• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.5-11
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• 1997

Multiple surgical procedures for the correction of hallux valgus have been described. The surgical algorithm is based on the degree of deformity, patient's age, and the presence or absence of arthritis. It is known that the role of an isolated distal soft-tissue procedure is limited and the procedure must be used in conjunction with the proximal metatarsal osteotomy to correct most hallux valgus. We reviewed retrospectively the clinical & radiological results of distal soft-tissue procedure with or without proximal metatarsal osteotomy, performed in 18 patients (29 cases ) who had mild to moderate degrees af hallux valgus deformity. The results were as follows : In 20 cases with isolated soft-tissue procedures, the preoperative hallux valgus angle (HV) averaged 30.6 degrees and the postoperative HV averaged 7.3 degrees. The preoperative intermetatarsal angle (IM) averaged 12.5 degrees and postoperative IM averaged 10.4 degrees. 2. In 9 cases with the proximal metatarsal osteotomy added, the preoperative HV averaged 32.5 degrees, and the postoperative HV averaged 8.0 degrees. The preoperative IM averaged 12.5 degrees, and postoperative IM averaged 10.1 degrees. 3. There was no significant difference of loss of correction, presence of complication, patients own satisfaction, between two groups. In conclusion, as for the patients with mild to moderate degrees of hallux valgus deformities, the clinical and radiological results following distal soft tissue procedure and proximal metatarsal osteotamy are not proved to be superior to those following isolated soft-tissue procedures.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.39-44
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• 2007

Purpose: The authors intended to analyze the operative results of moderate hallux valgus with proximal chevron metatarsal osteotomy and distal soft tissue procedure. Materials and Methods: Seventy feet of fifty-seven patients were followed for more than 1 year after the proximal chevron metatarsal osteotomy. The mean age was 47.2 years, and the mean follow up period was 2 years and 3 months. Clinically preoperative and postoperative AOFAS MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. Results: Additional Akin osteotomy was performed 48 out of 70 feet. Clinically AOFAS MP-IP scale was increased from 60.4 points preoperatively to 89.8 points postoperatively. Ninety-four percents of the patients were satisfied with the results. Radiologically hallux valgus angle was decreased from $34.8^{\circ}$ preoperatively to $12.8^{\circ}$ postoperatively. The intermetatarsal angle was decreased from $15.7^{\circ}$ preoperatively to $8.0^{\circ}$ postoperatively. Hallux valgus interphalangeal angle was increased from $7.4^{\circ}$ preoperatively to $9.8^{\circ}$ postoperatively. There were 3 recurrences, 1 hallux varus and 3 minor wound infections. There were no nonunion or malunion of the 1st metatarsal. Conclusion: Proximal chevron metatarsal osteotomy with distal soft tissue procedure and additional Akin osteotomy appears to be safe and satisfactory procedure.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.74-80
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• 2005

Purpose: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. Materials and Methods: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). Results: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). Conclusion: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.65-69
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• 2014

Purpose: Soft tissue reconstruction is essential for recovery of finger function and aesthetics in any traumatic defect. The authors applied a reverse homodigital artery island flap for soft tissue defect on distal part of digits. The aim of this study is to evaluate the efficacy of the procedure. Materials and Methods: Seven cases of soft tissue defects of finger tip were included in this study. There were six male and one female, mean age was 43 years and mean follow-up period was 38 months. The length of flaps ranged from 2.0 to 2.5 cm and width ranged from 1.0 to 2.0 cm. Flap survival, postoperative complications were evaluated. Results: All flaps survived without loss. Donor sites were repaired with primary closure in five cases and skin graft in two cases. None of the patients showed significant complications and their average finger motion was $255^{\circ}$ in total active motion at the last follow-up. Conclusion: The authors suggest that the reverse homodigital artery island flap could be a versatile treatment option for the soft tissue defect on distal part of digits.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.31-37
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• 2012

