• Journal of Korean Foot and Ankle Society
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• v.15 no.2
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• pp.68-71
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• 2011

Purpose: To analyze relation between age or parameters measured before operation and cartilage erosion of the first metatarsal head measured during operation. Materials and Methods: The study was targeted at 56 patients and 79 feet, who underwent Scarf osteotomy or Scarf and Akin osteotomy from November 2009 through November 2010, and whose cartilage lesion of the first metatarsal head referred to the cartilage grade III or IV of the International Cartilage Repair Society. The measurement parameters were age, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle. The cartilage erosion of the first metatarsal head was measured by one surgeon using cellophane. Occupancy rate and frequent involved sites of the cartilage erosion were recorded using Auto$CAD^{(R)}$ and adobe Illustrator CS4 program. SPSS correlation test and T-test were used for statistical analysis of the parameters and the cartilage erosion. Results: The cartilage erosion was incurred frequently in the sagittal groove and the site where subluxation or dislocation of the tibial sesamoild bone occurred but frequent involved sites had no statistical significance with cartilage erosion. The age showed a statistical significance with the cartilage erosion in the correlation test (p=0.003). Especially, the group of over 51 year old patients was turned out to have association with the cartilage erosion, compared to the group of below 51 (p=0.007). But, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle were no statistical significance with the cartilage erosion. Conclusion: We found the more the age of patients increased (especially above 51), the more cartilage erosion increased. And it is thought that we pay attention to reduce tibial sesamoid bone.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.223-229
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• 2006

Purpose: The purpose of this study was to analyze the results of the treatment of hallux valgus with metatarsal double osteotomy and longitudinal pin fixation. Materials and Methods: We reviewed 19 patients (21 feet) who had been treated by metatarsal double osteotomy and longitudinal pin fixation for the moderate or severe hallux valgus with increased distal metatarsal articular angle (DMAA), between 1999 and 2004. They were followed prospectively for a minimum of 20 months. Functional outcomes were measured via Hallux metatarsophalangeal-Interphalangeal (HMI) scale and Mayo clinic forefoot scoring system (FFSS). Radiographically, we assessed pre, postoperative and at the last follow-up, the hallux valgus angle (HVA), 1st and 2nd intermetararsal angle (IMA), DMAA. Results: The average preoperative HVA, IMA, DMAA measured $36.76^{\circ}$, $13.62^{\circ}$, $26.00^{\circ}$, respectively. At the last follow-up, HVA, IMA, DMAA measured $9.57^{\circ}$, $7.14^{\circ}$, $9.33^{\circ}$. The correction of HVA, IMA, DMAA were $27.19^{\circ}$, $6.48^{\circ}$, $6.67^{\circ}$. At the last follow-up, there were no recurrences and complications, except two patients complained of unsatisfactory stiffness in the 1st metatarsophalangeal joint and subjectively rated their results as fair. The others rated that as excellent or good. At the last follow-up, statistically, the mean HMI scale and FFSS improved significantly from pre-operative score. Conclusions: In the treatment of moderate or severe hallux valgus with increased DMAA by metatarsal double osteotomy and longitudinal pin fixation, we had good functional and radiological results without recurrences and significant complications. But the stiffness in the 1st metatarsophalangeal joint warrants further study.

• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.21-25
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• 2018

Purpose: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. Materials and Methods: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. Results: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and fortyfive patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p<0.001). Conclusion: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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• pp.238-249
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• 2003

Purpose: To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach. Materials and Methods: Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using an lateral approach from March, 1997 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn't. Radiographically B?hler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results. Results: According to Sanders classification, 19 cases of the 36 cases were classified as type II. Type III fracture were found in 12 cases and type IV in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type II and 7 cases(58.3%) in type ill, but no case in type IV. B?hler angles were improved from preoperative average 1.6?to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.8?, respectively. Among 36 cases, Computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satifactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satifactory results in 2 cases with 5mm gap or more. Conclusion: Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of B?hler angle are more important to obtain best results.

• Journal of Korean Foot and Ankle Society
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• v.2 no.1
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• pp.19-29
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• 1998

The characteristics of the patients after the calcaneal fracture that were associated with an unsatisfactory outcome were subtalar incongruity, decreased Bohler angle ratio of the fractured to the normal side, an age of more than fifty years, work involving strenuous labor, and increased time missed from work due to the injury. The purpose of this study was to examine the reliability of measurements of the range of motion of the subtalar joint. To determine reliability, evaluates of the correlatioinship between the degree of the displacement of the subtalar joint and Circle draw test after the calcaneal fracture. Fifty patients who had had fifty five calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between 4months and three years after the operation, with use of an evaluation system for the subtalar joint and with plain radiographs. At follow up evaluation, the result was assessed on the basis of restoration of anatomy and function of the subtalar joint. We evaluated the subtalar joint with plain films that consist of anteroposterior projection, lateral projection, calcaneal axial view, and Broden's view, and the measurements of the displacement of the subtalar joint surface after the calcaneal fracture. And we evaluated the range of motion of the subtalar joint with Circle draw test for physical evaluation. Circle draw test was evaluated and demonstrated the motion of flexion-supination-adduction and extension-pronation-abduction of the subtalar joint. And there are correlationship between the degree of the displacement and range of motion of the subtalar joint after the calcaneal fracture. The report critically reviews methords used to measure Circle draw test for physical examination of the follow up after the calcaneal fracture.

