• Journal of Korean Foot and Ankle Society
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• v.4 no.2
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• pp.83-86
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• 2000

A vascular necrosis of the talus has frequently been reported following trauma because talus has no muscle insertions, sixty percent of the surface of the talus is covered by hyaline cartilage, takes only a small area for entrance of a blood supply. Osteonecrosis is also associated with a variety of nontraumatic disorders. There are many indications for steroid usage, patient with rheumatoid arthritis, systemic lupus erythematosus, chronic obstructive pulmonary disease, and status- post renal or cardiac transplantation may be on long- term steroid usage, osteonecrosis may develop. A vascular necrosis of the talus secondary to chronic steroid usage is an unusual case. Delay in detection of osteonecrosis may lead to fragmentation and collapse of the talar body. When pain on range of motion is present and conservative treatment have been exhausted, surgical treatment is indicated, that is, fusion of the ankle joint. However it is important that conservative treatment may prevent its various sequelae with early diagnosis because steroid - treated patients have a more operative risk and increased risk for postoperative infection. We report a rare case of corticosteroid induced avascular necrosis of talus after cardiac transplantation.

• Journal of the Ergonomics Society of Korea
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• v.27 no.3
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• pp.93-101
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• 2008

Wedged soles and rocker soles are widespread shoe designs used to prevent the disorders and reduce the pain of the lower extremity caused by arthritis or diabetic feet. In this study, the effect of a shoe with a laterally wedged sole and a rocker sole simultaneously was analyzed on the kinematics and kinetics of the ankle joint during normal walking. Eight male participants without a history of lower extremity disorders were recruited. Each participant performed twenty walking cycles for each of three walking conditions: bare foot, wearing normal shoes and wearing shoes with laterally wedged rocker soles. The differences between the three walking conditions were statistically investigated including spatio-temporal variables, angular displacements, joint moments and ground reaction forces. The results showed that the laterally wedged rocker sole decreased the sagittal variation of angular displacements as well as the frontal/sagittal average moment on the ankle joints compared to the flat sole. In addition, the rate of angular displacements and loading decreased during the heel contact phase.

• Journal of Korean Foot and Ankle Society
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• v.27 no.2
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• pp.75-78
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• 2023

During bone tumor resection, many cases require medial malleolar osteotomy to achieve adequate access to the operative field. Various osteotomy methods have been developed to address this issue, including oblique, transverse, reverse V-shape, and step-cut osteotomies. However, medial malleolar osteotomy has several drawbacks, such as the excessive disruption of the joint surface, unstable screw fixation when fixing the medial malleolus, and iatrogenic medial ankle joint arthritis due to articular displacement during the reduction of the osteotomy site. In addition, there is a possibility of injury to the posterior tibial artery, tibial nerve, or posterior tibialis tendon if the osteotomy range is too aggressive. Therefore, the authors propose a new osteotomy method, which has shown promising clinical results, namely, partial posterior medial malleolar osteotomy. This method minimizes articular involvement and provides adequate access to the operative field during talar body bone tumor resection.

• Journal of Korean Foot and Ankle Society
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• v.26 no.1
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• pp.9-15
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• 2022

Syndesmotic injuries are found frequently in clinical practice, and they remain controversial because of the variety of diagnostic techniques and management options. Bony avulsions or malleolar fractures are commonly associated with syndesmotic disruptions. Even unstable isolated syndesmosis injuries are associated with a latent or frank tibiofibular diastasis and should not be ignored in the early phase. A relevant instability of the syndesmosis with diastasis results from collateral ligaments tears and requires operative stabilization. The treatment involves an anatomic reduction of the distal tibiofibular articulations followed by stable fixation. Syndesmotic transfixation screws or suture button implants are being proposed as a means of fixation. Recently, suture button fixation has shown more favorable outcomes, but the outcomes can still be controversial. Syndesmotic malreduction can lead to hardware failure, adhesions, heterotopic ossification, tibiofibular synostosis, chronic instability, and posttraumatic arthritis. In particular, the correct diagnosis and evidence-based treatment options for unstable syndesmotic injury should be considered.

• Journal of Acupuncture Research
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• v.26 no.6
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• pp.51-65
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• 2009

Objectives : This study was built to investigate the effect of Trachelospermi Caulis herbal-acupuncture on the Collagen-induced arthritis(CIA) in rats. Methods : Arthritis was induced by intradermal injection of Bovine type II collagen solution into base of tail. Experimental group were divided into 5 groups ; Normal(N) group, Control(C) group, Trachelospermi Caulis high(TH) group, Trachelospermi Caulis low(TL) group, Saline(S) group(n=7 for each group). Normal group was had no management. Control group was injected with Bovine type II collagen solution and taken no treatment. Trachelospermi Caulis high group was injected with Bovine type II collagen solution and taken high-intensity(10mg/kg) herbal-acupuncture treatment on $ST_{36}$. Trachelospermi Caulis low group was injected with Bovine type II collagen solution and taken low-intensity(5mg/kg) herbal-acupuncture treatment on $ST_{36}$. Saline group was injected with Bovine type II collagen solution and taken saline injection on $ST_{36}$. Body weight, paw edema volume and ankle joint thickness were measured during experimental day. On the last experimental day, we analyzed WBC count, TNF-$\alpha$ & IL-$1{\beta}$ concentration, c-fos immunohistochemistry and NADPH-d histochemistry for evaluating the effect of Trachelospermi Caulis herbal-acupuncture. Results : The results were as follows ; 1. In the change of paw edema volume, TH group only has significant difference compared with C group. 2. In the change of ankle joint thickness, TH group only has significant difference compared with C group. 3. In WBC count of serum, TH, TL groups have significant decrease compared with C group. 4. In TNF-$\alpha$ concentration of effusion, TH, TL groups have significant decrease compared with C group. and TH group has significant decrease compared with TL group. 5. In IL-$1{\beta}$ concentration of effusion, TH, TL groups have significant decrease compared with C group. and TH group has significant decrease compared with TL group. 6. In c-fos positive neurons of S1S2(cortex) region, TH, TL, S groups have significant decrease compared with C group. 7. In NADPH-d positive neurons of CPu(caudate putamen) region, TH, TL groups have significant decrease compared with C group. 8. In NADPH-d positive neurons of Tfp(transverse fibers of pons) region, TH, TL, S groups have significant decrease compared with C group. and TH group has significant decrease compared with S group. Conclusions : According to above results, we hope that Trachelospermi Caulis herbal-acupuncture may have the effect that decreases progression and development of CIA. And it can be suggested that Trachelospermi Caulis herbal-acupuncture may reduce the expression of c-fos and NOS.

