• 대한족부족관절학회지
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• 제5권2호
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• pp.142-148
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• 2001

Purpose: To investigate the short term result of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of rheumatoid arthritis, using a lag screw and dorsal mini-plate. Materials and Methods: From December 1999 to September 2001, The first metatarsophalangeal arthrodesis of 14 cases (9 patients) was underwent, using a lag screw and dorsal mini-plate. The follow-up period was averaged in 14.6 months. The subjective findings with respect to pain, functional aspect of ability to stand and walk, and to shoe-wearing were evaluated. The objective findings, such as the gross alignment and the radiological measurements for the hallux valgus angle, 1,2 intermetatarsal angle, and dorsiflexion angle were also studied. Results: After the arthrodesis of the first metatarsophalangeal joint, the subjective improvement in pain, function and alignment was graded as excellent in seven (50%) feet, good in seven (50%) feet, and fair or poor in none. The hallux valgus angle and 1,2 intermetatarsal angle were reduced from $44.1{\pm}7.1$ and $15.5{\pm}6.2$ degrees to $13.6{\pm}2.6$ and $10.2{\pm}2.2$ degrees respectively. The dorsiflexion angle was measured in $20.3{\pm}3.7$ degrees after the fusion. The radiological fusion was observed at average 8 weeks after the operation in all cases. The overall complication of the procedure was few, except the delayed wound healing in one. Conclusion: The arthrodesis of the first metatarsophalangeal joint using a lag screw and dorsal mini-plate was regarded as an excellent method of various operative modalities to correct the rheumatoid hallux valgus deformity.

• 대한족부족관절학회지
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• 제16권1호
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• pp.47-52
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• 2012

Purpose: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. Materials and Methods: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. Results: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. Conclusion: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.

• 대한족부족관절학회지
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• 제18권2호
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• pp.43-47
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• 2014

Hallux valgus is a lateral deviation of the first phalanx and medial deviation of the first metatarsal at the first metatarsophalangeal (MP) joint. Its incidence has increased due to developing footwear. The etiologies include fashion footwear, genetic causes, anatomical abnormality around the foot, rheumatoid arthritis, and neuromuscular disorders. Physiologic alignment of the first MP joint is maintained by congruent and symmetric alignment of the articular surface of the first proximal phalanx and first metatarsal head, physiologic relationship of the distal first metatarsal articular surface and the first metatarsal shaft axis, and stable balance of soft tissue around the first MP joint and stable tarsometatarsal joint. Several factors have been associated with hallux valgus, including pes planus, hypermobility of the first tarsometatarsal joint, flattened shape of the first metatarsal head, increased distal metatarsal articular angle, and deformation of the medial capsular integrity. History and physical examination are very important to diagnosis of hallux valgus. Simple radiography provides information on deformity, particularly in weight-bearing anteroposterior and lateral radiographs. Understanding the etiologies and pathophysiology is very important for success in treatment of patients with hallux valgus.

• 대한족부족관절학회지
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• 제11권2호
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• pp.171-176
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• 2007

Purpose: We assess the mid to long term follow up results of arthrodesis of the first metatarso-phalangeal (MTP) joint and resection arthroplasty of the lesser toes in rheumatoid arthritic forefoot deformity. Materials and Methods: Between 1998 to 2001 year, 25 cases (18 patients) rheumatoid forefoot deformities were surgically corrected. Follow up period was 83 months (range, 63 to 90 months). The clinical outcome was evaluated using subjective satisfaction and AOFAS score. The radiological measurements were hallux valgus angle, first and second intermetatarsal angle, second metatarso-phalangeal angle (MTP-$2^{nd}$ angle). Results: Subjective satisfaction was 76%. AOFAS score improved from 37 to 73. The hallux valgus angle improved from preoperative $39^{\circ}$ ($27{\sim}64^{\circ}$) to $14^{\circ}$ ($4{\sim}34$) at the last follow up. The intermetatarsal angle were preoperative $13^{\circ}$ ($6{\sim}22^{\circ}$) to $11^{\circ}$ ($3{\sim}13^{\circ}$) at the last follow up, The MTP-$2^{nd}$ angle were preoperative $24^{\circ}$ ($9{\sim}47$) to last follow up $15^{\circ}$ ($2{\sim}39^{\circ}$) respectively (p>0.05). Complication was intractable callus 10 cases, Interphalangeal arthritis 5 cases. Conclusion: Mid to long term outcomes rheumatoid forefoot reconstruction by first MTP arthrodesis and resection arthroplasty of lesser toes results a satisfaction and pain relief.

• 대한정형외과학회지
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• 제56권6호
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• pp.484-490
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• 2021

목적: 류마티스 전족부 변형은 심한 무지 외반증과 소족지의 갈퀴 족지 변형으로 이루어진다. 저자들은 류마티스 전족부 변형에 대한 변형 Hoffman 술식의 중기 결과를 분석하고자 하였다. 대상 및 방법: 18명, 22예의 환자가 변형 Hoffman 술식 후 최소 2년 이상 추시되었다. 평균 연령은 54.7세였고 평균 추시 기간은 3년 4개월이었다. 임상적으로 시각통증척도와 미국 정형외과 족부족관절학회 점수를 술 전 및 술 후에 비교하였다. 또한 술 후 합병증과 환자의 만족도 및 족저부 굳은살의 소실 여부를 조사하였다. 방사선학적으로 무지 외반각, 제1-2 중족골간각, 제1 족지 지간각, 제1 족지 지간 관절의 관절염 발생 여부, 제1 중족지 관절 족배 굴곡각, 제1 중족지 관절의 유합 기간 등을 측정하였다. 결과: 임상적으로 시각통증척도와 미국 정형외과 족부족관절학회 점수는 술 전 평균 7.1점과 평균 30.3점에서 최종 추시 시 평균 1.5점과 평균 83.1점으로 호전되었다(p<0.001). 술 후 만족도는 전 환자가 만족하였으며, 술 후 족저부 굳은살은 모든 예에서 소실되었다. 방사선학적으로 무지 외반각, 제1-2 중족골간각, 제1 족지 지간각은 술 전 각각 평균 52.8도, 13.3도, 7.5도에서 최종 추시시 16.2도, 8.7도, 14.6도로 변화하였다(p<0.001). 제1 중족지 관절의 족배 굴곡각은 평균 17.2도였으며, 제1 중족지 관절은 평균 11.1주에 유합되었다. 합병증으로 소족지의 거상지 변형이 2예, 창상 문제가 1예, 제1 족지 지간 관절의 관절염이 2예에서 발생하였다. 제1 중족지 관절의 불유합은 관찰되지 않았다. 결론: 류마티스 전족부 변형에 대해 변형 Hoffman 술식은 안전하고 만족스러운 술식으로 사료된다.