• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.62-67
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• 2018

Purpose: To evaluate the clinical significance and usefulness of a bone scan in accessory navicular bone. Materials and Methods: Eighty-five patients with foot pain and accessory navicular bone on radiography, who underwent bone scan from 2012 to 2015, were analyzed retrospectively. The subjects was divided into a symptomatic and asymptomatic group according to the presence of navicular bone tenderness. The grade of bone scan uptake was divided into 3 grades. Age, gender, grade of bone scan and size of the accessory navicular bone were analyzed. The symptomatic group were divided into a low (grade 0, 1) and high uptake (grade 2) group to determine the appropriate treatment. The low uptake group was treated conservatively for 3 months. The high uptake group was initially treated conservatively for 3 months and surgery was performed if pain persisted. For the clinical evaluation, the visual analogue scale, American Orthopaedic Foot and Ankle Society midfoot scale were evaluated in the first examination and last follow-up date. The patient's satisfaction grade was also evaluated at the last follow-up. Results: The asymptomatic group mostly showed no uptake in the bone scan. On the other hand, some patients in the asymptomatic group showed an increase in uptake. In these patients, the size of accessory navicular bone was related to the grade of bone scan uptake, showing that the bone scan uptake grade can be predicted when applying different cut off values for the bone size. The symptomatic group mostly showed uptake in the bone scan and the grade of uptake had a positive correlation with the size of the accessory navicular bone (p<0.05). Age and gender were not related to the bone scan uptake. In the clinical evaluation, conservative and surgical treatment showed a good outcome. Conclusion: The bone scan uptake grade alone cannot be used to completely predict the symptoms. On the other hand, the size of the accessory bone can increase the bone scan uptake. Therefore, the size of the accessory bone, and patient symptoms should be considered in patients with a high uptake when deciding treatment.

• Journal of Korean Foot and Ankle Society
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• v.25 no.2
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• pp.108-110
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• 2021

An extremely rare accessory bone of the foot located in the distal portion of the navicular that articulates with the medial cuneiform was observed. Os paracuneiforme is usually located medial to the medial cuneiform or the naviculocuneiform joint. Although os paracuneiforme is often referred to as an accessory bone around the foot, few cases of this type of accessory bone have been reported. This paper reports a patient with a painful Os paracuneiform who underwent surgical excision of the accessory bone.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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• pp.161-165
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• 2004

Purpose: To analyze clinical symptom and clinical course of accessory navicular bone and to evaluation of surgery of accessory navicular bone in sports players Materials and Methods: Twenty-two patients with accessory navicular bone were identified between January 1 2001 and June 30. 2003 Results: Subjective satisfaction of 23 patients rated very satisfaction (16), satisfaction (6), common (1). Symptomatic pain were thoroughly disappeared at average 2.5 months ($1{\sim}6$ months) after operation. On one year follow-up, most of patients could maintain daily life and could go back to their sports carreer at 3 months. Conclusion: In athlete, excision of accessory navicular and reattachment of posteior tibial tendon to navicular like non-athletes is the best solution to management of symptomatic accessory navicular failed to manage conservatively.

• Journal of the Korean Society of Radiology
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• v.82 no.1
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• pp.82-98
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• 2021

Sesamoid bones and accessory ossicles are normal anatomic variants with varying morphological appearances and incidences. They are usually small osseous fragments with well-corticated margins located adjacent to the joint space and bone. Patients with sesamoid bones and accessory ossicles are usually asymptomatic and commonly encountered in clinical practice. These sesamoids and accessory bones are occasionally painful because of fractures, dislocations, degenerative changes, avascular necrosis, accessory bone infections, or abnormalities of the adjacent tissue, such as nerve entrapment, tenosynovitis, or soft tissue impingement. This article aimed to illustrate the imaging features of symptomatic sesamoids bones and accessory ossicles at various anatomic locations and describe their clinical features and radiological differential diagnosis.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.20-25
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• 2005

Purpose: To determine the locations and incidences of sesamoids and accessory bones of the forefoot in normal Korean adults. Materials and Methods: The plain radiographs of the forefoot of 400 volunteers, 200 males and 200 females, were taken. The three orthopedic surgeons participated in the radiographic evaluation independently. Persons who had history of foot problem or injury were excluded. Results: Sesamoids of first metatarsophalangeal joint were nearly always present; medial 99% and lateral 100%. The bipartite sesamoid was more common in medial (9.8%) and in female (17.0%) than in lateral (0.3%) and in male (2.5%). Sesamoids of the interphalangeal joint of the first toe were seen in 35.8%. Sesamoids of metatarsophalangeal joints in other four toes were rarely observed. Their incidences were 5% in second toe, 0.8% in third, 0% in fourth, and 2.8% (lateral) and 7.5% (medial) in fifth. Sesamoids of interphalangeal joint in four lesser toes were not observed except two cases (0.5%) in the fifth toe. Accessory bone was very rarely observed. Os vesalianum was observed in five feet (1.3%), Os intermetatarseum in 14 feet (3.5%), and Os cuneo-metatarsal I tibiale in none. Conclusion: We determined the location and incidences of sesamoids and accessory bones of the forefoot, and we expected this to help to diagnose the forefoot problem.

