• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.64-70
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• 2004

Purpose: We compared the result of a proximal metatarsal closed wedge osteotomy and soft tissue procedure with a modified chevron osteotomy and soft tissue procedure in the treatment of hallux valgus. Materials and Methods: Between March 1999 and February 2003, we performed proximal metatarsal closed wedge osteotomy and soft tissue procedure on 17 feet (12 patients), and modified chevron osteotomy and soft tissue procedure on 12 feet (9 patients). Results: According to Mayo clinic forefoot scoring system (FFSS), group 1, with proximal metatarsal closed wedge osteotomy, shows 67.2 points postoperatively and group 2, with modified chevron osteotomy, shows 68.5 points postoperatively. In group 1, the average correction of hallux valgus angle and intermetatarsal angle was 20.8 degrees and 4.8 degrees, respectively. In group 2, the average correction of hallux valgus angle and intermetatarsal angle was 19.9 degrees and 4.7 degrees, respectively. The average shortening was 3.15 mm in group 1 and 1.38 mm in group 2. Conclusion: We obtained relatively good clinical and radiographic result in this study. The effect on shortening of the first metatarsal was greater in the proximal metatarsal closed wedge osteotomy than modified chevron osteotomy, but the metatarsal shortening did not related with metatarsalgia. So, both techniques seems optimal surgical treatment for hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.67-71
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• 2007

Purpose: To evaluate clinical results of the 5th proximal metatarsal intraarticular fracture (Zone I) with displacement treated operatively and to evaluate predisposing factors of the 5th proximal metatarsal fracture (Zone I). Materials and Methods: 11 patients treated for the 5th proximal metatarsal fracture (Zone I) operatively and 10 patients treated conservatively between Jan 2003 and Dec 2005, were followed for more than one year. Functions were graded by AOFAS foot scoring system and union time and postoperative complications were also evaluated. Calcaneal pitch angle was also evaluated. Results: Clinically there were no much difference in results. Clinical points were 94.5 in the operative group and 92.3 in the conservative group. At the last follow-up, the radiographic results showed union in all cases. During the follow-up period, there were no significant complications. But in the conservative group, displaced fracture with calcaneal pitch angle over 30 degree tends to show delayed union and time to loss of pain tends to be prolonged. Conclusion: Calcaneal pitch angle is thought to predisposing factor for 5th metatarsal base fracture. Operative treatment is viable option for the 5th proximal metatarsal intraarticular fracture with displacement and with calcaneal pitch angle over 30 degree. In cases of cavovarus foot deformity, we think operative treatment should be considered with deliberation and long term follow-up study for peroneal tendinopathy should be needed.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.217-222
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• 2011

Purpose: The aim of this study was to evaluate the result of combined Weil and dorsal closing wedge osteotomy for Freiberg's disease. Materials and Methods: We performed combined Weil and dorsal closing wedge osteotomy of the second metatarsal under the diagnosis of Freiberg's disease in 7 patients, 7 feet (2 male and 5 female). The mean age at the time of operation was 29 years and the mean follow-up period was 31 months. Patients had no trauma history and no combined deformity of the foot. The surgical results were evaluated by VAS and weight bearing radiographs in antero-posterior and oblique projection. Results: According to Smillie staging system, there were 1 of stage II, 2 of stage III and 4 of stage IV patients. The osteotomy site was united at 8 weeks and the second metatarsal was shortened in length of average 2.8 mm. Remodeling of the metatarsal head was observed at 24 months. The mean VAS was decreased from 8.2 points preoperatively to 2.7 points at follow-up. And average range of motion of second metatarso-phalangeal joint was increased from 30o preoperatively to 45o at follow-up. There was no transfer metatarsalgia or arthritis of the metatarsal head during follow-up. Conclusion: Combined Weil and dorsal closing wedge osteotomy of the metatarsal appears to be an effective procedure for the treatment of Freiberg's disease with a view to shortening of metatarsal length and elevation of metatarsal head.

• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.5-11
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• 1997

Multiple surgical procedures for the correction of hallux valgus have been described. The surgical algorithm is based on the degree of deformity, patient's age, and the presence or absence of arthritis. It is known that the role of an isolated distal soft-tissue procedure is limited and the procedure must be used in conjunction with the proximal metatarsal osteotomy to correct most hallux valgus. We reviewed retrospectively the clinical & radiological results of distal soft-tissue procedure with or without proximal metatarsal osteotomy, performed in 18 patients (29 cases ) who had mild to moderate degrees af hallux valgus deformity. The results were as follows : In 20 cases with isolated soft-tissue procedures, the preoperative hallux valgus angle (HV) averaged 30.6 degrees and the postoperative HV averaged 7.3 degrees. The preoperative intermetatarsal angle (IM) averaged 12.5 degrees and postoperative IM averaged 10.4 degrees. 2. In 9 cases with the proximal metatarsal osteotomy added, the preoperative HV averaged 32.5 degrees, and the postoperative HV averaged 8.0 degrees. The preoperative IM averaged 12.5 degrees, and postoperative IM averaged 10.1 degrees. 3. There was no significant difference of loss of correction, presence of complication, patients own satisfaction, between two groups. In conclusion, as for the patients with mild to moderate degrees of hallux valgus deformities, the clinical and radiological results following distal soft tissue procedure and proximal metatarsal osteotamy are not proved to be superior to those following isolated soft-tissue procedures.

• Physical Therapy Korea
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• v.13 no.4
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• pp.64-70
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• 2006

The purpose of this study was to determine whether a relationship existed between foot type and the location of plantar callus in healthy subjects. Twenty-five healthy subjects with plantar callus were recruited for this study. Foot deformities were classified according to the operational definitions as 1) a compensated forefoot varus, 2) an uncompensated forefoot varus or forefoot valgus, or 3) a compensated rearfoot varus. The location of plantar callus was divided into two regions. Fourteen of the 19 feet with compensated forefoot varus and six of the 9 feet showed plantar callus at the second, third or fourth metatarsal head. Five of the 6 feet with uncompensated forefoot varus and twenty of the 16 feet with forefoot valgus showed plantar callus at the first or fifth metatarsal head. A significant relationship was found between foot type and location of callus (p<.01). The results support the hypothesis that certain foot types are associated with characteristic patterns of pressure distribution and callus formation. We believe diabetic patients with insensitive feet and with the types of foot deformity should be fit with foot orthoses and footwears that accommodate their respective deformity in a position as near to the subtalar joint as possible with the goal of preventing plantar ulceration.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.129-132
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• 2009

Purpose: We evaluated the result of operative treatment of the hallux valgus in male patients. Materails and Methods: Total 11 cases (10 patients) of the hallux valgus deformity that treated with operation were evaluated. Following Mann's radiological classification system, there was 1 cases of mild, 8 cases of moderate, and 2 cases of severe. Preoperative, postoperative, postoperative 3 months and postoperative 6 months follow up standing radiographs were used as radiologic evaluation. And we evaluated radiological outcomes by hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA) and clinical outcomes by hallux-metatarsophalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS) score. Result: Radiologically, the mean preoperative HVA $37^{\circ}$ and IMA $13.7^{\circ}$ were improved postoperatively as HVA $11.9^{\circ}$ and IMA $4.7^{\circ}$, and the mean preoperative DMMA $29.4^{\circ}$ and PPAA $8.6$ were improved postoperatively DMMA $13.9^{\circ}$ and PPAA $7^{\circ}$. But, postoperative 6 months follow up HVA, IMA, DMMA and PPAA was increased at $14.2^{\circ}$, $6.3^{\circ}$, $16.1^{\circ}$ and $8.3^{\circ}$. Average AOFAS score were improved from 61.2 points to 75.2 points. Conclusion: In our study, operative treatment of hallux valgus in male patients with proximal metatarsal osteotomy and distal soft tissue procedure showed good results but it was necessary to pay attention to increase aspect of follow up radiologic measurements.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.117-121
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• 2008

Purpose: To determine the clinical and radiographic results of arthroereisis using the $Kalix^{(R)}$ implant (Newdeal, Lyon, France) for the treatment of flexible flatfoot deformity. Materials and Methods: From February 2005 to February 2007, we performed the subtalar arthroereisis on 8 patients (9 feet) of symptomatic flexible flat feet after more than 6 months of conservative treatment. Average age was 14.5 years ($11{\sim}29$ years) old. We checked the functional status with AOFAS functional score pre-operatively and at final follow-up. Radiologically, we took weight bearing anterior to posterior and lateral view of the feet, and measured the talo-first metatarsal angle, calcaneal pitch angle in pre-operatively and at final follow-up. Results: Mean follow up period was 34.4 months. Average AOFAS score improved from preoperatively 65.6 to postoperatively 94.8. Average lateral talo-first metatarsal angle reduced from $12.8^{\circ}$ preoperatively to $1.6^{\circ}$ at final follow-up. Average anterior to posterior talo-first metatarsal angle was reduced from $15.1^{\circ}$ preoperatively to $8.3^{\circ}$ at final follow-up. Average calcaneal pitch angle was increased from $9.5^{\circ}$ preoperatively to $12.0^{\circ}$ at final follow-up. Conclusions: Subtalar arthroereisis with Kalix$K^{(R)}$ implant can be considered to be one of treatment options symptomatic flatfoot deformity patients.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.218-222
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• 2006

