• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.43-47
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• 2014

Hallux valgus is a lateral deviation of the first phalanx and medial deviation of the first metatarsal at the first metatarsophalangeal (MP) joint. Its incidence has increased due to developing footwear. The etiologies include fashion footwear, genetic causes, anatomical abnormality around the foot, rheumatoid arthritis, and neuromuscular disorders. Physiologic alignment of the first MP joint is maintained by congruent and symmetric alignment of the articular surface of the first proximal phalanx and first metatarsal head, physiologic relationship of the distal first metatarsal articular surface and the first metatarsal shaft axis, and stable balance of soft tissue around the first MP joint and stable tarsometatarsal joint. Several factors have been associated with hallux valgus, including pes planus, hypermobility of the first tarsometatarsal joint, flattened shape of the first metatarsal head, increased distal metatarsal articular angle, and deformation of the medial capsular integrity. History and physical examination are very important to diagnosis of hallux valgus. Simple radiography provides information on deformity, particularly in weight-bearing anteroposterior and lateral radiographs. Understanding the etiologies and pathophysiology is very important for success in treatment of patients with hallux valgus.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.143-148
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• 2019

Although many patients who undergo bunion repair do well and have satisfactory results, a critical evaluation of these results shows the potential for improvement. Metatarsal deformity of the hallux valgus is a 3-dimensional deformity, including rotation in the coronal plane. Theoretically, it is important to understand the 3-dimensional displacement of the first metatarsal for correcting the deformities of valgus rotation in the frontal plane. Yet the current methods of metatarsal osteotomy principally attempt to correct the deformity in the transverse plane. The modified technique for the Lapidus procedure can be used in a variety of hallux valgus conditions and severities, and the early results suggest that a powerful correction can be maintained. In addition, efforts have been made to correct the 3-dimensional deformity by performing metatarsal shaft osteotomy. In the case of degenerative arthritis, first metatarsophalangeal joint arthrodesis is a good option to correct the 3-dimensional deformation. Correction of the 3-dimensional deformity, including a rotational deformity in the frontal plane of the metatarsals, should be considered when selecting surgical treatment and is essential for achieving a good prognosis for patients with hallux valgus. This article reviews the classification and treatment of hallux valgus for correction of the 3-dimensional deformity.

• Journal of Acupuncture Research
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• v.26 no.6
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• pp.121-132
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• 2009

Objectives : To evaluate the current status of East-West combination treatment in joint disorders. Methods : The medical records of patients who visited the Joints & Rheumatism Center at the Kyung Hee East-West Neo Medical Center from April 2006 to June 2009 were evaluated. The general characteristics of patients who underwent combination treatment, trend in number of cross-system referrals, and disorders and involved body regions of patients referred to the Eastern medical hospital from the Western medical hospital were initially assessed. 6 major disorders were found from the initial scanning. The trend in number of cross-hospital referrals, number of visits to the Eastern medical hospital, current status of combination treatment, treatment modality, and reason for cross-system referral was evaluated. Results : 1. 1510 patients were referred from the Eastern medical hospital to the Western medical hospital, and 1065 patients were referred from the Western medical hospital to the Eastern medical hospital. First visit patients reached a peak at the second quarter of 2007 and fourth quarter of 2006 respectively, and have steadily decreased from then on. Referrals of female patients were twice as common as male patient referrals. Patients in their sixth or seventh decade of life were most commonly referred, and more outpatients were referred compared to inpatients. 2. Patients with knee joint disorders were most commonly referred from the Western medical hospital to the Eastern medical hospital, followed by hip, shoulder, ankle, wrist, and elbow joint disorders. The most common disorders for each of the above regions in referred patients were knee osteoarthritis, avascular necrosis of the hip, adhesive capsulitis, and ankle strain and sprain. The generalized disorders rheumatoid arthritis and ankylosing spondylitis followed. 3. Patients referred to the Eastern hospital received approximately 3 to 10 Eastern medical treatment sessions. 45 percent remained on constant combination treatment, and 98 percent of referred patients received acupuncture treatment. Conclusions : In regard to the number of patients and duration of combination treatment, combination treatment was successfully performed for knee osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, while it was not so for avascular necrosis of the hip, adhesive capsulitis, and ankle strain and sprain. Further research on this subject is required.

• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.30-37
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• 1997

Pilon fracture is an intraarticular fracture of distal tibia. It is high energy injury with significantly associated soft tissue damage, bone comminution, and articular surface disruption. Until recently, this treatment has followed the AO principles, Because the risk of complications outweighs potential benefits, the principle of a Pilon fracture treatment are changing. Newer techniques using articulated external fixation minimize disturbance of the soft tissue envelope and have decreased these complications. Series of 5 patients with Pilon fracture were treated by articulated external fixator and followed up more than 12 monthes at the Department of orthopaedic surgery, Kang Dong Sacred Heart Hospital, College of medicine, Hallym University. The results were as follows: 1. The type of fracture were type C2(3 cases),type C3(2 cases) according to AO-$M{\ddot{u}}ller$ classification. 2. The clinical results according to functional criteria by Mast and Teipner were good in 4 cases and poor in 1 case, which is an old fracture. 3. Techniques utilizing articulated external fixator were associated with satisfactory results and appeared to significantly decrease the incidence of soft tissue complication, post-traumatic arthritis, osteoporosis, and fibrosis of ankle joint.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.154-159
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• 2007

Purpose: The purpose of the present study is to evaluate the proximal metatarsal chevron osteotomy outcomes for moderate to severe hallux valgus more than seven year follow up. Materials and Methods: Between 1996 and 1998, hallux valgus 61 cases were evaluated. The follow up period was more than seven years. The clinical review analyzed by the hallux metatarsophalangeal-interphalangeal scale of the American Orthopedic Foot and Ankle Society, radiologic review by the hallux valgus angle, first and second intermetatarsal angle. Complication also evaluated. Results: Clinically, preoperative AOFAS score was average 43 points (range; $16{\sim}60$ points) which significantly improved to 88 points (range; $61{\sim}100$ points) at last follow up periods. Radiologically, the mean preoperative, postoperative, last follow up hallux valgus angle was $34^{\circ}$, $5.2^{\circ}$, $10.9^{\circ}$. The mean preoperative, postoperative, last follow up intermetatarsal angle was $15.3^{\circ}$, $3.3^{\circ}$, $5.3^{\circ}$. Postoperative angle change were no statistical significance (p>0.05). Complication were hallux varus 6 cases, metatarsophalangeal joint arthritis 2 cases, recurrence 1 case. Conclusion: Proximal metatarsal chevron osteotomy shows satisfactory outcome for moderate to severe hallux valgus more than seven year follow up.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.40-48
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• 1999

The neck of the talus is its most vulnerable and fragile segment, because of narrow diameter, devoid of hyaline padding and honeycombed internally by vascular channels etc. Talar neck fractures comprise 50% of all major to the talus. The majority occurs as a result of high-energy injuries, such as motor vehicle accidents or fall from a height. Anatomically, talar surface is covered mainly with articular cartilage and blood supply to the talus is very poor. So, complications, such as non-union, avascular necrosis and post traumatic arthritis, are frequent. The authors reviewed fourteen cases of talar neck fractures treated in our clinics from Jan. 1992 to Mar. 1997, and average follow-up period was over 15 months. The results obtained were as follows; 1. Patients' average age was 31.2 years. 2. The most common cause was traffic accident(9/14, 64%), and hyperdorsiflexion injury of the ankle was common mechanism of the fractures. 3. According to the modified Hawkins classification, type I was four cases, type II was nine cases, type III was one case and type IV was no case. 4. Hawkins sign of subcortical radiolucency was found in 64% (9/14) of the fractures. 5. Avascular necrosis was occurred in 21% (3/14) of the fractures(in two cases of type II fractures, and in one of type III). 6. According to the Hawkins criteria, four cases in type I, five in type II were an excellent result. Two cases, one in type II and one in type III were good result, and two in type II were fair. One in type II was poor result.

