant (p<0.05). Mean pre-wearing AOFAS hindfoot score was $66.7{\pm}9.25$, midfoot score was $60.0{\pm}9.34$ forefoot score was $57.1{\pm}11.8$. Mean post-wearing AOFAS hindfoot score was $73.2{\pm}9.73$, midfoot score was $68.1{\pm}10.1$, forefoot score was $67.2{\pm}11.4$. The forefoot score was highest improving scores among the AOFAS scores. Conclusion: From our study, we concluded that medial arch support was effective for symptomatic flat feet of children in radiological and clinical results from our study.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.201-206
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• 2011

Purpose: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. Materials and Methods: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. Results: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). Conclusion: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.