• Journal of Korean Foot and Ankle Society
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• v.21 no.4
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• pp.135-138
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• 2017

Purpose: The purpose of this study is to determine the correlation between the correction loss of hallux valgus angle and the severity of valgus angle of the second toe. Materials and Methods: We selected 312 cases from 268 surgical patients with hallux valgus deformity receiving distal chevron osteotomy. For a radiological evaluation, we analyzed the changes in the hallux valgus angles, first to second intermetatarsal angles, and valgus angle of the second toe post index operations. All patients were women; the mean age was 46 years. The mean follow-up period was 17 months. Results: The mean hallux valgus angle was $33.6^{\circ}$ preoperatively (range, $25.7^{\circ}{\sim}44.8^{\circ}$), $13.1^{\circ}$ (range, $8.4^{\circ}{\sim}16.4^{\circ}$) after 4 weeks of postoperative period, and $17.1^{\circ}$ (range, $9.4^{\circ}{\sim}28.5^{\circ}$) at their final follow-up. The mean valgus angle of the second toe was $8.4^{\circ}$ preoperatively (range, $2.0^{\circ}{\sim}25.8^{\circ}$) and $8.3^{\circ}$ (range, $1.7^{\circ}{\sim}24.9^{\circ}$) at the final follow-up. Preoperatively, there was a positive correlation between the valgus angle of the second toe and hallux valgus angle (r=0.747, p=0.001). The correction loss of hallux valgus angle had a significant correlation with the severity of valgus angle of the second toe (r=0.802, p=0.001). Conclusion: The existence of the second toe valgus deformity may present itself as a cause of correction loss of hallux valgus angle. The preoperative measurement of the second toe valgus angle may be a good predictor of correction loss; therefore, thorough preoperative warning on the possibility of correction loss should be conducted to maximize patient satisfaction after the procedure.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.141-144
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• 2007

Purpose: To statistically evaluate the contributing role of the 3 radiographic factors (Obliquity, Asymmetry, Joint deviation) of the hallux valgus interphalangeus with comparison to the normal control group. Materials and Methods: The study is based on the standing foot AP radiographs of the 77 feet (56 patients) of the hallux valgus interphalangeus out of 119 feet of randomly sampled patients of the age range 20 to 60. Fractures or other foot disorders have been excluded. Obliquity, asymmetry and joint deviation factors formed by proximal and distal phalanges of hallux are measured by one observer and evaluated the statistical significance of the contribution of the 3 factors to the hallux interphalangeal angle (HIA). Results: The average age of the patients were 36.0 years old and average HIA was $14.5^{\circ}{\pm}2.8^{\circ}$. Obliquity was measured $4.8^{\circ}{\pm}2.90^{\circ}$, asymmetry $8.2^{\circ}{\pm}3.28^{\circ}$ and joint deviation $2.0^{\circ}{\pm}1.85^{\circ}$. All 3 factors showed the statistical significance as the contributing factors to the HIA and among them, the asymmetry played the biggest role (p<0.05). Conclusion: Hallux interphalangeal angle is formed by 3 radiographic factors (Obliquity, Asymmetry, Joint deviation), and among them the asymmetry factor plays the biggest role.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.129-132
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• 2009

Purpose: We evaluated the result of operative treatment of the hallux valgus in male patients. Materails and Methods: Total 11 cases (10 patients) of the hallux valgus deformity that treated with operation were evaluated. Following Mann's radiological classification system, there was 1 cases of mild, 8 cases of moderate, and 2 cases of severe. Preoperative, postoperative, postoperative 3 months and postoperative 6 months follow up standing radiographs were used as radiologic evaluation. And we evaluated radiological outcomes by hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA) and clinical outcomes by hallux-metatarsophalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS) score. Result: Radiologically, the mean preoperative HVA $37^{\circ}$ and IMA $13.7^{\circ}$ were improved postoperatively as HVA $11.9^{\circ}$ and IMA $4.7^{\circ}$, and the mean preoperative DMMA $29.4^{\circ}$ and PPAA $8.6$ were improved postoperatively DMMA $13.9^{\circ}$ and PPAA $7^{\circ}$. But, postoperative 6 months follow up HVA, IMA, DMMA and PPAA was increased at $14.2^{\circ}$, $6.3^{\circ}$, $16.1^{\circ}$ and $8.3^{\circ}$. Average AOFAS score were improved from 61.2 points to 75.2 points. Conclusion: In our study, operative treatment of hallux valgus in male patients with proximal metatarsal osteotomy and distal soft tissue procedure showed good results but it was necessary to pay attention to increase aspect of follow up radiologic measurements.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.124-128
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• 2009

Purpose: The authors intended to analyze the operative results of mild to moderate hallux valgus treated with distal chevron metatarsal osteotomy. Materials and Methods: Twenty six feet of twenty three patients were followed for more than 1 year after the distal chevron metatarsal osteotomy. Biplanar osteotomy with wedge resection was done when the distal metatarsal articular angle (DMAA) was increased. The mean age was 39 years, and the mean follow up period was 27 months. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA and sesamoid position before and after the operation were analyzed. Results: Distal chevron osteotomy was done in 15 cases and biplanar osteotomy was done in 11 cases. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from $21.9^{\circ}$ preoperatively to $8.5^{\circ}$ postoperatively. The first intermetatarsal angle was decreased from $11.8^{\circ}$ preoperatively to $6.7^{\circ}$ postoperatively. DMAA was decreased from $11.8^{\circ}$ preoperatively to $5.5^{\circ}$ postoperatively. There was one case of minor wound infection. Conclusion: Distal chevron metatarsal osteotomy appears to be safe and satisfactory procedure for mild to moderate hallux valgus.

