• Journal of radiological science and technology
• /
• v.42 no.3
• /
• pp.167-173
• /
• 2019

The Cobey method and the modified Cobey method are most commonly used in clinical practice. Therefore, the purpose of this study was to investigate the radiological differences between Cobey and modified Cobey and provide radiographic information about changes of hindfoot image with X-ray entrance center and tube angle change in modified Cobey. This study was performed on foot and ankle phantom. First, for image comparison of Cobey and modified Cobey, the images obtained by applying the same X-ray entrance center to the ankle joint were compared and analyzed. Second, in the modified Cobey, the X-ray entrance center is set as ankle joint and lateral malleolus. The X-ray tube angle was varied from $10^{\circ}$ to $40^{\circ}$ at $5^{\circ}$ intervals for each X-ray entrance center. The images obtained by varying the X-ray tube angle from $10^{\circ}$ to $40^{\circ}$ at intervals of $5^{\circ}$ for each X-ray entrance center were compared and analyzed. The irradiation conditions were the same with 110 kVp, 200 mA, 10 ms, and 110 cm of source - image receptor distance (SID). Image evaluation was performed by two radiologists. Measurements were made on the lateral point, middle point, and calcaneus width based on a hypothetical line parallel to the calcaneal tuberosity. Data were analyzed by using descriptive statistics as the mean of the distance to each measurement location. The modified Cobey was longer than the Cobey by an average of 3 to 4 mm lateral and medial points, and the calcaneus width was similar (ICC = 0.939). In modified Cobey method, when the X-ray entrance center is ankle joint, the lateral point is about 3 mm and the medial point is about 4.3 mm longer than lateral malleolus. Also, when the X-ray tube angle is more than $20^{\circ}$, the degree of distortion is large. The ICCs for the lateral, medial point, and calcaneus width were 0.998, 0.961, and 0.997, respectively, as the X-ray entrance center and tube angle were changed. There was no significant difference between Modified Cobey and Cobey. Modified Cobey showed no need to compensate the $20^{\circ}$ detector angle of the Cobey. In addition, we suggest that tube angle should be limited within $20^{\circ}$ when modified Cobey is performed.

• Journal of Korean Foot and Ankle Society
• /
• v.20 no.1
• /
• pp.23-26
• /
• 2016

Purpose: Nerve conduction study (NCS) test is a standard diagnostic study of the tarsal tunnel syndrome. The purpose of this study was to determine the relation between the results of the NCS and postoperative clinical results. Materials and Methods: From June 2004 to July 2015, 104 patients were diagnosed with tarsal tunnel syndrome and treated surgically. Of 104 patients diagnosed through NCS preoperatively and postoperatively, 41 patients were included in this study. There were 23 male and 18 female patients with mean age of 49.2 years old and the average follow-up period was 15.5 months. NCS, pain visual analogue scale (VAS) score, and subjective satisfaction were examined preoperatively and postoperatively. Results: On the preoperative NCS, 32 patients (78.0%) were positive and 9 patients (22.0%) were negative, and 32 positive NCS patients consisted of 9 positive (28.1%), 16 improved (50.0%), and 7 negative (21.9%) postoperatively. VAS score was 7.4 preoperatively and 4.4 postoperatively. According to satisfaction, there were 8 excellent (19.5%), 21 good (51.2%), 6 fair (14.6%), and 6 poor (14.6%) patients. For 32 patients who were positive on the preoperative NCS, the postoperative VAS score was 4.87 and there were 7 excellent (21.9%), 16 good (50.0%), 4 fair (12.5%), and 5 poor (15.6%) patients. Sixteen patients were negative on the postoperative NCS, with a VAS score of 3.75, 1 excellent (6.3%), 11 good (68.8%), 2 fair (12.5%), and 2 poor (12.5%). There was no statistical correlation between the preoperative NCS and postoperative VAS score (p=0.10), between preoperative NCS and postoperative satisfaction (p=0.799), between preoperative NCS and postoperative VAS score (p=0.487), and between postoperative NCS and postoperative satisfaction (p=0.251). Conclusion: For patients diagnosed with tarsal tunnel syndrome and treated surgically, NCS showed little correlation with postoperative result.