Purpose: We evaluate the results of subtalar arthroereisis with $Kalix^{(R)}$ implant (Newdeal, Lyon, France) that were performed in painful flatfoot deformity. Materials and Methods: We performed the subtalar arthroereisis on 16 feet of children symptomatic flexible flat feet after more than 6 months of conservative treatment. Average age was 11 years (8-14 years) old. We checked the functional status with AOFAS functional score in pre-operatively and at final follow-up. Radiologically, we took weight bearing anterior to posterior and lateral view of the feet, and measured the talo-$1^{st}$ metatarsal angle, calcaneal pitch angle, cuboid-surface height. Finally, we asked to patient's parents for satisfaction of the surgery. Results: Mean follow up period was 34.1 months. Average AOFAS score improved from preoperatively 71.9 to postoperatively 91.3. Only one patient has subtalar pain. Average lateral $1^{st}$ metatarsal angle reduced from $-18.2^{\circ}$ preoperatively to $-4.6^{\circ}$ at final follow-up. Average anterior to posterior $1^{st}$ metatarsal angle was reduced from $18.9^{\circ}$ preoperatively to $6.5^{\circ}$ at final follow-up. Average calcaneal pitch angle was increased from $8.6^{\circ}$ preoperatively to $12.6^{\circ}$ at final follow-up. Average cuoboid-surface height was improved from 12.1 mm preoperatively to 16.0 mm at final follow-up. All patients had excellent or good satisfaction. Conclusions: Subtalar arthroereisis with $Kalix^{(R)}$ implant is a viable surgical alternative for painful flatfoot deformity of children.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.161-164
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• 2010

Purpose: The purpose of this study is to find out the normal angles of the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle for diagnosis of foot deformity in Korea. This would be helpful as it would provide a basic angular measurement of flat and cavus foot that indicates the need for operation. Materials and Methods: Within a period of four months from January 2007 to April 2007, We have established 600 feet of 300 males without trauma history of foot. The source to image distance is 40 inches and erect weight bearing radiographs are obtained in anteroposterior and lateral projections. The significant angular measurements that define flat or cavus foot are the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle. Results: The mean age was 21 years (19-22 years) old. The mean talus-1st metatarsal angle was $0{\pm}6.9{^{\circ}}$, the mean talo-horizontal angle was $25.8{\pm}4.5{^{\circ}}$ and the mean calcaneal pitch angle was $23.9{\pm}5.1{^{\circ}}$. Conclusion: We can consider that mean talus-1st metatarsal angle, talo-horizontal angle and calcaneal pitch angle are $0{\pm}6.9{^{\circ}}$, $25.8{\pm}4.5{^{\circ}}$ and $23.9{\pm}5.1{^{\circ}}$ as an normal angle limit of young age in Korea.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.140-144
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• 2008

Purpose: The purpose of this study is to compare the treatment outcomes of distal chevron osteotomy with those of proximal metatarsal closing wedge osteotomy in patients with moderate severity hallux valgus. Materials and Methods: Forty-two patients (51 feet) who were underwent either distal chevron osteotomy (Group I, 22 patients, 27 feet) or proximal metatarsal closing wedge osteotomy (Group II, 20 patients, 24 feet) for the correction of moderate hallux valgus deformity were evaluated retrospectively. We assessed the radiographic results with several parameters including hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). And clinical results with modified AOFAS score at last follow-up. Results: There were no significant differences in IMA, HVA and DMAA between two groups preoperatively. We can achieve the good results with both procedures, but mean HVA and IMA of group II was significantly lower than those of group I. There was some loss of correction in group I at the last follow-up. There was no significant difference in clinical results according to modified AOFAS scoring between two groups at the last follow-up. Conclusion: The proximal metatarsal closing wedge osteotomy for the hallux valgus with moderate severity is better treatment option to achieve better radiographic correction and to prevent loss of correction or recurrence than distal chevron osteotomy.