• Journal of Korean Foot and Ankle Society
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• v.15 no.2
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• pp.62-67
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• 2011

Purpose: The authors evaluated the differences between K-wires and Cannulated screw, plate for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 62 patients (79 feetz) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. We divided the patients into 4 groups, Two K-wire fixed group as A, one cannulated screw fixed group as B. Two cannulated screw fixed group as C, Plate fixed group as D, Group A were patients (26 feet) and Group B were patients z(9 feet), Group C were patients (31 feet) and Group D were patients (13 feet). Preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patient. ANOVA test and Student t-test were done for statistical analysis. Results: Mean follow up period was 43.8 months (range: 12~82 months). Preoperative mean IMA was $16.4{\pm}3.5$, $17.7{\pm}11.3$, $17.3{\pm}5.9$ and $16.6{\pm}2.3$ degrees in respectively group A, B, C, D. Immediate postoperative mean IMA was $5.6{\pm}3.4$, $7.3{\pm}4.4$, $7.6{\pm}4.4$ and $6.7{\pm}2.8$ degrees in respectively group A, B, C, D. The final mean IMA was $8.9{\pm}4.5$, $15.2{\pm}7.5$, $10.3{\pm}4.4$ and D $7.7{\pm}3.5$ degrees in respectively group A, B, C, D. There were significant statistical increase in final mean IMA of group B and C (p<0.05). Conclusion: The IMA was significantly increased in the group which used one or two cannulated screw for fixation on follow up, therefore more caution should be needed when using one or two cannulated screw fixation technique after proximal chevron osteotomy.

• Journal of Korean Foot and Ankle Society
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• v.21 no.2
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• pp.61-65
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• 2017

Purpose: The purpose of this study was to determine the correlation and ratio between the calcaneal length and width for predicting the width of calcaneus. Materials and Methods: A total of 190 feet (190 patients) were included based on computed tomography scans. The length of calcaneus (CL) was measured on the line connecting the center of a circle tangent to the cortical margin in the anterior and posterior parts of the calcaneus in a sagittal plane (W1, W2). The width of the calcaneus was defined as the horizontal line of each part (W1, W2, W3) on the same axial plane. The relationship between the measurement was determined through a correlation analysis. The reliability was assessed based on intraclass correlation coefficients. Results: The CL and widths of calcaneus (W1, W2, W3) had a good positive correlation (r=0.848 [W1/CL], r=0.738 [W2/CL], r=0.769 [W3/CL]; p<0.001). The mean CL and widths ratios were 0.33 (W1/CL), 0.37 (W2/CL), and 0.37 (W3/CL). Using these ratios to estimate the widths by multiplying each ratio by the measured calcaneal length, we found a difference between the estimated calcaneal widths and the actual measured calcaneal widths values was 0.25 mm, 0.43 mm, and 0.16 mm. All measurements showed good-to-excellent inter- and intraobserver reliability. Conclusion: This study analyzed the correlation and ratio between the length and width of the calcaneus. The results will help orthopedic surgeons fixate screws in a stable manner to prevent iatrogenic injuries to the medial neurovascular structures of the calcaneus.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.173-178
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• 2005

Propose: There have been many debates about the ideal surgical technique for acute Achilles tendon rupture. The purpose of this study is to review and analyze the clinical outcome of the acute Achilles tendon ruptures that had been repaired by indirect suture technique with minimal incision that utilized an instrument called Achillon (Newdeal, France). Materials and Methods: This study is based on the 14 cases (14 patients) of acute Achilles tendon total ruptures that have been repaired by minimal incision technique utilizing Achillon instrument from June 2003 to December 2004. Two cases were reruptured before 8 weeks and repaired again using Krackow suture which left 12 feet for postoperative functional evaluation with at least 6 months of follow-up. Ten cases were men and average age at time of injury was 34.4 (26-49) years. The time from injury to surgery was an average of 4.5 (1-9) days and the postoperative evaluations were done by an Arner-Lindholm scale and AOFAS score. The ability to return to original work and sports activities as well as patient satisfaction were also evaluated. Results: The follow-up period was averaged for 13.2 (6-24) months. Seventy-one percent of cases were ruptured during sports activities. The ruptured level was the average of 5.1 cm (3.2-8 cm) above calcaneal attachment and the skin incision was averaged for 2.7 cm (2.5-3.0 cm) long. At final follow-up, standing on tip-toe was possible in all cases while the heel-floor height on ruptured side was shorter by 0.7 cm (0-2 cm). By Arner-Lindholm evaluation scale, 9 cases were excellent, and 3 cases were good. Overall AOFAS score was an average of 96.1 (94-100), and all patients were satisfied with the result. Patients returned to work at an average of 1.3 months after the surgery and pre-injury sports activities were all possible from at 6 months after operation. Conclusion: Since we have treated acute Achilles tendon ruptures with minimal incision technique utilizing the Achillon and gained encouraging functional results with all patients returning to previous work with high patient satisfaction, this technique could be recommended as one of the ideal surgical options for the Achilles tendon ruptures.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.20-25
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• 2008

