• 대한족부족관절학회지
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• 제17권2호
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• pp.115-120
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• 2013

Purpose: Calcaneal lengthening osteotomy is one option for the treatment of symptomatic flexible flatfoot in adults. The aim of the study was to evaluate the short term clinical and radiologic results and analyze its complications. Materials and Methods: Twelve feet who had undergone calcaneal lengthening osteotomy without flexor digitorum longus transfer between December 2009 and July 2011 were included. The mean age was 40.6 years (23~75 years). The mean followup was 17.3 months (13~25 months). Clinical outcome were assessed using American Orthopadics Foot ans Ankle Society (AOFAS) score and visual analogue scale (VAS) for pain. Four radiologic parameters were measured from weightbearing radiographs to evaluate the difference between preoperatively and postoperatively measures. To analyze the complications, calcaneocuboid joint subluxation and degenerative change were measured postoperatively. Results: The mean AOFAS score improved from 55.3 points preoperatively to 82.2 points at lastest follow-up (p=0.000). The mean VAS improved from 6.3 points preoperatively to 3.2 points postoperatively (p=0.002).All radiologic parameters, the mean talonavicular coverage angle on AP view, the mean talo-1st metatarsal angle on AP and lateral view and the mean calcaneal pitch angle, significantly improved after calcaneal lengthening osteotomy. Nine feets (75%) were shown the degenerative change in the calcaneocuboid joint at latest follow-up radiographs. Conclusion: Calcaneal lengthening osteotomy for the symptomatic flexible flatfoot in adults produced significant improvement in clinical and radiologic parameters, but calcaneocuboid joint osteoarthritis occurred postoperatively remained a major problem.

• 대한족부족관절학회지
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• 제1권2호
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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.

• 대한족부족관절학회지
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• 제13권2호
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• pp.197-202
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• 2009

Calcaneal or calcaneovalgus deformity can occur after surgical treatment of equinus or eguinovarus deformity in cerebral palsy patient. It is a serious complication and the results of many conservative and operative treatments are reported unsatisfactory. We experienced one case of both calcaneovalgus deformity following operative treatment of diplegic equinovarus deformity in a spastic cerebral palsy patient and report about the result of the treatment.

• 대한족부족관절학회지
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• 제7권1호
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• pp.30-35
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• 2003

Purpose: The purpose of this study was to evaluate the result of open wedge osteotomy at the anterior calcaneus with iliac bone graft (Evans procedure) for symptomatic flexible flatfeet in children. Materials and Methods: A retrospective study was conducted between October 1995 and September 2002. Six cases in 3 patients who had symptomatic flexible flatfeet was included. Follow-up averaged 39.5 months. We evaluated the patients' satisfaction by Mann and Reynolds scorring and compared the radiographic results between preoperative and final radiography. Results: The satisfaction outcomes at the last follow-up were excellent in five and good in one. The mean lateral talo-first metatarsal angle was improved from $-20^{\circ}$ to $-3^{\circ}$. The mean calcaneal inclination angle was improved from $8.5^{\circ}$ to $20.8^{\circ}$. The talo-navicular coverage angle was improved from $47.5^{\circ}$ to $7.5^{\circ}$. In one case, we found the subluxation of calcaneocuboidal jont in postoperative radiography. Conclusion: Open wedge osteotomy at the anterior calcaneus for symptomatic flexible flatfeet in children was considered as one of the effective treatment methods.

• 대한족부족관절학회지
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• 제22권4호
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• pp.181-183
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• 2018

Hallux valgus is a deformity that causes pain in the first metatarsophalangeal joint. Surgical methods are quite diverse and a range of osteotomies are used at the proximal and distal part of the metatarsal bone and proximal phalange. Fixation methods, such as plate, screw, K-wire, and others have been used in various ways. The fixation device is often removed with various side effects due to the fixation devices. In the case of instruments that are absorbed in vivo, these procedures are not necessary to remove and there is an advantage of not performing the second operation. Three patients were treated, in which a proximal chevron osteotomy was used with a bioabsorbable screw (K-$MET^{TM}$; U&I Corporation).

• 대한족부족관절학회지
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• 제12권1호
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• pp.1-8
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• 2008

Purpose: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. Materials and Methods: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. Results: The mean preoperative HVA and IMA were $40.4^{\circ}$, $17.4^{\circ}$ and the mean amounts of correction were $31.2^{\circ}$ and $11.5^{\circ}$. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. Conclusion: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.