• Journal of Korean Foot and Ankle Society
• /
• v.10 no.2
• /
• pp.117-124
• /
• 2006

Purpose: This study was aimed at elucidating the pathogenesis of talar osteochondral lesion by analyzing the histopathological findings. Materials and Methods: Twenty specimens from 20 patients who underwent surgical treatment for talus osteochondral lesions were studied. Preoperative MRI images including T1, T2, and stir images were taken and cases were classified according to modification of the Anderson's classification. There were 5 cases of MRI group 1, 6 cases of group 2, 7 cases of group 3 and 2 cases of group 4. A full thickness osteochondral plug including the osteochondral lesion of the talus was harvested from each patient and reviewed histopathologic changes of osteochondral fragment using H-E staining. Mean diameter of specimens was 8.5 mm and mean depth was 10.3 mm. Pathologic changes of articular cartilage and subchondral bone were observed. Subchondral bone was divided into superficial, middle and deep zones according to depth. Cartilage formation, trabecular thickening and marrow fibrosis were observed in each zone. Results: There were detachment of the joint cartilage at the tidemark in 16 cases of 20 cases and the separated cartilages were almost necrotic on the histopathologic findings. Cartilage formation within subchondral bone was discovered beneath the tidemark in 12 cases. Trabeculae were increased and thickened in 17 cases. These pathologic changes were similar to fracture healing process and these findings were more conspicuous near the tidemark and showed transition to normal bone marrow tissue with depth. No correlation between the pathological progression and MRI stages was found. A large cyst shown on MRI's was microscopically turned out to be multiple micro-cysts accompanied by fibrovascular structure and newly formed cartilage tissue. Conclusion: The histopathologic findings of osteochondral lesions are detachment of overlying cartilage at the tidemark and subsequent changes of subchondral bone. Subchondral bone changes are summarized as cartilage formation, marrow fibrosis and trabecular thickening that mean healing process following repeated micro fractures of trabecular. These osteochondral lesions should have differed from osteochondral fractures.

• Journal of Korean Foot and Ankle Society
• /
• v.26 no.3
• /
• pp.123-129
• /
• 2022

Purpose: To evaluate the correlation between the fibrillar pattern of the Achilles tendon on ultrasonography (US) and functional outcomes in patients who underwent open tendon repair after Achilles tendon rupture. Materials and Methods: Data of 44 patients who had been subjected to US at least 6 months after repair, during the period between July 2012 and July 2019 were reviewed. Those with bilateral tendon rupture, re-rupture, open injury, and chronic or insertional rupture, were excluded from the review. We divided them into two groups, the homogenous group (HoP) and the heterogenous group (HeP) based on the fibrillar pattern on US. We also divided the HoP into linear and wavy subgroups, and the HeP into no hypoechoic lesion and hypoechoic lesion subgroups. The rupture type of the Achilles tendon, radiographic factors including US and magnetic resonance images, patient-related, surgical factors, and clinical results at the last visit after repair were assessed retrospectively. Results: The tendon thickness was 11.4±1.7 mm in the HoP, and 14.5±3.0 mm in the HeP (p<0.001). A shredded pattern was observed in 17 cases (65.4%) in the HoP, and in 17 cases (94.4%) in the HeP (p=0.031). The mean value of the number of sutures used was 8.9±3.05 in the HoP and 11.39±1.75 in the HeP (p=0.001). The mean value of the difference in calf circumference was 0.9±0.67 cm in the HoP and 1.36±0.71 cm in the HeP (p=0.037). There were no statistically significant differences in the fibrillar patterns and patient-related factors. Conclusion: The fibrillar pattern observed after repair was correlated with the functional outcome and showed a significant relationship with the rupture pattern and the number of sutures used. Therefore, we suggest a careful individualized postoperative rehabilitation protocol to maximize functional outcomes by referring to the fibrillar pattern in US, especially in shredded ruptures.

• Journal of Korean Foot and Ankle Society
• /
• v.19 no.3
• /
• pp.102-106
• /
• 2015