• Journal of Korean Foot and Ankle Society
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• v.17 no.2
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• pp.121-129
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• 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
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• v.1 no.2
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• pp.119-125
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• 1997

The fracture and fracture-dislocation of the neck of the talus (Hawkins' type I-IV) are uncommon injuries and represent only 0.12 to 0.32% of all fracures. Authors clinically evaluated in 12 cases Whom treated fracures of the neck of the talus, at department of orthopaedic surgery, Sun General Hospital, from 1990 to 1996, and the following results are obtained. 1. Of 12 cases, there were 11 males and 1 female, average age was 30 years. 2. Causes of fracture was fall down injury in 7 cases(58%), traffic accident in 4 cases(33%), direct trauma in 1 case(8%). 3. According to the classification by Hawkins' type I in 2 cases(17%), type II in 7cases (58%), type III in 3cases(25%). 4. Associated injuries were calcaneal fracture in 3 cases, fracture-dislocation of talus in 3 cases, subtalar dislocation in 3 cases, medial malleolar fracture in 5 cases, soft tissue injury in 3 cases, femur and tibia fracture in 1 case, and lumbar Spine compression fracture in 1 case. 5. Average time to operation after injury was 2.5 days. 6. In 2 cases were treated conservatively and 10 cases were treated open reduction and internal fixation with screw or K-wire. 7. Complications were avascular necrosis in 4 cases, post traumatic arthritis in 2 cases, skin necrosis in 4 cases, and then ankle fusion was done in 2 cases. 8. High rate of complication was seen in the talar neck fracture associated with calcaneal fracture. In the analysis of above results, evaluated by Hawkins' scoring system were excellent to fair in 75%.

• Journal of Korean Foot and Ankle Society
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• v.20 no.2
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• pp.67-72
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• 2016

Purpose: The purpose of this study was to assess the 2-year follow-up results of patients with a trimalleolar fracture, who had undergone an anterior incision cannulated screw fixation of the posterior malleolar fragment, which had more than 25% of articular involvement or had no cortical continuity with the distal tibia. Materials and Methods: Among 28 patients with a trimalleolar fracture who had undergone fixation of the posterior malleolar fragment between February 2005 and February 2010, 14 patients, who underwent an anterior incision cannulated screw fixation of posterior malleolar fragment and were followed-up for more than 2 years, were selected. The postoperative clinical and radiological findings immediately and at the 1- and 2-year follow-up were compared. The clinical findings were evaluated as American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological assessment was evaluated as the maintenance of reduction, period to bone union, and the presence of nonunion, malunion, and complications. Results: The clinical outcome by mean AOFAS score revealed 83.0 points in the group with preoperative displacement below 2 mm and 80.7 points in the group with preoperative displacement above 2 mm postoperatively. The mean AOFAS score was 91.7 and 93.1 points in the group with preoperative displacement below 2 mm on 1- and 2-year follow-up, respectively, and 89.8 and 91.7 points in group with the preoperative displacement above 2 mm on 1- and 2-year follow-up, respectively. After a 2-year follow-up among 14 cases selected for this study, 13 cases showed an excellent reduction state and only 1 case (7.1%) showed a displacement of more than 2 mm. No complication were encountered in the group with preoperative displacement below 2 mm. On the other hand, among 8 patients in the group with preoperative displacement above 2 mm, there were 3 with limitations of the range of motion of the ankle joint (37.5%) and 1 post-traumatic arthritis (12.5%) at the 2-year follow-up. Conclusion: Anterior incision cannulated screw fixation of the posterior malleolar fragment could be a valuable method for the treatment of trimalleolar fractures that provides satisfactory results.

• 대한관절경학회:학술대회논문집
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• 2009.10a
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• pp.93-98
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• 2009

족관절 고정술은 족관절에 발생한 심한 관절염(end-stage arthritis)에서 전통적으로 시행하던 술식으로 현재 사용되고 있는 인공 족관절 치환술이 발달되기 전까지는 gold standard 로 알려져 있었으며 현재에도 심한 족관절의 변형이나 파괴, 족관절 인공 관절의 실패시에 시행되고 있다. 1897년 Albert가 처음으로 족관절 고정술을 소개한 이후로 30여가지가 넘는 방법이 행해지고 있으나 개방적 관절 고정술의 단점인 수술 후 염증, 유합 지연, 연부조직의 손상에 의한 피부 괴사 등을 극복하고 유합물을 높이기 위해 다양한 내고정 및 외고정 장치를 사용하고 있다. 관절경 술식이 발달하면서 Schnider가 1983년 최초로 관절경을 이용한 족관절 고정술을 발표한 이후로 관절경하의 족관절 고정술은 개방적 족관절 고정술 보다 높은 유합율과 적은 수술 합병증으로 인해 관심의 대상이 되었지만 족관절의 변형이 심한 경우에는 시행하기 어려운 단점이 있는 것으로 알려져 왔다.