• 대한족부족관절학회지
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• 제17권3호
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• pp.220-224
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• 2013

Purpose: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, it could lead to skin irritation and medial pain after the surgery. The purpose of this paper was to report our clinical and radiographic results with transarticular fixation of Akin osteotomy for the treatment of patients with hallux valgus after resection of the medial protrusion of base of the proximal phalanx. Materials and Methods: Our study is subject to 34 cases of 30 patients who went through proximal phalanx medial corticectomy among patients undergone both hallux valgus surgery and Akin osteotomy at our institution from March 2006 to March 2012. In all cases, we used absorbable suture material through the articular surface for Akin osteotomy after resection of the medial protrusion in proximal phalanx. Radiographs were reviewed to assess the union and displacement of osteotomy site at the time of postoperative 6 months. The clinical results were assessed by using AOFAS score and complication such as skin irritation and pain. Results: AOFAS score was improved from average 44 points(36-58), before operation and average 87 points(74-96), 12 months after operation. In two cases, partial union was suspected in radiological perspective, however, complete union on the osteotomy site was observed in all cases, 12 months after the operation. No patients was dissatisfied with pain, joint discomfort, skin irritation and inflammation from the knot. Conclusion: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, We have good results by transarticular fixation of Akin osteotomy using absorbable suture material.

• 대한족부족관절학회지
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• 제14권1호
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• pp.5-10
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• 2010

Purpose: This study was performed to compare the contact area between three different correcting angles after the proximal crescentic and Ludloff osteotomies of the first metatarsal. Materials and Methods: We used the two sawbone models. Proximal crescentic (PCO) and Ludloff osteotomies (LO) were performed and secured using K-wires under the correcting intermetatarsal angle (IMA) $5^{\circ}$, $10^{\circ}$, and $15^{\circ}$. Then each 6 osteotomized model was scanned five times and measured the contact area using the calculating program. We excluded the highest and lowest values. Results: The mean area of cutting surface was 189 $mm^2$ in PCO, 863 $mm^2$ in LO. The mean contact area (contact ratio; contact area $\times$100/area of cutting surface) of PCO was 149 $mm^2$ (79%) in $5^{\circ}$, 139.5 $mm^2$ (74%) in $10^{\circ}$, 107 $mm^2$ (57%) in $15^{\circ}$ IMA. The mean contact area (contact ratio) of LO was 711 $mm^2$ (82%) in $5^{\circ}$, 535.5 $mm^2$ (62%) in $10^{\circ}$, 330 $mm^2$ (38%) in $15^{\circ}$ IMA. Conclusion: A significant decrease in the contact area and contact ratio according to increase in correcting IMA was noticed in LO. We recommend the PCO rather than LO, when the IMA is needed to correct over $15^{\circ}$.

• 대한족부족관절학회지
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• 제19권2호
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• pp.51-57
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• 2015

Purpose: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. Materials and Methods: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. Results: The mean hallux valgus angle measured at preoperation was $37.7^{\circ}$ and $15.9^{\circ}$ at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were $15.2^{\circ}$ and $8.3^{\circ}$. The mean distal metatarsal articular angle changed from $12.6^{\circ}$ at preoperation to $7.8^{\circ}$ at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was $37^{\circ}$ and 13o, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. Conclusion: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under $37^{\circ}$ and distal metatarsal articular angle under $13^{\circ}$ can lead to good clinical results without recurrence.

• 대한족부족관절학회지
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• 제13권2호
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• pp.223-226
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• 2009

Freiberg disease is a osteochondrosis of the lesser metatarsal heads. Various surgical treatment have been recommanded including joint debridement and metatarsal head reshaping, metatarsal dorsal wedge osteotomy, metatarsal head excision and joint arthroplasty. Autogenous osteochondral graft for the treatment of Freiberg disease is an effective restorative procedure that provides early range of motion exercise, weight bearing, and reduces other morbidity. We report a case of late stage Freiberg disease treated with arthrotomy, removal of loose body and autogenous osteochondral graft.

