• 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.

• Archives of Reconstructive Microsurgery
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• v.17 no.1
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• pp.28-35
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• 2008

The purpose of this study was to present the clinical analysis of the results of lateral arm free flap for small sized and infected diabetic foot ulcer around toes. From May 2006 to December 2007, Seven patients were included in our study. Average age was 52.8 years, six were males and one was female. All had infected diabetic foot ulcer and had exposures of bone or tendon structures. Ulcers were located around great toe in four patients, 4th toe in one and 5th toe in two. Three patients had osteomyelitis of metatarsal or phalanx. After appropriate control of infection by serial wound debridement and intravenous antibiotics, lateral arm flap was applied to cover remained soft tissue defects. Posterior radial collateral artery of lateral arm flap was reanastomosed to dorsalis pedis artery of recipient foot by end to side technique in all cases in order to preserve already compromised artery of diabetic foot. All flaps were designed over lateral epicondyle to get longer pedicle and averaged pedicle length was 8 cm. Two cases were used as a sensate flap to achieve protective sensation of foot. All flaps survived and provided satisfactory coverage of soft tissue defects on diabetc foot ulcers. All patients could achieve full weight-bearing ambulation. No patients has had recurrence of infection, ulceration and further toe amputations. There were three complications, a delayed wound healing of flap with surrounding tissue, a partial peripheral loss of flap and a numbness of forearm below donor site. All patients were satisfied with their clinical results, especially preserving their toes and could return to the previous activity levels. Lateral arm free flap could be recommend for infected diabetic foot ulcers around toes, to preserve toes, coverage of soft tissue defect and control of infection with low donor site morbidity.

• Journal of Korean Foot and Ankle Society
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• v.24 no.4
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• pp.148-155
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• 2020

Purpose: Minor foot amputations are performed for recurrent or infected ulcers or osteomyelitis of the diabetic feet. Patients may require a large amount of bone resection for wound closure. On the other hand, this results in more foot dysfunction and a longer time to heal. The authors describe fillet flap coverage to avoid more massive resection in selected cases. This study shows the results of fillet flap coverage for the closure of diabetic foot minor amputation. Materials and Methods: This was a retrospective case series of patients who underwent forefoot and midfoot amputation and fillet flap for osteomyelitis or nonhealing ulcers between March 2013 to November 2017. In addition, the patient comorbidities, hospital days, complications, and duration to complete healing were evaluated. Results: Fourteen fillet flap procedures were performed on 12 patients. Of those, two had toe necrosis, nine had forefoot necrosis, and three had midfoot necrosis. Eleven forefoot amputations and three midfoot amputations were performed. Among forefoot necrosis after a fillet flap, three patients had revision surgery for partial necrosis of the flap, and two patients had an additional amputation. Two patients had additional amputations among those with midfoot necrosis. By the fillet flap, the amputation size was reduced as much as possible. The mean initial healing days, complete healing days, and hospital stay was 70.6 days, 129.0 days, and 60.0 days, respectively. Conclusion: The fillet flap facilitates restoration of the normal foot contour and allows salvage of the metatarsal or toe.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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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.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.25-30
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• 2010

Purpose: The purpose of this study was to evaluate the clinical and radiological outcomes of the S.E.R.I. (simple, effective, rapid, inexpensive) operation for the bunionette deformity. Materials and Methods: Between March 2005 and February 2009, 22 patients (26 feet) who had been treated for the bunionette deformity with minimally invasive osteotomy were reviewed retrospectively. Clinically, Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, shoes selectivity, disappearance of callus and patient's satisfaction level by Coughlin scoring system were evaluated. Radiologically, the bunionette was classified as four types according to the Fallat classification. The 4-5$^{th}$ intermetatarsal angle (4-5$^{th}$ IMA), the 5$^{th}$ metatarsophalangeal angle (5$^{th}$ MPA) and the length of 5th metatarsal bone (5$^{th}$ MTL) were analyzed at preoperatively and at final follow up visit. Results: VAS improved from $6.8{\pm}1.8$ points to $2.2{\pm}1.8$ points (p<0.05). AOFAS score improved from $54.0{\pm}14.2$ points to $90.0{\pm}4.8$ points (p<0.05). There was no change in shoes selectivity. 9 feet (34.6%) were satisfied with excellent results, 16 feet (61.5%) with good results and 1 foot (3.9%) with fair results. The average 4-5$^{th}$ IMA was corrected from $10.1{\pm}2.3^{\circ}$ to $4.4{\pm}1.7^{\circ}$ (p<0.05). The average 5$^{th}$ MPA was corrected from $11.5{\pm}8.6^{\circ}$ to $-0.1{\pm}4.1^{\circ}$ (p<0.05). The average 5$^{th}$ MTL was changed from $66.1{\pm}4.3$ millimeters to $64.1{\pm}4.4$ millimeters (p=0.069). There was no malunion, nonunion or delayed union and other perioperative complications. Conclusion: S.E.R.I. operation is less invasive and easy technique. This procedure is recommendable for the treatment of the bunionette deformity.

