• Journal of Korean Foot and Ankle Society
• /
• v.17 no.2
• /
• pp.121-129
• /
• 2013

Purpose: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. Materials and Methods: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, $1^{st}-2^{nd}$ intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of $1^{st}-2^{nd}$ metatarsal declination angle and distance between the $1^{st}-2^{nd}$ metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). Results: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the $2^{nd}$ metatarsal and distance between the $1^{st}-2^{nd}$ metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). Conclusion: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length, metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.

• Journal of Korean Foot and Ankle Society
• /
• v.18 no.4
• /
• pp.173-177
• /
• 2014

Purpose: The purpose of this study is to evaluate the characteristics of hallux valgus with severe hallux valgus angle (HVA) and moderate intermetatarsal angle (IMA) after proximal chevron osteotomy. Materials and Methods: Between January 2008 and December 2010, 41 patients (48 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic severe hallux valgus deformity ($HVA{\geq}40^{\circ}$). Patients were divided into two groups, group M (IMA< $18^{\circ}$) and group S ($IMA{\geq}18^{\circ}$). Mean age of patients was 55.7 years (34~70 years) in group M and 60.0 years (44~78 years) in group S. Mean duration of follow-up was 20.4 months (12~41 months) in group M and 18.5 months (12~35 months) in group S. Radiographic parameters, including HVA, IMA, sesamoid position, metatarsus adductus angle (MAA), and distal metatarsal articular angle (DMAA), were compared between groups. Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Recurrence rate at the last follow-up was compared between group M and group S. Results: Preoperative HVA and grade of sesamoid position did not differ between the groups. However, immediate postoperative HVA and grade of sesamoid position were significantly larger in group M. Preoperative MAA and DMAA were significantly larger in group M. No significant difference in AOFAS score and VAS was observed between the groups at the last follow-up. Ten of the 27 feet (37.0%) in group M and two of the 21 feet (9.5%) in group S showed hallux valgus recurrence at the last follow-up. Group M showed a significantly higher recurrence rate than group S. Conclusion: Recurrence rate for severe hallux valgus with moderate IMA is higher than that of severe hallux valgus with severe IMA.

• Journal of Korean Foot and Ankle Society
• /
• v.21 no.4
• /
• pp.135-138
• /
• 2017

Purpose: The purpose of this study is to determine the correlation between the correction loss of hallux valgus angle and the severity of valgus angle of the second toe. Materials and Methods: We selected 312 cases from 268 surgical patients with hallux valgus deformity receiving distal chevron osteotomy. For a radiological evaluation, we analyzed the changes in the hallux valgus angles, first to second intermetatarsal angles, and valgus angle of the second toe post index operations. All patients were women; the mean age was 46 years. The mean follow-up period was 17 months. Results: The mean hallux valgus angle was $33.6^{\circ}$ preoperatively (range, $25.7^{\circ}{\sim}44.8^{\circ}$), $13.1^{\circ}$ (range, $8.4^{\circ}{\sim}16.4^{\circ}$) after 4 weeks of postoperative period, and $17.1^{\circ}$ (range, $9.4^{\circ}{\sim}28.5^{\circ}$) at their final follow-up. The mean valgus angle of the second toe was $8.4^{\circ}$ preoperatively (range, $2.0^{\circ}{\sim}25.8^{\circ}$) and $8.3^{\circ}$ (range, $1.7^{\circ}{\sim}24.9^{\circ}$) at the final follow-up. Preoperatively, there was a positive correlation between the valgus angle of the second toe and hallux valgus angle (r=0.747, p=0.001). The correction loss of hallux valgus angle had a significant correlation with the severity of valgus angle of the second toe (r=0.802, p=0.001). Conclusion: The existence of the second toe valgus deformity may present itself as a cause of correction loss of hallux valgus angle. The preoperative measurement of the second toe valgus angle may be a good predictor of correction loss; therefore, thorough preoperative warning on the possibility of correction loss should be conducted to maximize patient satisfaction after the procedure.