Purpose: We wanted to compare the results between cadaveric and radiological measurements of calcaneus. Materials and Methods: Sixty three calcaneus of 33 cadavers donated between December 2012 and December 2014 were actually measured. Computed tomography (CT) images of 244 calcaneus in 122 patients of the same age group with cadavers were radiologically measured. Maximum length, maximum width, maximum height, $B{\ddot{o}}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were measured. Results: In cadaveric measurement, the mean maximal height, length, and width were $41.8{\pm}3.3mm$, $73.3{\pm}3.4mm$, and $40.7{\pm}2.2mm$, respectively. In radiological measurement, the mean maximal height, length, and width were $38.5{\pm}4.3mm$, $74.0{\pm}5.7mm$, and $44.7{\pm}1.4mm$, respectively. In cadaveric measurement, the mean $B\ddot{o}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were $32.1^{\circ}{\pm}6.2^{\circ}$, $110.8^{\circ}{\pm}8.1^{\circ}$, $55.8^{\circ}{\pm}6.8^{\circ}$, and $59.7^{\circ}{\pm}4.6^{\circ}$, respectively. In radiological measurement the mean $B{\ddot{o}}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were $32.6^{\circ}{\pm}3.8^{\circ}$, $113.7^{\circ}{\pm}5.7^{\circ}$, $62.2^{\circ}{\pm}3.9^{\circ}$, and $61.6^{\circ}{\pm}6.3^{\circ}$, respectively. The mean maximal height was significantly higher in the cadaveric measurement group (p<0.001) and the mean maximal length and width were significantly higher in the radiologic measurement group (p<0.001, p<0.001). The mean Gissane angle, Fowler-Philip angle, and $B{\ddot{o}}hler$ angle were significantly higher in the CT group (p=0.001, p<0.001, p=0.016, respectively). There was no significant difference in the mean tala-articular angle (p=0.352). Conclusion: Significant differences in length parameters were observed between the cadaveric measurement group and the radiologic measurement group. However, no significant differences in angular measurements were observed between the two groups. The authors carefully conclude that radiological measurement values may be different from actual values in the calcaneus.

• Journal of Korean Foot and Ankle Society
• /
• v.12 no.2
• /
• pp.197-202
• /
• 2008

Purpose: Haglund's disease represents a painful heel caused by mechanically induced inflammation of the retrocalcaneal bursa and insertional Achilles tendinosis may coexist. Traditional open surgery can cause complications such as skin breakdown, painful scar and altered sensation around the heel. Endoscopic treatment offers the advantages that are related to minimally invasive procedure and we evaluate the clinical results and operative techniques of endoscopic decompression of retrocalcaneal space for Haglund's disease. Materials and Methods: Our retrospective study included seven heels in six consecutive patients for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-one years (range, 28 to 53 years). All of the patients had typical complaints of inflammation of the retrocalcaneal bursa and Fowler-Philip angle of more than $75^{\circ}$ and positive parallel pitch lines were present on the lateral calcaneal radiograph. The endoscopic procedure consists of the resection of inflamed retrocalcaneal bursa and enough bone to prevent impingement of the bursa between the calcaneus and Achilles tendon. All patients were evaluated with radiologic angle, visual analogue scale (VAS) for pain and Ogilvie-Harris functional score. The mean follow-up was 18 months (range, 15 to 21 months). Results: The mean operation time was 61 minutes (range, 50 to 85 minutes). VAS for pain and Fowler-Philip angle were decreased from preoperative 8.7 and $82^{\circ}$ to postoperative 2.3 and $57^{\circ}$, respectively. One patient with ankylosing spondylitis had a fair result, 2 patients had good results and the remaining 3 patients had excellent results according to Ogilvie-Harris functional score. There were no surgical complications such as infection, Achilles tendon avulsion or abnormal heel sensation. Conclusion: The endoscopic decompression for Haglund's disease was demonstrated to have several advantages including low morbidity, allowance of functional rehabilitation, short recovery time and quick sports resumption. However a comparative study is needed to determine the value of endoscopic decompression and particular caution should be exerted for the enthesiopathy.

• Journal of Korean Foot and Ankle Society
• /
• v.8 no.1
• /
• pp.22-25
• /
• 2004

Purpose: The heel fat pad has a unique structure that is important for its shock absorbing function. Loss of elasticity and change in the thickness of the heel pad have been suggested as cause of heel pain. The present study shows the relationship between the thickness of heel fat pad and age, sex, obesity and plantar heel pain. Materials and Methods: A study of heel pad thickness using plain lateral radiographs, unloaded by body weight, was carried out on 66 patients with plantar heel pain and 326 normal subjects. The population was divided into two or three groups according to their age, sex, body mass index, and the presence of symptom. We evaluated the differences in heel pad thickness between groups, and the relationship between BMI and Sex and Age was also determined, using statistically analytic method by SPSS version 10.1 program. Results: Heel pad thickness was greater in the subject over 40 years old (p<0.001), and in the overweight (p<0.001), and male heel pad was thicker than female (p<0.001). But there was no statistically significant difference for heel pad thickness between normal subject and plantar heel pain group. Conclusion: In this study, we found that there is a relationship between heel pad thickness and age, sex, and obesity. But we could not show that the difference of heel pad thickness is contributing factor to plantar heel pain. Although it could not be proved statistically, we believe that a change of heel pad thickness play a role in the development of heel pain. So we are planning to assess a relationship of heel pad elasticity and thickness and plantar heel pain again with prospective study method on the basis of the results of this study.

