• Investigative Magnetic Resonance Imaging
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• v.12 no.2
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• pp.148-152
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• 2008

Purpose : To find the MR findings and evaluate the usefulness of MR in flexor hallucis longus(FHL) dysfunction. Materials and Methods : From 1992 to 2003, fourty patients were found to have surgically confirmed FHL dysfunction. 24 cases of 22 patients who had performed MR were included in this study. We analyzed the signal intensity of FHL tendon and muscle, tendon sheath, sheath effusion, and bone lesions, retrospectively. Results : Non-specific, increased sheath effusion of FHL tendon was seen in 12 cases (50%). Large amount of sheath effusion(grade 3) was observed in 5 cases (21%). The signal intensity of FHL tendon was normal in all cases. High signal intensity at the FHL muscle, proximal to musculotendinous junction was seen in 1 case (4%). One case (4%) of marrow edema of the talus and another one case (4%) of osteochondritis dissecans of the talus was seen. Conclusion : Non-specific, increased sheath effusion of FHL tendon was observed on MR in FHL dysfunction patients. Therefore, MR has a limited role in diagnosis of FHL dysfunction and is useful to exclude other bone and tendon diseases causing medial ankle pain.

• Journal of Korean Foot and Ankle Society
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• v.15 no.2
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• pp.86-91
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• 2011

Purpose: To evaluate the effectiveness as well as correct the post-traumatic severe ankle equinus deformity by conducting the treatment surgery, which is divided into 2 stages, soft tissue adhesiolysis and ankle arthrodesis. Materials and Methods: We have conducted the methods, which are Z-plasty Achilles tendon lengthening, multiple capsulotomy and tendon lengthening (flexor hallucis longus muscle, flexor digitorum longus, posterior tibialis tendon) for 10 patients who has shown equinus deformity after post-traumatic compartment syndrome due to the injury. The average age of patients was 33.7 year-old; there were 8 men and 2 women, and the follow up period was 13 months (6~31 mon). Outcomes were rated based on American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Visual Analogue Scale (VAS) and patient's satisfaction after operation. Results: The average degree of preoperative equinus deformity was 64 degree (-60~-70), and we've obtained AOFAS anklehindfoot score that was evaluated after 4 months of 2nd operation which was 76.7 score on average. We've also checked the decreased pain score from all of the patients according to the fact that the average VAS before the surgery was 6 (4~8), but it reduced to 3 (1~4). The patient's satisfaction showed generally great satisfactions which was 5 cases were excellent, 2 cases were good, and 3 cases were fair. Conclusion: The two staged surgical treatment of post -traumatic severe ankle equinus deformity, which was conducted of soft tissue adhesiolysis and arthrodesis, could be one of the effective methods to improve patients walking ability.

• The Journal of Korean Medicine
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• v.32 no.3
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• pp.1-9
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• 2011

Objectives: This study was carried out to observe the foot gworeum meridian muscle from a viewpoint of human anatomy on the assumption that the meridian muscle system is basically matched to the meridian vessel system as a part of the meridian system, and further to support the accurate application of acupuncture in clinical practice. Methods: Meridian points corresponding to the foot gworeum meridian muscle at the body surface were labeled with latex, being based on Korean standard acupuncture point locations. In order to expose components related to the foot gworeum meridian muscle, the cadaver was then dissected, being respectively divided into superficial, middle, and deep layers while entering more deeply. Results: Anatomical components related to the foot gworeum meridian muscle in human are composed of muscles, fascia, ligament, nerves, etc. The anatomical components of the foot gworeum meridian muscle in cadaver are as follows: 1. Muscle: Dorsal pedis fascia, crural fascia, flexor digitorum (digit.) longus muscle (m.), soleus m., sartorius m., adductor longus m., and external abdominal oblique m. aponeurosis at the superficial layer, dorsal interosseous m. tendon (tend.), extensor (ext.) hallucis brevis m. tend., ext. hallucis longus m. tend., tibialis anterior m. tend., flexor digit. longus m., and internal abdominal oblique m. at the middle layer, and finally posterior tibialis m., gracilis m. tend., semitendinosus m. tend., semimembranosus m. tend., gastrocnemius m., adductor magnus m. tend., vastus medialis m., adductor brevis m., and intercostal m. at the deep layer. 2. Nerve: Dorsal digital branch (br.) of the deep peroneal nerve (n.), dorsal br. of the proper plantar digital n., medial br. of the deep peroneal n., saphenous n., infrapatellar br. of the saphenous n., cutaneous (cut.) br. of the obturator n., femoral br. of the genitofemoral n., anterior (ant.) cut. br. of the femoral n., ant. cut. br. of the iliohypogastric n., lateral cut. br. of the intercostal n. (T11), and lateral cut. br. of the intercostal n. (T6) at the superficial layer, saphenous n., ant. division of the obturator n., post. division of the obturator n., obturator n., ant. cut. br. of the intercostal n. (T11), and ant. cut. br. of the intercostal n. (T6) at the middle layer, and finally tibialis n. and articular br. of tibial n. at the deep layer. Conclusion: The meridian muscle system seemed to be closely matched to the meridian vessel system as a part of the meridian system. This study shows comparative differences from established studies on anatomical components related to the foot gworeum meridian muscle, and also from the methodical aspect of the analytic process. In addition, the human foot gworeum meridian muscle is composed of the proper muscles, and also may include the relevant nerves, but it is as questionable as ever, and we can guess that there are somewhat conceptual differences between terms (that is, nerves which control muscles in the foot gworeum meridian muscle and those which pass nearby) in human anatomy.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.138-141
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• 2009