• Journal of Korean Foot and Ankle Society
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• v.20 no.4
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• pp.152-157
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• 2016

Purpose: To evaluate the effect of shortening scarf osteotomy on pain relief and range of motion (ROM) of the first metatarsophalangeal joint in hallux rigidus patients. Materials and Methods: Twenty-three cases of 19 patients who had been treated with shortening scarf osteotomy for the hallux rigidus between January 2007 and December 2013 were reviewed. The mean follow-up period was 21.4 months, and the mean age was 59.2 years. The first metatarsal bone was shortened until the ROM of the first metatarsophalangeal joint was greater than $80^{\circ}$ or $40^{\circ}$ of dorsiflexion. The length shortened by scarf osteotomy was measured. The authors also measured and compared the joint interval difference of the standing foot using an anteroposterior radiography. Moreover, the difference of ROM of the first metatarsophalangeal joint between the preoperative and final follow-up periods was also compared. The clinical results were evaluated and compared using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and visual analogue scale (VAS) score. Results: The mean shortening length was about 6.5 mm (range, 4~9 mm). The joint space has been increased to 1.8 mm, and the ROM of the first metatarsophalangeal joint has also been increased to $18.4^{\circ}$ after the operation. In three cases, the postoperative ROM has been decreased to less $10^{\circ}$. The AOFAS score has been improved from 41.7 (range, 32~55) to 86.2 (range, 65~95), and the VAS score was also decreased from 3.7 (range, 3~5) to 1.3 (range, 0~3). Two cases have shown no decrease in pain even after the operation. Conclusion: Shortening scarf osteotomy was found to decrease joint pain by decompressing the pressure of the first metatarsophalangeal joint. This osteotomy also helped improve the ROM of the first metatarsophalangeal joint. Shortening scarf osteotomy can be considered one of the effective methods for joint preservation.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.2
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• pp.82-86
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• 2012

Purpose: The purpose of this study was retrospectively to evaluate the results of the modified Kidner procedure for symptomatic accessory navicular in athletes. Materials and Methods: Between July 1999 and December 2004, 26 feet in 22 patients with symptomatic accessory navicular who had underwent modified Kidner procedure were available for clinical follow-up, and 12 cases in 9 patients were available for clinical and radiological follow-up with a minimum follow-up of 5 years were included in this study. All those patients had symptomatic accessory navicular bone who underwent modified Kidner procedure. American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, Visual Analogue Scale (VAS), and satisfaction rate were investigated. Talo-first metatarsal (T-MT1) angle, talo-calcaneal (TC) angle, and calcaneal pitch (CP) angle were measured in standing lateral radiograms. Results: AOFAS score was improved from $40.8{\pm}7.5$ (32~57) preoperatively to $88.7{\pm}8.0$ (72~100) postoperatively, and the difference was significant (p<0.01). VAS was improved from $7.0{\pm}0.9$ (5~9) preoperatively to $1.8{\pm}0.8$ (1~4) postoperatively, and the difference was significant (p<0.01). At the lastest follow up, 11 feet were very satisfied, 11 feet satisfied, and 4 feet unsatisfied (a satisfaction rate 85.0%). No significant difference was observed for T-MT1 angle (p=0.67), TC angle (p=0.93), and CP angle (p=0.49). Conclusion: Modified Kidner procedure for the symptomatic accessory navicular showed satisfactory results and is appeared to be one of the useful treatments.