• Journal of Korean Foot and Ankle Society
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• v.21 no.1
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• pp.7-11
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• 2017

Purpose: We retrospectively analyzed the radiographic and clinical results after the first ray of forefoot osteotomy using low profile wedge plate without additional cancellous bone grafting for pes planus correction. Materials and Methods: Twenty-four patients were enrolled in this study. Medial cuneiform opening wedge osteotomy was performed in 12 patients (Cotton osteotomy, group C) and first metatarsal base osteotomy was performed in 12 patients (group MT). Results: On average, the wedge size was 5.61 mm (5~6 mm). The mean time to radiographic union was 3.18 and 3.27 months in groups C and MT, respectively. Postoperative talonavicular coverage angle, talo-first metatarsal angle (anteroposterior), talo-first metatarsal angle (lateral), talo-calcaneal angle (lateral), medial cuneiform height, and American orthopaedic foot, as well as ankle society midfoot scale were significantly improved in both groups. Nonunion, delayed union or fixation failure was not presented in our series. Conclusion: We have shown that low profile wedge plate was effective in the case of first ray forefoot osteotomy for pes planus correction without any additional cancellous bone grafting.

• Journal of Korean Foot and Ankle Society
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• v.19 no.4
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• pp.165-170
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• 2015

Purpose: The purpose of this study is to analyze the measurement differences of simple radiographs according to radiation projection angle using a phantom and to propose methods for objective analysis of simple radiographs. Materials and Methods: We took simple radiographs with different projection angles using a C-arm image intensifier and measured five parameters of the foot on the simple radiographic images. Five parameters include lateral tibiocalcaneal angle, lateral talocalcaneal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and lateral calcaneo-first metatarsal angle. Intraobserver and interobserver reliability were verified, and then intraclass correlations of parameters were analyzed. Results: Radiographic parameters of the foot showed high intraobserver and interobserver reliability. Lateral tibiocalcaneal angle has a strong negative linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral talocalcaneal angle has a moderate positive linear relationship with rotation and a strong positive linear relationship with tilt. Naviculocuboid overlap has a strong positive linear relationship with rotation and a moderate positive linear relationship with tilt. Lateral talo-first metatarsal angle does not have a linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral calcaneo-first metatarsal angle has a moderate positive linear relationship with rotation and tilt. Conclusion: More precise evaluation of the foot with a simple radiograph can be performed by understanding the changes of radiographic parameters according to radiation projection angle.

• 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.14 no.2
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• pp.130-134
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• 2010

Purpose: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. Materials and Methods: We performed a dorsal closing wedge $1^{st}$ metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-$1^{st}$ metatarsal, calcaneus-$1^{st}$ metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. Results: Talo-$1^{st}$ metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of $21^{\circ}$ and $25^{\circ}$ to $12^{\circ}$ and $19^{\circ}$, respectively, at last followup. Also, calcaneus-$1^{st}$ metatarsal angle was increased from the mean $114^{\circ}$ to $114^{\circ}$. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. Conclusion: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.

• Journal of Korean Foot and Ankle Society
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• v.1 no.2
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• pp.75-80
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• 1997

Radiographs were made of the feet of one hundred and twenty four normal children who were ranged in age from 1 to 13 years. On lateral radiographs that were made with the feet in standing, the talo-first metatarsal, calcaneal pitch and calcaneo-fifth metatarsal angles and arch ratio were measured. Most of the children in this study revealed flattened feet in earlier ages and the mean values were changed with age up to normal range later in the early school ages. These data might provide one of the standard for assessment of the flatfoot in children. However, the diagnosis and treatment of the flatfoot should be based on clinical assessment and radiographic values should not determine clinical management even if the values are beyond the normal range.

• Journal of Korean Foot and Ankle Society
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• v.24 no.2
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• pp.75-80
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• 2020

Purpose: The purpose of this study is to evaluate the results of Kidner procedure combined with medial displacement calcaneal osteotomy (MDCO) in patients with the symptomatic accessory navicular with hindfoot valgus. Materials and Methods: From January 2014 to January 2019, fifteen patients (15 cases) who had undergone a Kidner procedure combined with MDCO for symptomatic accessory navicular with hindfoot valgus were included. Their mean age was 36.3 years old (19~61 years old) and there were 6 males and 9 females. The clinical results were evaluated using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, and postoperative subjective satisfaction. The radiographic results were evaluated using the talonavicular coverage angle and the anteroposterior talo-first metatarsal angle, the lateral talo-first metatarsal angle, the calcaneal pitch angle, and the hindfoot alignment angle. The postoperative complications were also evaluated. Results: The VAS and AOFAS midfoot scores continuously improved until 12 months after surgery. Subjective satisfaction after surgery was excellent in 10 cases and good in 5 cases. The hindfoot alignment angle significantly changed after surgery. Pain due to lateral impingement disappeared in five patients, and persisted in one patient. Five patients complained of irritation caused by their fixation devices, and all the symptoms improved after removal of the fixation devices. Conclusion: Kidner procedure combined with MDCO in patients with the symptomatic accessory navicular with hindfoot valgus showed good clinical results with satisfactory correction of hindfoot valgus. In particular, the clinical results showed continuous improvement until 12 months after surgery.