• 대한족부족관절학회지
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• 제9권1호
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• pp.64-68
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• 2005

Purpose: The purpose of this study was to evaluate the outcome of Ludloff osteotomy for treatment of hallux valgus with regard to patient satisfaction and clinical and radiological results. Materials and Methods: 43 feet of 28 patients underwent Ludloff osteotomy between January 2003 and August 2003. 21 patients (32 feet) who were available for follow up for more than one year were enrolled in this study. Average follow up period was 16 months. All patients were female and the average age was 51 years ranging 28 years to 72 years. Patient satisfaction was assessed and VAS (Visual Analogue Scale) was used for subjective outcome, AOFAS (American Orthopaedic Foot and Ankle Society) score and presence of metatarsalgia were used for clinical outcome, and hallux valgus angle and intermetatarsal angle were used for radiological outcome assessment. Results: Patient satisfaction regarding cosmesis was excellent in 6 cases, good in 21 cases, fair in 4 cases and poor in 1 case. VAS was improved from preoperative 6 points to postoperative 2 points and AOFAS score was improved from preoperative 53 points to postoperative 82 points. Metatarsalgia was observed in 18 cases preoperatively and 9 cases postoperatively. HVA and IMA were 35.8 and 15.2 degrees preoperatively, 12.5 and 6.6 degrees at 3 months follow up, and 13.2 and 7.1 degrees at last follow up respectively. At the last follow up, loss of angle of correction for HVA was 0.7 degrees and for IMA was 0.5 degrees. Conclusion: Ludloff osteotomy is an appropriate surgery of moderate to severe hallux valgus.

• 대한족부족관절학회지
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• 제17권2호
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• pp.93-99
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• 2013

Purpose: Proximal metatarsal chevron osteotomy for hallux valgus is followed by significant amount of postoperative pain. Periarticular multimodal drug local injection can be an option for pain control. This study was attempted to evaluate the efficacy of the morphine as multimodal drug and to confirm the effect of periarticular multimodal drug local injection on controlling early postoperative pain. Materials and Methods: Between March 2012 and June 2012, 22 patients received proximal metatarsal chevron osteotomy for the correction of hallux valgus deformity. 10 patients (Group A) received periarticular injection of the test solution made with morphine, ropivacaine, ephinephrine and ketorolac. 12 patients (Group B) received periarticular injection of the test solution without morphine. The visual analog scale (VAS) was checked at 2, 4, 6, 8 hours, 1 day and 2 days each after surgery. Results: The VAS score at postoperative 2 hours to 1 day between two groups showed no significant difference, but the VAS score at postoperative 2 days was significantly higher in Group A compared to the VAS score of group B. The amount of additional pain control (tramadol HCL) between two groups showed no significant difference for 3 days after surgery. Conclusion: Periarticular multimodal drug local injection was effective in reducing pain after hallux valgus surgery regardless of mixing with morphine.

• 대한족부족관절학회지
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• 제11권1호
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• pp.23-27
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• 2007

Purpose: Scarf osteotomy can provide the simultaneous correction of the hallux valgus angle (HVA), 1-2 intermetatarsal angle ($IMA_{1-2}$), DMAA and the plantar displacement of the fragment. The study was conducted to understand the multi-dimensional correction of the hallux valgus. Materials and Methods: Fourty eight patients who had undergone Scarf osteotomy with hallux valgus at more than $30^{\circ}$ of HVA and more than $15^{\circ}$ of $IMA_{1-2}$ were studied. Before an osteotomy, a reference K-wire was inserted to the 1st metatarsal head. After the osteotomy, the plantar fragment was moved laterally and the proximal end of the fragment was forced beyond the distal end which resulted in an internal rotation of the head fragment to correct the DMAA. Results: The HVA improved an average of $33.3^{\circ}$ to $7.7^{\circ}$ with the IMA1-2 respectively from $15.4^{\circ}$ to $6.5^{\circ}$. The DMAA improved an average of $19.5^{\circ}$ ($5.2-30.9^{\circ}$) to $4.5^{\circ}$ ($0.4-13.8^{\circ}$). By checking the angle, which was at an average of $25^{\circ}$ between the plantar surface of the foot and the osteotomy plane, the average distance of 1.9 mm (1.18-3.1 mm) of plantar displacement was measured using the value of sine (sin 25 = 0.422). Conclusions: It is possible to correct the HVA, IMA1-2 and DMAA simultaneously with one osteotomy making the lateral shift, the internal rotation and the plantar displacement of the plantar head fragment as desired. Despite the technicality and difficulty of the Scarf osteotomy, once familiarized through myriad procedures, all disadvantages are outweighed by the success and satisfaction of both patient and surgeon.

• 대한족부족관절학회지
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• 제20권4호
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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.