• Journal of Korean Foot and Ankle Society
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• v.24 no.2
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• pp.81-86
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• 2020

Purpose: Ankle fractures with dislocations and pilon fractures at the distal tibia are usually associated with soft tissue damage caused by high-energy damage. Recently, a two-stage operation to perform internal fixation after the application of external fixation devices for stabilizing soft tissues has been accepted as the treatment of choice. This paper reports the clinical result of these injuries treated with threaded trans-calcaneal pin external fixation devices. Materials and Methods: Thirty-three patients diagnosed with ankle fractures with dislocations or tibial pilon fractures without open wounds. They underwent surgical treatment with threaded trans-calcaneal pin external fixation from January 2008 to February were enrolled in this study. This study evaluated the visual analogue scale (VAS), foot function index (FFI), and Olerud & Molander score as well as whether complications occurred. Results: The average VAS showed a meaningful decrease (p<0.001) from 7.4 before surgery to 2.6 after application of the external fixation device, and 1.4 at 12 months after surgery. The FFI also decreased significantly from 84.3 preoperatively to 20.3 at 12 months postoperatively (p<0.001). The Olerud & Molander score averaged 71.4 points, showing good clinical results. Complete bone union was observed in all patients. One patient each underwent debridement due to wound necrosis and infection in the pin insertion site. At the final follow-up, seven patients had posttraumatic ankle joint arthritis, according to a radiological examination. Conclusion: Manual reduction and external fixation using a threaded trans-calcaneal pin is a suitable surgical technique that is easy to perform and shows good clinical outcomes in stabilizing soft tissue damage in fractures and dislocations of ankle fracture or tibia pilon fractures in foot and ankle injury.

• Journal of Acupuncture Research
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• v.26 no.6
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• pp.91-100
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• 2009

Objectives : The objective of this study is to investigate Anti-nociceptive and anti-inflammatory effects of Clematidis Radix (CR) herbal-acupuncture on the test rats with induced acute pain. Methods : The effects of Clematidis Radix (CR)-distillates were investigated in three types of models with three different pain. Highly purified distillate of CR called CR herbal-acupuncture was injected to Zusanli ($ST_{36}$) acupoint. In the tail flick test, the CR herbal-acupuncture treatment did not show a significant effect of relieving acute pain. To investigate the anti-inflammatory effect of CR herbal-acupuncture, the second testing model'pain was induced by injecting formalin to its planter. For the last model, carrageenan was injected into tarsal joint. the medicinal effect of CR herbal-acupuncture was evaluated through the behavioral analyses such as licking time, weight distribution ratio and ankle circumference. Results : In the formalin test, the analgesic effect of CR herbal-acupuncture was more pronounced in the late phase (for 20 min after the early phase) than in the early phase (for the first 10 min post formalin injection). It was proven by weight distribution ratio testing and ankle edema testing that herbal-acupuncture of CR inhibited arthritis caused by the carrageenan. Conclusions : These results revealed that CR herbal-acupuncture was effective to alleviate the inflammatory pain and could be used as an analgesic treatment with an anti-inflammatory effect.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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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.

• Journal of Korean Foot and Ankle Society
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• v.5 no.2
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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.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.168-173
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• 2008

Purpose: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular joint depression type fracture of calcaneus. Materials and Methods: Thirteen cases with intra-articular joint depression type fracture of calcaneus, from September 2004 to March 2006, were reviewed. There were 9 males and 4 females with 52.5 years old mean age (range: $31{\sim}74$ years old). The average follow-up period was 18 months (range: $8{\sim}32$ months). Steinmann pins and Freers were used for closed reduction. After closed reduction, Acutrak screws and K-wires were inserted. The patients were evaluated with Creighton-Nebraska health foundation assessment sheet for calcaneal fracture, the extent of recovery of Bohler angle, fragment size, and state of subtalar joint. Results: Clinical results according to Creighton-Nebraska health foundation assessment sheet for calcaneal fracture were excellent in 6 cases (46%), good in 4 cases (30%), fair in 2 cases (15%), and poor in 1 case (7%). Average preoperative Bohler angle was $7.6^{\circ}$ (range: $2^{\circ}{\sim}13^{\circ}$). Average postoperative Bohler angle was $24.4^{\circ}$ (range: $4^{\circ}{\sim}33^{\circ}$). There were no soft tissue complications. There were one mild subtalar arthritis and one moderate subtalar arthritis. Conclusion: We think that closed reduction and percutaneous Acutrak screw fixation with or without K-wire is a good option for joint depression type fracture of calcaneus.