• 대한족부족관절학회지
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• 제7권1호
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• pp.7-12
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• 2003

Purpose: To study the relationship of the 1st to 2nd intermetatarsal angle(1-2 IMA) between the intra-operative and weight bearing postoperative anterior-posterior(AP) radiography, and evaluate the intra-operative predictability for the postoperative 1-2 IMA after proximal metatarsal osteotomy(PMO) in the hallux valgus deformity. Materials and Methods: 20 cases of moderate to severe hallux valgus patients were included in this study. After the oblique PMO(Ludloff procedure) was performed and the osteotomy site was fixed temporarily, the AP view was taken intra-operatively. About 10 weeks after surgery, postoperative weight bearing AP view was taken. The pre -. intra -, and postoperative 1-2 IMAs were compared and ana lysed statistically. Results: The 1-2 IMAs of the weight bearing preoperative, non-weight bearing intra-operative and weight bearing postoperative AP view were $15.9^{\circ}{\pm}1.8^{\circ},\;4.7^{\circ}{\pm}2.1^{\circ}$, and $6.8^{\circ}{\pm}2.5^{\circ}$ (Mean${\pm}$SD) respectively. The postoperative 1-2 IMA was greater than intra-operative measurement by $2.1^{\circ}{\pm}1.8^{\circ}$ (range; $-1^{\circ}$ to $6^{\circ}$) which was stastistically significant(p<0.05). To get less than $9^{\circ}$ postoperatively as an average normal, intra-operative 1-2 IMA should be within $3.8^{\circ}$ to $5.2^{\circ}$ (95% confidence interval), and intra-operative 1-2 IMA should be within $3.4^{\circ}{\pm}$to $5.4^{\circ}$(95% confidence interval) to get more than $6^{\circ}$ difference between preoperative and postoperative 1-2 IMA, which is regarded as more than average correction by the distal metatarsal osteotomy. Conclusion: In hallux valgus surgery, it should be considered that intra-operative 1-2 IMA was less than the postoperative. To achieve postoperative 1-2 IMA less than $9^{\circ}$ and more than correction angle of $6^{\circ}$, it is suggested that the intra-operative 1-2 IMA should be measured less than about $5^{\circ}$.

• 대한족부족관절학회지
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• 제12권1호
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• pp.31-35
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• 2008

Purpose: The authors intended to evaluate the results of symptomatic bunionette treated with a diaphyseal oblique osteotomy. Materials and Methods: Nine patients were followed for more than 1 year after diaphyseal oblique osteotomy for a bunionette deformity with plantar callosity. The mean age was 43 years (23-69 years), and the mean follow-up period was 27 months (12-70 months). As a combined disorder, 7 patients had hallux valgus, for which 3 distal metatarsal oteotomies, 3 proximal osteotomies, and 1 double osteotomy were performed. Clinically, preoperative and postoperative AOFAS MP-IP scale, patient's satisfaction, postoperative complications were analyzed. Radiologically, the 4th intermetatarsal angle and the 5th metatarso-phalangeal angle were analyzed. Results: Clinically, AOFAS MP-IP scale was increased from 59 points preoperatively to 93 points postoperatively, and all patients were satisfied with the results. The plantar callosity had all disappeared at the final follow up. The 4th intermetatarsal angle was decreased from $12.6^{\circ}$ preoperatively to $4.3^{\circ}$ postoperatively, and the 5th metatarsophalangeal angle was decreased from $21.9^{\circ}$ preoperatively to $2.4^{\circ}$ postoperatively. There were no significant postoperative complications. Conclusion: Diaphyseal oblique osteotomy of the 5th metatarsal appears to be safe and satisfactory procedure for the treatment of a symptomatic bunionette with plantar callosity.

• 대한족부족관절학회지
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• 제17권1호
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• pp.1-10
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• 2013

The bunionette, or a 'tailor's bunion', is a lateral bony prominence of the fifth metatarsal head. A bony deformity itself rarely causes symptom but if a painful inflammation of the overlying soft tissue is accompanied, it needs treatment. Conservative care using a shoe modification, padding, or orthosis is effective in most cases. Surgical management is indicated when the conservative methods have failed to improve symptoms, and the techniques include exostectomy, metatarsal osteotomies (distal, diaphyseal, or proximal), metatarsal head resection or fifth ray resection. We reviewed the etiology, clinical features, radiographic classification, nonoperative and operative treatments of the bunionette.

