• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.69-73
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• 2005

Purpose: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. Materials and Methods: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. Results: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. Conclusion: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.5-10
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• 2010

Purpose: This study was performed to compare the contact area between three different correcting angles after the proximal crescentic and Ludloff osteotomies of the first metatarsal. Materials and Methods: We used the two sawbone models. Proximal crescentic (PCO) and Ludloff osteotomies (LO) were performed and secured using K-wires under the correcting intermetatarsal angle (IMA) $5^{\circ}$, $10^{\circ}$, and $15^{\circ}$. Then each 6 osteotomized model was scanned five times and measured the contact area using the calculating program. We excluded the highest and lowest values. Results: The mean area of cutting surface was 189 $mm^2$ in PCO, 863 $mm^2$ in LO. The mean contact area (contact ratio; contact area $\times$100/area of cutting surface) of PCO was 149 $mm^2$ (79%) in $5^{\circ}$, 139.5 $mm^2$ (74%) in $10^{\circ}$, 107 $mm^2$ (57%) in $15^{\circ}$ IMA. The mean contact area (contact ratio) of LO was 711 $mm^2$ (82%) in $5^{\circ}$, 535.5 $mm^2$ (62%) in $10^{\circ}$, 330 $mm^2$ (38%) in $15^{\circ}$ IMA. Conclusion: A significant decrease in the contact area and contact ratio according to increase in correcting IMA was noticed in LO. We recommend the PCO rather than LO, when the IMA is needed to correct over $15^{\circ}$.

• 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.19 no.2
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• pp.51-57
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• 2015

Purpose: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. Materials and Methods: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. Results: The mean hallux valgus angle measured at preoperation was $37.7^{\circ}$ and $15.9^{\circ}$ at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were $15.2^{\circ}$ and $8.3^{\circ}$. The mean distal metatarsal articular angle changed from $12.6^{\circ}$ at preoperation to $7.8^{\circ}$ at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was $37^{\circ}$ and 13o, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. Conclusion: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under $37^{\circ}$ and distal metatarsal articular angle under $13^{\circ}$ can lead to good clinical results without recurrence.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.38-46
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• 2012

Purpose: This study was performed retrospectively to evaluate clinical outcomes of distal metatarsal osteotomy using bio-compression screw as the joint preservation method for advanced hallux rigidus. Materials and Methods: Eleven cases were followed up for more than 1 year after distal metatarsal dorsal wedge osteotomy for advanced hallux rigidus. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction score. The range of motion, and the period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were evaluated. As the radiographic evaluation, the interval of $1^{st}$ MTP (metatarsophalangeal) joint space and the period to union were measured. Results: The AOFAS hallux score had improved significantly from preoperative average 50.7 points to 87.6 points at the last follow-up (p=0.005). The subjective satisfaction score was average 90.6 points. There were no case of subsequent fusion or additional operation, and no complication associated with bio-compression screw. The period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were average of 24.8 weeks, 20.4 weeks, 16.8 weeks, 18.5 weeks respectively. Dorsiflexion of $1^{st}$ MTP joint had improved significantly from preoperative average $17.5^{\circ}$ to $44^{\circ}$ (p<0.001). All cases achieved union of osteotomy site, and the period to union was average 10.4 weeks. The interval of $1^{st}$ MTP joint space had improved significantly from preoperative average 1.2 mm to 3.5 mm (p=0.014). Conclusion: Distal metatarsal osteotomy using bio-compression screw seems to be one of effective treatment methods for advanced hallux rigidus, because of restoration of the first MTP joint motion, and reliable pain relief, and needlessness of hardware removal.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.234-237
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• 2006

Purpose: Authors analyzed and compared the treatment result of distal chevron osteotomy between with and without adductor tenotomy. Materials and Methods: 36 patients (60 feet) with a minimum follow-up of one year were involved in this retrospective study. The chevron osteotomy without adductor tenotomy was performed for 20 patients (30 feet) and chevron osteotomy with adductor tenotomy was done for 16 patients (30 feet). The first metatarsophalangeal (MTP) angle and angle between first and second metatarsal longitudinal axis (IM) was measured. The difference of these angles were measured pre-and postoperatively and compared using Student's T-test. Results: In the group of chevron osteotomy with adductor tenotomy, the mean first MTP angle corrected $29^{\circ}$ pre-operatively to $9^{\circ}$ and the mean first IM angle corrected $16^{\circ}$ pre-operatively to $12^{\circ}$. In the group of chevron osteotomy without adductor tenotomy the mean first MTP angle corrected $31^{\circ}$ pre-operatively to $11^{\circ}$ (P>0.05) and the mean first IM angle corrected $13^{\circ}$ pre-operatively to $11^{\circ}$ (P>0.05). Deep peroneal neuroma were found in 3 cases of chevron osteotomy with adductor tenotomy. Conclusions: Adductor tenotomy should be performed in selected patient with chevron osteotomy to prevent deep peroneal neuroma.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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• pp.121-125
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• 2004