• Journal of Korean Foot and Ankle Society
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• v.28 no.2
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• pp.60-67
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• 2024

Purpose: Sinus tarsi syndrome (STS) is caused by various pathologies. However, the exact etiology of STS remains controversial. This study evaluated the imaging and arthroscopic findings of patients who underwent surgical treatment after conservative treatment for STS failed. Materials and Methods: Between December 2014 and August 2018, 20 patients (21 cases) who underwent surgical treatment for STS were included in the study. The clinical results were analyzed using the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scale. The radiographic results were analyzed using Meary's angle, calcaneal pitch angle, and hindfoot alignment angle. The pathologic conditions of sinus tarsi were confirmed by magnetic resonance imaging (MRI) and subtalar arthroscopy. Synovitis, bone edema, and accessory anterolateral talar facet (AALTF) were evaluated on MRI. Synovial thickening, cartilage damage, interosseous talocalcaneal ligament (ITCL) and cervical ligament rupture, soft tissue impingement, AALTF, and accessory talar facet impingement (ATFI) were evaluated by subtalar arthroscopy. Results: The mean duration of symptoms was 28.7 months (4~120). All patients showed significant improvement in the VAS and AOFAS ankle-hindfoot scale. Significant improvements in hindfoot alignment angle and Meary's angle postoperatively were noted in patients who underwent medial displacement calcaneal osteotomy. MRI confirmed synovitis in all patients, AALTF in 19 cases (90.5%), and ATFI with bone edema in seven cases (33.3%). In subtalar arthroscopy, pathologic conditions were observed in the following order: synovitis in 21 cases (100%), AALTF in 20 cases (95.2%), ITCL partial rupture in nine cases (42.9%), and soft tissue impingement in seven cases (33.3%). All cases had two or more pathological conditions, and 15 (71.4%) had three or more. Conclusion: In cases of STS that do not respond to conservative treatment, a comprehensive examination of the lesions of the tarsal sinus and lesions around the subtalar joint is essential.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.62-68
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• 2001

Purpose: to investigate the etiology and the results of surgical treatment of the symptomatic accessory navicular in adults. Materials and Methods: Between 1996 and 2000, 17 cases in 16 adult patients who were older than 20 years were diagnosed as painful accessory na vicular. 11 patients could recall a twisting injury of the ankle, and 8 of them were inversion sprain. 4 patients had tibialis posterior tendon lesions. 13 feet of 12 patients were treated by resection of accessory navicular, the synchondrosis, the medial portion of the navicular and reattachment of tibialis posterior tendon without transposition. 9 feet in 8 patients were followed for more than one year after surgery. In 4 patients with tibialis posterior tendon lesions, additional procedures were performed according to the state of the lesion. Results: All were type II accessory navicular bone which had synchondroses. There was gross motion of the synchondrosis in 'the operating field in all feet. Of the 9 feet which were followed for more than one year after surgery, results were excellent in five and good in four. Conclusion: The painful accessory navicular in adult might be closely associated with inversion ankle sprain, and also with the tibialis posterior tendon lesions. Satisfactory result could be obtained without transposition of the tibialis posterior tendon to the undersurface of the navicular and immediate postoperative weight bearing does not have harmful effect on the result.

• 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.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.827-830
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• 2010

Purpose: Congenital spinal dermal sinus tract is a rare lesion connecting skin to deeper structures including neural tissue. It results from the failure of the neuroectoderm to separate from the cutaneous ectoderm in the third to fifth week of gestation. The common locations are the lumbosacral and occipital regions. Sometimes it extends to spinal canal. In this paper we report a case of congenital spinal dermal sinus tract in the coccyx. Methods: A 21-month-old male child born after an uncomplicated full-term pregnancy was admitted to our institute with a midline dermal sinus and a cartilaginous protrusion in the coccygeal region. There were no signs of infection. Neurologic examination showed no functional deficit in both lower limbs. He was treated with complete excision of the tract and an underlying accessory cartilage. Results: The spinal dermal sinus tract was extended from the skin to the coccyx. The stalk was loosely attached to the accessory cartilage of coccyx. At that point, it was dissected from the accessory cartilage and resected. The accessory cartilage was also resected at the bone and cartilage junction. During the follow-up period of 6 months, the wound healed well without any complication nor recurrence. Conclusion: Congenital spinal dermal sinus tract is known as a form of spinal dysraphism. In order to prevent complications, timely surgical intervention including complete resection of sinus tract with correction of associated abnormalities is of utmost importance.

• Korean Journal of Oriental Medicine
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• v.14 no.1
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• pp.49-58
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• 2008

Objective : To provide information about the accessory product of Broussonetia kazinoki Siebold or Broussonetia papyrifera (L.) Vent by analyzing old books of oriental medicine, domestic/international papers and related patents Methods : Old books related to the accessory product in the field of oriental medicine were reviewed. Research papers regarding the pharmacological activity of the by-products were reviewed and analyzed. Patents about the residual products were examined and classified by year and subject Results : Seven kinds of by-products from Broussonetia kazinoki Siebold or Broussonetia papyrifera (L.) Vent has been used as medicines in oriental medicine. Recently, anti-oxidating, anti-cancer, anti-mutagenic and anti-inflammation activity of the residual product of these plants has been investigated through scientific research. There were 19 patents related with the accessory products of these plants, which were in the subjects of functional cosmetics, anti-inflammation, cleansing goods, hair restorers or improvement of learning ability. Further investigations about the activity of these plants are needed in bone metabolism, water balance and hemostasis in the future. Conclusion : Residual products from these plants is being used in various ways. However, more studies on the efficacy and mechanism, as well as safety, of these plants should be conducted precisely in the future.