• Archives of Reconstructive Microsurgery
• /
• v.12 no.2
• /
• pp.93-98
• /
• 2003

Purpose : The purpose of this study is to investigate an occurrence of valgus deformity of ankle joint after vascularized fibular graft in children. Materials and Methods : Four children under 15 years who were surgically treated with vascularized fibular graft were studied. The age of the patients was from 4 years to 13 years, the follow-up period was from 24 months to 108 months. The causes of vascularized fibular graft were open fracture (1 case), congenital psuedarthrosis (2 cases), hypoplastic ulna (1 case). The tibiofibular synostosis was done in 3 cases and not in 1 case. We measured the tibiotalar angle and bimalleolar angle at immediately postoperative and final radiography, and checked ankle motion, pain, and instability of ankle joint. Results : The A-P mortise angle was not different between initial and final radiography in all cases. The intermalleolar angle increased in all cases at the final radiography. There were no pain, instability and limitation of ankle motion. Conclusion: We consider the tibiofibular synostosis can prevent from ankle valgus deformity after vascularized fibular graft in children.

• Journal of Korean Foot and Ankle Society
• /
• v.8 no.2
• /
• pp.126-130
• /
• 2004

Purpose: In this study, we tried to develop the technique of osteotomy for hallux valgus. The new modified technique of osteotomy was accomplished with even more greater stability, accurate correction of the deformity and more effective than 'chevron' osteotomy in terms of correction of the deformity. Materials and Methods: Between March 1998 and December 2001, 55 cases of new modified osteotomy for hallux valgus were performed for 39 patients, 16 of whom underwent operation of both feet. Operations were made for 34 women and 5 men whose average age was 46 years old (range, $20{\sim}71$ years). Average follow up period was three years (range, $2{\sim}5$ years), and during the follow up, the patients underwent physical examination and assessment with use of the American Orthpaedic Foot and Ankle Society's hallux-metatarso-phalangealinterphalangeal scale and standard foot radiographic measurements. Results: 37 patients (53 cases) out of 39 patients (55 cases) had no pain, good cosmesis, and all of the patients were satisfied with the results of the operation. Two had occasional mild discomfort. The average score according to the hallux-metatarso-phallangeal-interphalangeal scale was 93.2 points (range, $78{\sim}100$ points). The average preoperative intermetatarsal angle was $14.4^{\circ}$, which was decreased to $7.9^{\circ}$ after the osteotomy with an average correction of $6.5^{\circ}$ and The average preoperative hallux valgus angle was $34.1^{\circ}$, which was decreased to $11.1^{\circ}$ after the osteotomy with an average correction of $23^{\circ}$. This new modified technique would prevent the angulation or shortening at the osteotomy site and it was also even more stable at osteotomy site, and could do even more effective and accurate correction of the deformity than conventional Chevron osteotomy. Conclusion: New modified chevron osteotomy for the treatment of symptomatic hallux valgus was done in 55 cases, and the results were satisfactory in all cases. This method was more stable at the osteotomy site than conventional Chevron osteotomy and was also possible to do more accurate and more effective correction of the deformity. It was also easy to control the distal fragment of first metatarsal bone.

• Physical Therapy Korea
• /
• v.27 no.4
• /
• pp.227-232
• /
• 2020

Background: Hallux valgus (HV) is a foot deformity developed by mediolateral deviation of the first metatarsophalangeal joint. Although various foot-toe orthoses were used to correct the HV angle, verification of the effects of kinetics variables such as ground reaction force (GRF) through three-dimensional (3D) gait analysis according to the various type of orthoses for HV is insufficient. Objects: This study aimed to investigate the effect of soft and hard types of foot and toe orthoses to correct HV deformity on the GRF in individuals with HV using 3D motion analysis system during walking. Methods: Twenty-six subjects participated in the experiment. Participants had HV angle of more than 15° in both feet. Two force platforms were used to obtain 3D GRF data for both feet and a 3D motion capture system with six infrared cameras was used to measure exact stance phase point such as heel strike or toe off period. Total walk trials of each participant were 8 to 10, the walkway length was 6 m. Two-way repeated measures ANOVA was used to determine the effects of each orthosis condition on the various GRF values. Results: The late anteroposterior maximal force and a first vertical peak force of the GRF showed that the hard type orthosis condition significantly increased GRF compared to the other orthosis conditions (p < 0.05). Conclusion: There were significant effects in GRF values when wearing the hard type foot orthosis. However, the hard type foot orthosis was uncomfortable to wear during walking. Therefore, it is necessary to develop a new foot-toe orthosis that can compensate for these disadvantages.