Purpose: The purpose of this study is comparison of radiological and clinical outcomes between proximal metatarsal osteotomy and distal chevron osteotomy for the correction of hallux valgus. Materials and Methods: In this retrospective study, we included subjects who underwent the correction of hallux valgus in our institution between March 2001 and August 2006, with a minimum follow-up of 12 months. The group of proximal metatarsal osteotomy was 23 patients (34 feet); the group of distal chevron osteotomy was 20 patients (26 feet). The group of proximal metatarsal osteotomy was composed of 26 severe cases (76.5%) and 8 moderate cases (23.5%); the group of distal chevron osteotomy was composed of 13 severe cases (50.0%) and 13 moderate cases (50.0%). Results: Compared to preoperative values, the hallux valgus angle, the first-second intermetatarsal angle and the distance of first-fifth metatarsal head were significantly decreased in two groups (p<0.05). In each parameter, the hallux valgus angle was decreased 66.3% (proximal metatarsal osteotomy) versus 49.6% (distal chevron osteotomy), which were significant (p=0.037). The first-second intermetatarsal angle and the distance of first-fifth metatarsal head were not significant. Mayo clinic forefoot scoring system (FFSS) score was significantly improved in two groups (p<0.05). The ratio of improvement was not significant (p=0.762). In severe group, hallux valgus angle and the first-second intermetatarsal angle was significantly decreased in proximal metatarsal osteotomy group compared to distal chevron osteotomy group (p<0.05), but the difference of the distance of first-fifth metatarsal head and FFSS score was not significant in both groups. In moderate group, the difference of all parameters was not significant in both groups. Conclusion: Although both proximal metatarsal osteotomy and distal chevron osteotomy showed satisfactory result in FFSS, proximal metatarsal osteotomy was more proper operative technique than distal chevron osteotomy in severe group, because of superiority of correction in radiological parameters.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.7-12
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• 2003

Purpose: To study the relationship of the 1st to 2nd intermetatarsal angle(1-2 IMA) between the intra-operative and weight bearing postoperative anterior-posterior(AP) radiography, and evaluate the intra-operative predictability for the postoperative 1-2 IMA after proximal metatarsal osteotomy(PMO) in the hallux valgus deformity. Materials and Methods: 20 cases of moderate to severe hallux valgus patients were included in this study. After the oblique PMO(Ludloff procedure) was performed and the osteotomy site was fixed temporarily, the AP view was taken intra-operatively. About 10 weeks after surgery, postoperative weight bearing AP view was taken. The pre -. intra -, and postoperative 1-2 IMAs were compared and ana lysed statistically. Results: The 1-2 IMAs of the weight bearing preoperative, non-weight bearing intra-operative and weight bearing postoperative AP view were $15.9^{\circ}{\pm}1.8^{\circ},\;4.7^{\circ}{\pm}2.1^{\circ}$, and $6.8^{\circ}{\pm}2.5^{\circ}$ (Mean${\pm}$SD) respectively. The postoperative 1-2 IMA was greater than intra-operative measurement by $2.1^{\circ}{\pm}1.8^{\circ}$ (range; $-1^{\circ}$ to $6^{\circ}$) which was stastistically significant(p<0.05). To get less than $9^{\circ}$ postoperatively as an average normal, intra-operative 1-2 IMA should be within $3.8^{\circ}$ to $5.2^{\circ}$ (95% confidence interval), and intra-operative 1-2 IMA should be within $3.4^{\circ}{\pm}$to $5.4^{\circ}$(95% confidence interval) to get more than $6^{\circ}$ difference between preoperative and postoperative 1-2 IMA, which is regarded as more than average correction by the distal metatarsal osteotomy. Conclusion: In hallux valgus surgery, it should be considered that intra-operative 1-2 IMA was less than the postoperative. To achieve postoperative 1-2 IMA less than $9^{\circ}$ and more than correction angle of $6^{\circ}$, it is suggested that the intra-operative 1-2 IMA should be measured less than about $5^{\circ}$.