• Journal of Korean Foot and Ankle Society
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• v.19 no.3
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• pp.91-96
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• 2015

Purpose: The purpose of this study is to evaluate the sequential changes of clinical and radiographic results after proximal chevron osteotomy in patients with moderate to severe hallux valgus. Materials and Methods: Between January 2008 and December 2009, 93 patients (117 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. The mean age of patients was 51 years (range, 19 to 71) and the mean duration of follow-up was 27.5 months (range, 24 to 35). Clinical results were evaluated using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively, at 3, 6, and 12 months after surgery, and at the last follow-up. Radiographic parameters including hallux valgus angle, intermetatarsal angle, and sesamoid position were evaluated preoperatively, immediately postoperatively, at 6 weeks, at 3, 6, and 12 months after surgery, and at the last follow-up. Results: VAS and AOFAS score showed significant improvement until 12 months after surgery. Hallux valgus angle and sesamoid position stabilized at 12 months after surgery and intermetatarsal angle stabilized at 6 months after surgery. Conclusion: Clinical and radiographic results were stabilized beyond 12 months after proximal chevron osteotomy in patients with moderate to severe hallux valgus.

• 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.9 no.1
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• pp.81-86
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• 2005

Propose: This study was retrospectively to review the surgical results for moderate to severe hallux valgus corrected with a modified McBride procedure and proximal metatarsal crescentic osteotomy. Materials and Methods: Between August 1997 and August 2001, 15 patients with 22 bunion underwent surgical correction and were followed for an average 29.3 months (range, 18 to 53 months). Clinical results were evaluated with AOFAS clinical rating system for hallux and radiological measurements were done preoperatively and at a minimum of 12 months postoperatively. Results: The average AOFAS clinical rating score improved from 47.5 to 86.0. Union of the osteotomy site occurred at 9.5 weeks except one delayed union. The hallux valgus angle improved an from $36.5^{\circ}$ to $15.7^{\circ}$ and the intermetatarsal angle improved from $17.4^{\circ}$ to $8.6^{\circ}$ on average. Dorsiflexion of the first metatarsal at the osteotomy site was present in three (13.6%) with average $4^{\circ}$. Complications were two recurred deformity, one hallux varus and one painful transfer lesion. There was a high level of satisfaction with clinical results in 11 patients (73.3%) with 17 feets and cosmesis in 18 feets (81.8%). Conclusion: Modified McBride procedure and proximal metatarsal crescentic osteotomy based on careful patient selection and meticulous technique showed satisfactory outcome for moderate to severe hallux valgus.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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• pp.174-178
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• 2003

Purpose: The purpose of this study was to evaluate the radiographic results and complications after the proximal dome osteotomy for hallux valgus. Material and Methods: 127 cases of clinically moderate to severe hallux valgus from October 1994 to September 1997 were included in this study. All had been surgically corrected with proximal dome osteotomy, bunionectomy, and distal soft tissue release. We compared the hallux valgus angle(HVA) and intermetatarsal angle(IMA) at preoperative, postoperative 3 weeks, postoperative 6 weeks, and postoperative 3 months. Also we reviewed the postoperative com plications. Result: The HVA averaged $34.1^{\circ}$ at preoperative, $4.3^{\circ}$ at 3 weeks after operation, $8.1^{\circ}$ at 6 weeks after operation, and $10.2^{\circ}$ at 3 months after operation. The lMA averaged $14.6^{\circ}$ at preoperative, $5.1^{\circ}$ at 3 weeks after operation, $5.6^{\circ}$ at 6 weeks after operation, and $7.3^{\circ}$ at 3 months after operation. We experienced 7 cases of malunion, 5 cases of limitation of motin at the first metatarso-phalangeal joint, 3 cases of hallux varus deformity, 2 cases of delayed union. Conclusion: Proximal dome osteotomy for moderate to severe hallux valgus deformity was considered as one of the effective treatment methods. And we try to avoid limitation of motion at the first metatarso-phalangeal joint after operation.

• Journal of Korean Foot and Ankle Society
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• v.16 no.4
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• pp.223-228
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• 2012

Purpose: To treat hallux valgus in old age patients with chevron metatarsal osteotomy and to see the subsequent clinical and radiological outcomes. Materials and Methods: 23 cases of 18 hallux valgus patients of age 60 years or older who received proximal or distal corrective osteotomy from April 2007 to August 2009 and were followed up for at least 1 year were included in the study. The mean age at operation was 65 years (range, 60~81 years), and the mean follow-up period was 2 years and 6 months (range, 1 year~3 years 6 months). Clinical outcome was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, satisfaction rate, as well as measurements and comparison of pre- and postoperative hallux valgus angles, the 1st~2nd intermetatarsal angle, and the position of hallucal medial sesamoid bone. Results: The AOFAS score was improved from preoperative average of 35.1 (range, 13-47) to average 85.1 at last follow-up (range, 75-100). Patients were satisfied about the operation in 21 cases (91.3%). Preoperative hallux valgus angle was $31.7^{\circ}$ on average (range, $19.1^{\circ}-48.9^{\circ}$), and $4.9^{\circ}$ on average at last follow-up (range, $0.3^{\circ}-21.2^{\circ}$). The 1st~2nd intermetatarsal angle was $14.4^{\circ}$on average (range, $8.7^{\circ}-25.7^{\circ}$) and $3.1^{\circ}$ on average at last follow-up (range, $0.6^{\circ}-7.5^{\circ}$). The hallucal medial sesamoid bone position was improved from preoperative average 3.5 (range, 3-4) to postoperative average 1.0 (range, 0-2). Conclusion: Proximal and distal metatarsal osteotomy treatment yielded good clinical and radiological outcomes in old age hallux valgus patients.

• 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.