• Journal of Korean Foot and Ankle Society
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• v.19 no.4
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• pp.176-180
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• 2015

Purpose: The aim of the current study is to report on the clinical and radiographic results after calcaneo-stop procedure in Korean children with symptomatic flexible flatfoot. Materials and Methods: Twenty-two children suffering pain along the medial aspect of midfoot with flexible flatfoot whose symptoms did not improve with conservative measures and therefore underwent calcaneo-stop procedure were identified retrospectively. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analogue scale (VAS) were evaluated. Radiographically, standing anteroposterior and lateral radiographs of the foot and Saltzman's alignment views were taken and talonavicular coverage angle, lateral talo-first metatarsal angle, and hindfoot alignment angles were measured and analyzed. Results: Clinically, AOFAS ankle-hindfoot scale improved from $70.3{\pm}5.6$ to $97.3{\pm}2.5$ and VAS improved from $6.4{\pm}1.6$ to $0.2{\pm}0.4$. Radiographically, talonavicular coverage angle improved from $28.3^{\circ}{\pm}12.3^{\circ}$ to $10.9^{\circ}{\pm}8.1^{\circ}$, lateral talo-first metatarsal angle improved from $-19.3^{\circ}{\pm}9.0^{\circ}$ to $-2.4^{\circ}{\pm}8.1^{\circ}$, and hindfoot alignment angle improved from valgus $11.9^{\circ}{\pm}10.0^{\circ}$ to $3.5^{\circ}{\pm}4.3^{\circ}$ at minimum 2-year follow-up. No complications occurred postoperatively. Conclusion: Calcaneo-stop procedure is a simple and very effective procedure for management of pediatric symptomatic flexible flatfoot that does not respond to conservative treatment.

• Journal of Korean Foot and Ankle Society
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• v.15 no.1
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• pp.1-6
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• 2011

Purpose: The purpose of this study was to compare the clinical and radiological results of single and double fusions in the transverse tarsal joint. Materials and Methods: Between December 2000 and April 2009, 16 patients (16 feet) who had been treated by fusion of transverse tarsal joint were included in this study. In 8 patients, only talonavicular joint was fused and in the other 8 patients, both talonavicular and calcaneocuboid joints were fused simultaneously. We have measured talo-first metatarsal angle, calcaneal pitch angle, talonavicular coverage angle and presence of adjacent joint arthritis for radiological assessment at both preoperative and last visit. Furthermore, we have evaluated Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction. Results: In a single fusion group, VAS was improved from $6.4{\pm}1.4$ to $0.8{\pm}1.0$ (p=0.0011) and AOFAS score was improved from $63.8{\pm}6.2$ to $89.4{\pm}9.8$ (p=0.0012). In a double fusion group, VAS was improved from $8.0{\pm}0.75$ to $2.0{\pm}1.8$ (p=0.0011) and AOFAS score was improved from $60.5{\pm}11.2$ to $89.5{\pm}6.0$ (p=0.0012). In the difference of talo-first metatarsal angle between two groups, a single fused group was more improved than a double fused group (p=0.04). Conclusion: Both single and double fusions are useful and attractive treatment for the transverse tarsal joint arthritis. Furthermore, a single fusion has advantages of less invasiveness and preserving some degree of hindfoot motion and could be an effective alternative to a double fusion if patient meets appropriate criteria through careful preoperative evaluation.

• Journal of Korean Foot and Ankle Society
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• v.21 no.2
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• pp.55-60
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• 2017

Purpose: Stiffness in the first metatarsophalangeal joint after surgery for hallux valgus has been reported. The goal of this study was to test the efficacy of releasing plantar aponeurosis for improving the range of extension in the first metatarsophalangeal joint that was limited after hallux valgus surgery. Materials and Methods: Thirteen patients (1 man, 12 women [17 feet]; median age, 54.4 years; range, 44~69 years) with limited first metatarsophalangeal joint extension after hallux valgus surgery, who underwent an additional procedure of plantar aponeurosis release between March 2015 and August 2015, were included. Subsequently, the passive range of extension in the first metatarsophalangeal joint was evaluated via knee extension and flexion positions. Hallux valgus angle, inter-metatarsal angle, distal metatarsal articular angle, and talo-first metatarsal angle were measured on weightbearing dorsoplantar and lateral radiographs of the foot preoperatively. Results: The mean range of extension for the first metatarsophalangeal joint improved significantly, from $2.5^{\circ}$ to $40.9^{\circ}$ in the knee extension position (p<0.00). The mean extension range for the first metatarsophalangeal joint also improved, from $18.2^{\circ}$ to $43.2^{\circ}$ in the knee flexion position (p<0.00). In all patients, congruence of the first metatarsophalangeal joint was recovered. Conclusion: Plantar aponeurosis release is an effective additional procedure for improving the extension range of the first metatarsophalangeal joint after hallux valgus surgery.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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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.