• Journal of Korean Foot and Ankle Society
• /
• v.12 no.1
• /
• pp.26-30
• /
• 2008

Purpose: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. Results: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was $3.21{\pm}1.7$ and group B $1.76{\pm}1.0$. Preoperative mean AOFAS score of group A was $45.61{\pm}8.3$, group B $44.41{\pm}8.9$, the final mean score of group A was $88.87{\pm}8.3$ and group B $92.47{\pm}4.4$. Preoperative mean HVA was $30.82{\pm}6.6$ degrees in group A and $32.88{\pm}14.5$ degrees in group B, the final mean angle of group A was $14.89{\pm}8.3$ degrees and group B $17{\pm}4.4$ degrees. The preoperative mean IMA of group A was $13.69{\pm}3.6 $degrees and group B $12.35{\pm}5.2$, the final mean angle of group A was $9.26{\pm}3.6$ degrees and group B $12.35{\pm}5.8$ degrees. Conclusion: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.

• Journal of Korean Foot and Ankle Society
• /
• v.12 no.1
• /
• pp.93-99
• /
• 2008

Purpose: To evaluate the result of the early exercise and rehabilitation after limited posterior operative treatment of the calcaneal fractures. Materials and Methods: Between May 2005 and December 2007, 43 cases with intraarticular calcaneal fractures were treated by open reduction with K-wires and Steinmann pins. Mean age and mean follow-up period were 42.5 years old and 15 months. All patients were treated with the same postoperative protocol, the early exercise of subtalar joint without short leg splint and cast was began after postoperative 1 day, non-weight bearing crutch ambulation did after 2 weeks, partial-weight bearing crutch ambulation did after 6 weeks, without crutch ambulation did after 10 weeks. The fractures was classified by Essex-Lopresti and Sanders classification using radiographs and the functional outcomes were evaluated by circle draw exercise, AOFAS score. Results: By Essex-Lopresti classification, the tongue type was 6 cases (14%), the joint depression type was 15 cases (35%), the combined type was 22 cases (51%). By Sanders classification, type II were 10 cases (23%), type III were 15 cases (58%), and type IV were 8 cases (19%). By AOFAS functional evaluation, the mean preoperative scores were 70.3 and 70.5 respectively, mean postoperative scores were 83.7 and 86.9 respectively. There were satisfactory results in 40 cases but 3 cases were unsatisfactory including on case of lateral impingement and 2 cases of traumatic arthritis of subtalar joint. Conclusion: We obtained satisfactory result of the early exercise of subtalar joint without short leg splint and cast and rehabilitation after limited posterior operative treatment of the calcaneal fractures.

• Journal of Korean Foot and Ankle Society
• /
• v.6 no.1
• /
• pp.40-45
• /
• 2002

Purpose: To analyze the radiographic results between the simple bone excision and simple bone excision and posterior tibial tendon advancement for prehallux. Materials and Methods: Thirty-four patients who underwent operative treatment for prehallux between 1995 and 2000 were reviewed. Twenty-six patients who underwent simple bone excision and posterior tibial tendon advancement and eight patients who underwent simple bone excision were available for follow-up. Follow-up averaged 44 months(15-59 months). We evaluated and compared the cuboidal height and the talo-1st metatarsal angle in the preoperative and postoperative radiography. Results: The average span of disappearing pain is 3.7 months(2-7 months) after the operation. Mean cuboidal height and talo-1st metatarsal angle were increased $6.7{\pm}1.8mm$, $5.0{\pm}2.1^{\circ}$ before to $7.8{\pm}0.2mm$, $5.6{\pm}0.7^{\circ}$ after simple bone excision and posterior tibial tendon advancement. Mean cuboidal height and talo-1st metatarsal angle were increased $6.6{\pm}0.7mm$, $4.6{\pm}1.1^{\circ}$ before to $7.7{\pm}0.9mm$, $5.1{\pm}0.4^{\circ}$ after simple bone excision and posterior tibial tendon advancement. One case of extra-osseous migration of the Mitek anchor inserted into navicula was seen during the follow-up period. Conclusion: This study shows that the remarkable differences between the two procedures are not found. So, simple bone excision without advancement of posterior tibial tendon for prehallux can generate relatively good results.