Purpose: The purpose of our study is the comparison of radiological and clinical outcomes between modified distal chevron osteotomy and proximal metatarsal osteotomy for the patients who had moderate to severe hallux valgus deformity. Materials and Methods: In this retrospective study, we included 54 patients (65 feets) who underwent the operation of moderate to severe hallux valgus in our hospital from May 2007 to August 2010. Our study compares two groups. For Group 1, a modified distal chevron osteotmy and a distal soft tissue procedure were done and for Group 2, a proximal metatarsal osteotmy and a distal soft tissue procedure were done. The group 1 were 29 feets; the group 2 were 36 feets, and the average follow up was 9 months. Results: The radiological results show that the hallux valgus angle and the first-second intermetatarsal angle were significantly decreased in two groups. In each parameter, the correction of the hallux valgus angle was $19.1^{\circ}$ (Group 1) and $24.3^{\circ}$ (Group 2), the correction of the first-second intermetatarsal angle was $9.6^{\circ}$ (Group 1) and $10.3^{\circ}$ (Group 2). Shortening of the first metatarsal length was 0.87 mm (Group 1) and 0.77 mm (Group 2). There are no significant clinical results (American Orthopaedic Foot and Ankle Society score, AOFAS score) in two groups. Conclusion: It is thought that a modified distal chevron osteotomy and a distal soft tissue procedure are a considerable operative treatment of moderate to severe hallux valgus deformity because of the similar cilinical results, more simple operative techniques, and less complications than a proximal metatarsal osteotomy.

• Journal of Korean Foot and Ankle Society
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• v.27 no.4
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• pp.123-130
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• 2023

Purpose: "Hallux valgus" is a common disease encountered in clinical practice and is accompanied by foot deformities. Conservative treatment is commonly used in the early stages of hallux valgus. On the other hand, surgical treatment often becomes necessary as the deformity progresses. Surgical treatments involve various osteotomy methods or joint fusion procedures combined with soft tissue release, and outcomes from these surgical treatments are generally favorable. This study compared two soft tissue release techniques in the hallux region. Materials and Methods: This study conducted a retrospective cohort study on 48 participants who underwent surgical treatment for hallux valgus at a single institution from March 1, 2018, to March 31, 2023. A scarf osteotomy was performed in all cases, and the "Modified Mcbride procedure" or "Trans-articular approach" was done for soft tissue release. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and the degree of subluxation of the lateral sesamoid were measured through simple foot radiographs taken before surgery and one year after surgery. Results: In the Modified Mcbride procedure group, HVA, IMA, and the sesamoid position grade decreased from 34.94° to 9.98°, 15.64° to 5.44°, and 2.47 to 0.44, respectively. In the trans-articular approach group, HVA, IMA, and the sesamoid position grade decreased from 33.42° to 7.34°, 15.06° to 6.03°, and 2.17 to 0.58, respectively. There was no significant difference in these changes between the preoperative and one-year postoperative measurements for both techniques (p-value>0.05). Conclusion: A radiological assessment of soft tissue release through the Modified Mcbride procedure and trans-articular approach in hallux valgus did not show significant differences. Therefore, both surgical techniques can be considered in the distal soft tissue release for a hallux valgus correction.

• Journal of Korean Foot and Ankle Society
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• v.24 no.4
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• pp.129-134
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• 2020

Purpose: This study compared the results of proximal and distal chevron osteotomy in patients with severe hallux valgus. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include severe hallux valgus. Materials and Methods: This study analyzed 127 severe hallux valgus surgeries. Of these, 76 patients (76 feet) were excluded for lack of adequate follow-up and additional procedures (Akin procedure), leaving 51 patients (51 feet) in the study. The mean age of the patients was 58 years (21~83 years), and the mean follow-up duration was 18 months (12~32 months). The patients were divided into two groups. Group 1 underwent distal chevron osteotomy, and group 2 underwent proximal chevron osteotomy performed sequentially by a single surgeon. The patients were interviewed for the American Orthopaedic Foot and Ankle Society (AOFAS) score before and one year after surgery. The anteroposterior weight-bearing radiography of the foot was taken before and one year after surgery. Results: There were no significant differences in pain and function after one year in either group. Both groups experienced significant pain reduction and an increase in the AOFAS score. Significant improvement of the hallux valgus and intermetatarsal angle corrections was observed in both groups, and the sesamoid position was similar in each group. More improvement in radiographic correction of intermetatarsal angle was noted in group 2. Both procedures gave similar good clinical and radiological outcomes. Conclusion: This study suggests that a distal chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting severe hallux valgus as a proximal chevron osteotomy with a distal soft-tissue procedure.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.96-102
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• 1997