• Journal of Korean Foot and Ankle Society
• /
• v.13 no.2
• /
• pp.129-132
• /
• 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
• /
• v.17 no.1
• /
• pp.40-44
• /
• 2013

Purpose: To study inter- and intra-observer reliabilities of computerized measurements of the angular parameters of hallux valgus deformity, using two different kinds of software tools for angle measurement on the digital radiography. Materials and Methods: On 35 digital radiographies of standing foot anteroposterior view of hallux valgus, two observers (A, B) independently measured hallux valgus angle (HVA) and 1-2 intermetatarsal angle ($IMA_{1-2}$) twice, using two methods. In method I, an angle was determined from duplicated lines to longitudinal axes made for bisecting line on the target bones with software tool. In method II, an angle was calculated automatically and directly from bisecting lines (longitudinal axes) made on the target bones. We compared two methods using paired t-test to determine significance of differences. Inter- and intraobserver reliabilities were evaluated using the intraclass correlation coefficients (ICC). Results: There were no significant differences between measurements of method I and II for each observer (p>0.05) and intraobserver reliability were good. (ICC>0.9) Inter-observer reliability for method I and II was good of the HVA (ICCs, 0.912 and 0.905) and moderate of the $IMA_{1-2}$ (ICCs, 0.505 and 0.537). There were interobserver differences in HVA of method I and II. Conclusion: No significant difference was found statistically between measurements of method I and II. Both methods I and II would be acceptable to measure angular parameters of hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
• /
• v.7 no.2
• /
• pp.174-178
• /
• 2003

Purpose: The purpose of this study was to evaluate the radiographic results and complications after the proximal dome osteotomy for hallux valgus. Material and Methods: 127 cases of clinically moderate to severe hallux valgus from October 1994 to September 1997 were included in this study. All had been surgically corrected with proximal dome osteotomy, bunionectomy, and distal soft tissue release. We compared the hallux valgus angle(HVA) and intermetatarsal angle(IMA) at preoperative, postoperative 3 weeks, postoperative 6 weeks, and postoperative 3 months. Also we reviewed the postoperative com plications. Result: The HVA averaged $34.1^{\circ}$ at preoperative, $4.3^{\circ}$ at 3 weeks after operation, $8.1^{\circ}$ at 6 weeks after operation, and $10.2^{\circ}$ at 3 months after operation. The lMA averaged $14.6^{\circ}$ at preoperative, $5.1^{\circ}$ at 3 weeks after operation, $5.6^{\circ}$ at 6 weeks after operation, and $7.3^{\circ}$ at 3 months after operation. We experienced 7 cases of malunion, 5 cases of limitation of motin at the first metatarso-phalangeal joint, 3 cases of hallux varus deformity, 2 cases of delayed union. Conclusion: Proximal dome osteotomy for moderate to severe hallux valgus deformity was considered as one of the effective treatment methods. And we try to avoid limitation of motion at the first metatarso-phalangeal joint after operation.

• Journal of Korean Foot and Ankle Society
• /
• v.6 no.1
• /
• pp.15-20
• /
• 2002

Authors studied 24 cases in 18 patients with the hallux valgus deformity treated by Reverdin osteotomy at Department of Orthopaedic Surgery, Wallace Memorial Baptist Hospital from January 1995 to December 1999. Reverdin osteotomy is one of the distal metatarsal osteotomies in the treatment of hallux valgus in adults. We performed Reverdin osteotomy on 24 cases (18 patients) for painful hallux valgus associated with an increased hallux valgus angle (> 35degrees) and first-second intermetatarsal angle(>13 degrees). The results were as follows. 1. The average first-second intermetatarsal angle was 16.8 degrees and average valgus angle was 37.3 degrees, preoperatively. they were corrected to 7.8 degrees and 12 degrees respectively. 2. The metatarsalgia of the great toe was subsided in all cases and they were satisfied with the result of their operations in respect to cosmetically and functionally. Avascular necrosis of capital fragment, nonunion, and dorsal angulation were not developed in any case. But one case had superficial wound infection and delayed union, presumably due to secondary infection.