Purpose: We try to retrospectively evaluated the amount of dorsal angulation angle of the first metatarsal commonly occurring as the complication of proximal dome osteotomy for hallux valgus. Materials and Methods: Between January 2004 and March 2004, 34 patients who underwent proximal dome osteotomy for moderate to severe hallux valgus. Two of 34 patients were male, and thirty-two were female. The average age was 57.6 years. We measured and compared hallux valgus angle, 1st-2nd intermetatarsal angle, dorsal angulation angle of 1st metatarsal on preoperative, postoperative, postoperative 3 weeks', postoperative 3 months' X-ray. Results: Osteotomy sites were completely united on plane X-ray in all cases. The hallux valgus angle averaged $41.2^{\circ}$ ($30{\sim}60^{\circ}$) at preoperative, $4.3^{\circ}$ ($-10{\sim}20^{\circ}$) at postoperative, $5.5^{\circ}$ ($-1{\sim}20^{\circ}$) at 3 weeks after operation, $7.8^{\circ}$ ($-2{\sim}20^{\circ}$) at 3 months after operation. The 1st-2nd intermetatarsal angle averaged $17.1^{\circ}$ ($12{\sim}24^{\circ}$) at preoperative, $6.3^{\circ}$ ($0{\sim}13^{\circ}$) at postoperative, $7.2^{\circ}$ ($0{\sim}15^{\circ}$) at 3 weeks after operation, $8.7^{\circ}$ ($0{\sim}18^{\circ}$) at 3 months after operation. The dorsal angulation angle averaged $0.4^{\circ}$ ($0{\sim}3^{\circ}$) at postoperative, $1.6^{\circ}$ ($0{\sim}7^{\circ}$) at 3 weeks after operation, $2.1^{\circ}$ ($0{\sim}8^{\circ}$) at 3 months after operation. There were no statistically correlation between increase of dorsal angulation angle of the distal segment of the first metatarsal and increase of hallux valgus angle or 1st-2nd intermetatarsal angle. Conclusion: Our results shows that the dorsal angulation of distal fragment occurring after the proximal dome osteotomy in the treatment of hallux valgus may be minimized with meticulous surgery and patient's education.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.238-241
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• 2006

Purpose: The purpose of this study was to figure out the appropriate and systemic insurance charge for the hallux valgus operations. Materials and Methods: 5 Hospitals for hallux valgus operations were analyzed how they have been charging the national health insurance corporation for their operation fees and how to use the estimated guide and authoritive interpretation through the guide book of health insurance medical treatment grant expense and the guide book of Health insurance medical treatment. Results: There are nothing for guiding principle of hallux valgus operations in both books but a guide of Mcbride operation which is approved 'JA-93-KA and JA-31' for operation fee. So majority of hospitals have charged operation fee depending on their own interpretations they like. According to the guide books, there was a authoritive interpretation that simultaneous operation of osteotomy and tendon transfer for cerebral palsy and flat foot can be eatimated as 'osteotomy+JA-93-NA'. Conclusion: Distal soft tissue procedure should be approved as 'JA-93-NAx100%+JA-31x50%' according to the the estimated guide and authoritive interpretation if transected adductor hllucis is transfered to first metatarsal head. So distal chevron osteotomy could be 'JA-30-1-RAx100%+JA-31x50%', proximal metatarsal osteotomy could be 'JA- 93-NAx100%+JA-31-50%+JA-30-1-RAx50%', first metatarsocuneiform joint arthrodesis could be 'JA-93-NAx100%+ JA-31x50%+JA-73-RAx50%'.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.15-20
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• 2002

Authors studied 24 cases in 18 patients with the hallux valgus deformity treated by Reverdin osteotomy at Department of Orthopaedic Surgery, Wallace Memorial Baptist Hospital from January 1995 to December 1999. Reverdin osteotomy is one of the distal metatarsal osteotomies in the treatment of hallux valgus in adults. We performed Reverdin osteotomy on 24 cases (18 patients) for painful hallux valgus associated with an increased hallux valgus angle (> 35degrees) and first-second intermetatarsal angle(>13 degrees). The results were as follows. 1. The average first-second intermetatarsal angle was 16.8 degrees and average valgus angle was 37.3 degrees, preoperatively. they were corrected to 7.8 degrees and 12 degrees respectively. 2. The metatarsalgia of the great toe was subsided in all cases and they were satisfied with the result of their operations in respect to cosmetically and functionally. Avascular necrosis of capital fragment, nonunion, and dorsal angulation were not developed in any case. But one case had superficial wound infection and delayed union, presumably due to secondary infection.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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• pp.157-165
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• 2003

Purpose: The purpose of this study was to the evaluate the clinical and radiographic results and complication of the Scarf osteotomy which is one of the surgical treatment of Hallux valgus. Material and Method: Fifty feet (30 patients) of moderate to severe hallux valgus deformity were operated by Scarf osteotomy procedure from January 2002 to July 2002. Patients were asked about their satisfaction in terms of pain, appearance and motion. The AOFAS clinical ratio scales and radiographic results for hallux valgus were evaluated. Result: The mean Hallux valgus angle improved from an average of 30.6 degrees to 9.0 degrees and the first intermetatarsal angle improved from an average 13.3 degrees to 5.2 degrees respectively. The preoperative mean AOFAS score was 58 points and on last follow up AOFAS score improved to 88 points. Complication which including troughing, nonunion, malunion was not developed. Conclusion: We found that Scarf osteotomy is a reliable operation for mild to moderate Hallux valgus deformity as regards firm fixation and early postoperative ambulation and large contact area for union.