The gracilis that is frequently used as a donor of free muscle trasfer is appropriate in the muscular shape and vascular position. This muscle is belonged to the second type of muscle group by the classification of the pattern of muscular nutrient vessel. The adductor branch or first perforating branch of deep femoral artery which supplies the proximal 1/3 of this muscle is a dominant one and this is used for the microscopic anastomosis of muscle or musculocutaneous flap. The minor vascular pedicles which enter the distal 1/3 of this of this muscle are branches of the superficial femoral artery and it is 0.5mm in diameter, 2cm in length with two venae comitantes. These minor pedicles supplies distal half of the gracilis muscle. This island musculocutaneous flap using distal vascular pedicle can be used to cover the defect of soft tissue around the distal femoral supra-condylar area, knee joint and proximal tibial condyle area which cause limitation of motion of knee joint, or in the cases that usual skin graft is impossible. The important operative procedure is as follows; The dissection is carried proximally and distally and the entire gracilis muscle including proximal and distal pedicle is completely dissected. After temporary blocking of the proximal vascular pedicle, the adequate muscle perfusion by the distal pedicle is identified and it is rotated to the recipient site around knee joint. The advantages of this procedure are simple, no need of microscopic vascular anastomoses and no significant functional loss of donor site. Especially in the cases of poor condition of the recipient vessel, this procedure can be used effectively. From 1991 to 1996, we performed 4 cases; complete survival of flap in 3 cases and partial survival of flap with partial necrosis in 1 case. This procedure is though to be useful in the small sized soft tissue defect of distal femoral supra-condylar area, knee joint and proximal tibial condylar area, especially in the defect of anterior aspect which expected to cause limitation of motion of knee joint due to scar contracture. But the problems of this procedure are the diameter of distal vascular pedicle is small and the location of distal vascular pedicle is not constant. To reduce the failure rate, identify the muscular perfusion of distal vascular pedicle after blocking the proximal pedicle, or strategic delay will be helpful.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.77-84
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• 2006

Purpose: We present clinical usefulness of saphenous neurocutaneous island flap for reconstruction of soft tissue defect of the lower leg, especially anteromedial aspect, including foot and ankle. Materials and Methods: Thirteen cases of soft tissue defects in the lower leg including foot and ankle which were 6 cases of pretibial area, 2 cases of anteromedial aspect of distal two third, 2 cases of ankle, and 3 cases of foot were treated saphenous neurocutaneous island flap. They were proximally based flap 3 cases and distally based flap 10 cases. Clinically the flaps ranged in size from $4{\times}5\;cm$ to $6{\times}12\;cm$. Results: All of the flaps except 1 case survived completely. Three cases, however, had marginal necrosis. One case of flap failure was proximal tibia fracture accompanied with injury of the flap pedicle which was difficult in flap elevation, subsequently. Conclusion: The saphenous neurocutaneous island flap is a simple, reliable procedure with a versatility for soft tissue coverage of the lower leg, especially anteomedial aspect, including foot and ankle. In case of another injuries accompanied near the saphenous nerve, careful attention should be made.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.115-118
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• 2003

Purpose: We are going to present a report from clinical and radiographic results of hallux valgus done only by soft-tissue procedure, when intermetatarsal joint is totally unfit under mild to moderate deformity. Materials and Methods: As a retrospective study, among all the patients who went under the surgery for hallux valgus, and of those who were possible to follow up,(excluding those whose intermetatarsal joint is fit) it was done over 28 cases (18 patients). the soft-tissue procedure was all done by Modified Mc Bride. Results: Hallux valgus angle and intermetatarsal angle each showed correction of $19.4^{\circ}$ and $5.2^{\circ}$, and from the final follow up, they were each decreased by $5.1^{\circ}$ and $1.5^{\circ}$. 21% (6case) were recurred, in one case, the intermetatarsal angle decreasing 120 and the other 5 case all decreased by $13^{\circ}$. Conclusion: when the intermetatarsal joint is unfit and there is no degenerative change, and, if the intermetatarsal angle is not large, moderate hallux valgus can show a good result, just by the distal soft-tissue procedure. a critical indication and a well through out preparation can reduce unneccessary surgeries.