Purpose: Regardless of potential and actual complications, the sesamoidectomy either tibial side or fibular side or both, had been used as a surgical option for various pathologic conditions. The objective of this cadaveric study was to identify the changes of range of motion of great toe after sesamoidectomy. Material and Methods: Eight fresh cadaver legs were used. The angular changes of the hallucal articulations were measured by traction of the flexor hallucis longus tendon at the proximal border of fibro-osseous tarsal tunnel and by traction of the extensor hallucis longus tendon at the superior border of inferior extensor retinaculum. The measurement started at neutral position and proceeded to the maximum for respective tendons. After sesamoidectomy either partial or total, same procedures were repeated and the angular changes were measured. Results: In flexion of great toe, there were significant metatarsophalangeal angular differences at 1 cm traction in total sesamoidectomy and lateral sesamoidectomy. In extension of great toe, there were significant metatarsophalangeal angular differences at more than 2 cm traction in total sesamoidectomy. In other measurements, there were no significant angular changes of the hallucal articulations. Conclusion: The sesamoidectomy resulted in change of motion of great toe. Statistical analysis showed that the significant increases in the initial flexion and maximal extension occurred with total sesamoidectomy and the significant increase in the initial flexion occurred with lateral sesamoidectomy.

• The Korean Journal of Pain
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• v.26 no.2
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• pp.173-176
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• 2013

The hallucal interphalangeal sesamoid bone is usually asymptomatic, but it is not uncommon for it to be symptomatic in cases of undue pressure, overuse, or trauma. Even in symptomatic cases, however, patients often suffer for extended periods due to misdiagnosis, resulting in depression and anxiety that can steadily worsen to the extent that symptoms are sometimes mistaken for a somatoform disorder. Dynamic ultrasound-guided evaluations can be an effective means of detecting symptomatic sesamoid bones, and a simple injection of a small dose of local anesthetics mixed with steroids is an easily performed and effective treatment option in cases, for example, of tenosynovitis.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.109-114
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• 2010

Purpose: The purpose of this study was to report the surgical outcome of reconstruction of neglected chronic Achilles tendon ruptures with various methods including Achilles tendon allograft. Materials and Methods: Between October 2003 and November 2008, 8 consecutive neglected chronic Achilles tendon ruptures with the defect gap of more than 4 cm underwent surgical reconstruction including V-Y advancement, gastrocnemius fascial turn-down flap, flexor hallucis longus transfer and Achilles tendon allograft. There were 7 males and 1 female who were evaluated at more than 18 months after surgery. At the time of followup, all patients were assessed with regard to postoperative complications, their self-reported level of satisfaction, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, 10 repetitive single heel rise, single leg hopping test, and ankle range of motion. Results: The AOFAS score increased from average 71.4 (50-87) to 96.4 (86-100). All patients were able to perform 10-repetitive single heel raise and single leg hopping at the latest follow up. No patient experienced wound complications and deep infection. Six patients were rated as 'excellent' and the other two as 'good'. Conclusion: Neglected chronic Achilles tendon ruptures could be successfully treated with careful selection of the reconstruction method according to the amount of defect gap. With an extensive defect, Achilles tendon allograft can be a good option when the reconstruction is not feasible otherwise.