• 대한족부족관절학회지
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• 제8권2호
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• pp.121-125
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• 2004

Purpose: We try to retrospectively evaluated the amount of dorsal angulation angle of the first metatarsal commonly occurring as the complication of proximal dome osteotomy for hallux valgus. Materials and Methods: Between January 2004 and March 2004, 34 patients who underwent proximal dome osteotomy for moderate to severe hallux valgus. Two of 34 patients were male, and thirty-two were female. The average age was 57.6 years. We measured and compared hallux valgus angle, 1st-2nd intermetatarsal angle, dorsal angulation angle of 1st metatarsal on preoperative, postoperative, postoperative 3 weeks', postoperative 3 months' X-ray. Results: Osteotomy sites were completely united on plane X-ray in all cases. The hallux valgus angle averaged $41.2^{\circ}$ ($30{\sim}60^{\circ}$) at preoperative, $4.3^{\circ}$ ($-10{\sim}20^{\circ}$) at postoperative, $5.5^{\circ}$ ($-1{\sim}20^{\circ}$) at 3 weeks after operation, $7.8^{\circ}$ ($-2{\sim}20^{\circ}$) at 3 months after operation. The 1st-2nd intermetatarsal angle averaged $17.1^{\circ}$ ($12{\sim}24^{\circ}$) at preoperative, $6.3^{\circ}$ ($0{\sim}13^{\circ}$) at postoperative, $7.2^{\circ}$ ($0{\sim}15^{\circ}$) at 3 weeks after operation, $8.7^{\circ}$ ($0{\sim}18^{\circ}$) at 3 months after operation. The dorsal angulation angle averaged $0.4^{\circ}$ ($0{\sim}3^{\circ}$) at postoperative, $1.6^{\circ}$ ($0{\sim}7^{\circ}$) at 3 weeks after operation, $2.1^{\circ}$ ($0{\sim}8^{\circ}$) at 3 months after operation. There were no statistically correlation between increase of dorsal angulation angle of the distal segment of the first metatarsal and increase of hallux valgus angle or 1st-2nd intermetatarsal angle. Conclusion: Our results shows that the dorsal angulation of distal fragment occurring after the proximal dome osteotomy in the treatment of hallux valgus may be minimized with meticulous surgery and patient's education.

• 대한족부족관절학회지
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• 제14권1호
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• pp.11-15
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• 2010

Purpose: The purpose of this study was to retrospectively analyze the clinical and radiologic results of the proximal crescentic osteotomy for moderate to severe hallux valgus deformity. Materials and Methods: Between March 2001 and March 2008, 55 patients (71 feet) who had undergone crescentic osteotomy and distal soft tissue procedure for hallux valgus were followed up for more than one year. The average follow-up period was 15.8 months (12~28 months) and the average age at the time of surgery was 49.8 years (20~69 years). We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA), the length of 1st metatarsal bone and the position of medial sesamoid in preoperative and the last follow-up radiographs. The American Othopeaedic Foot and Ankle Society (AOFAS) score and patient satisfaction were measured by modifying Johnson's method which were used for clinical outcome assessments. Results: The HVA and the IMA were 36.2 and 15.8 degrees preoperatively, and 10.8 and 3.9 degrees at the last follow-up, respectively. The amount of shortening of 1st metatarsal bone averaged $2.3{\pm}1.1$ rum postoperatively. The medial sesamoid position improved from a preoperative average of grade 6.6 to the last follow-up average of grade 1.9. The AOFAS score improved from a preoperative average of 45.3 points to an average 90.6 points at the last follow-up. The patient's satisfaction was completely satisfied in 61 cases (85.9%), satisfied with minor reservations in 6 cases (8.5%), satisfied with major reservations in 2 cases (2.8%), and dissatisfied in 2 cases (2.8%). Conclusion: Proximal crescentic osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

• 대한족부족관절학회지
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• 제18권1호
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• pp.19-23
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• 2014

Purpose: The purpose of this study is to evaluate the clinical and radiographic results of symptomatic bunionette treated with a diaphyseal oblique osteotomy. Materials and Methods: We retrospectively reviewed 12 feet of nine patients diagnosed as symptomatic bunionette and treated with diaphyseal oblique osteotomy. All patients were female and the average age at the time of surgery was 48 years. We checked the foot standing anteroposterior, oblique, and lateral images pre- and post-operatively. We measured the fourth intermetatarsal angle and fifth metatarsophalangeal angle and evaluated the clinical results using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scale preoperatively and six months postoperatively. Results: Of the nine patients, hallux valgus was combined with symptomatic bunionette in seven feet of five patients. In all of our cases, the average AOFAS lesser MTP-IP scale showed improvement after surgery. Painful callosity around the fifth metatarsophalangeal joint disappeared after surgery in all of our cases. The fourth intermetatarsal angle improved from $12.7^{\circ}$ to $3.1^{\circ}$ and the fifth metatarsophalangeal angle improved from $16.6^{\circ}$ to $2.3^{\circ}$. Conclusion: Diaphyseal oblique osteotomy of the fifth metatarsal appears to be a safe and satisfactory surgical procedure for treatment of symptomatic bunionette.