• 대한족부족관절학회지
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• 제7권1호
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• pp.7-12
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• 2003

Purpose: To study the relationship of the 1st to 2nd intermetatarsal angle(1-2 IMA) between the intra-operative and weight bearing postoperative anterior-posterior(AP) radiography, and evaluate the intra-operative predictability for the postoperative 1-2 IMA after proximal metatarsal osteotomy(PMO) in the hallux valgus deformity. Materials and Methods: 20 cases of moderate to severe hallux valgus patients were included in this study. After the oblique PMO(Ludloff procedure) was performed and the osteotomy site was fixed temporarily, the AP view was taken intra-operatively. About 10 weeks after surgery, postoperative weight bearing AP view was taken. The pre -. intra -, and postoperative 1-2 IMAs were compared and ana lysed statistically. Results: The 1-2 IMAs of the weight bearing preoperative, non-weight bearing intra-operative and weight bearing postoperative AP view were $15.9^{\circ}{\pm}1.8^{\circ},\;4.7^{\circ}{\pm}2.1^{\circ}$, and $6.8^{\circ}{\pm}2.5^{\circ}$ (Mean${\pm}$SD) respectively. The postoperative 1-2 IMA was greater than intra-operative measurement by $2.1^{\circ}{\pm}1.8^{\circ}$ (range; $-1^{\circ}$ to $6^{\circ}$) which was stastistically significant(p<0.05). To get less than $9^{\circ}$ postoperatively as an average normal, intra-operative 1-2 IMA should be within $3.8^{\circ}$ to $5.2^{\circ}$ (95% confidence interval), and intra-operative 1-2 IMA should be within $3.4^{\circ}{\pm}$to $5.4^{\circ}$(95% confidence interval) to get more than $6^{\circ}$ difference between preoperative and postoperative 1-2 IMA, which is regarded as more than average correction by the distal metatarsal osteotomy. Conclusion: In hallux valgus surgery, it should be considered that intra-operative 1-2 IMA was less than the postoperative. To achieve postoperative 1-2 IMA less than $9^{\circ}$ and more than correction angle of $6^{\circ}$, it is suggested that the intra-operative 1-2 IMA should be measured less than about $5^{\circ}$.

• 대한족부족관절학회지
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• 제15권2호
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• pp.62-67
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• 2011

Purpose: The authors evaluated the differences between K-wires and Cannulated screw, plate for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 62 patients (79 feetz) 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. We divided the patients into 4 groups, Two K-wire fixed group as A, one cannulated screw fixed group as B. Two cannulated screw fixed group as C, Plate fixed group as D, Group A were patients (26 feet) and Group B were patients z(9 feet), Group C were patients (31 feet) and Group D were patients (13 feet). Preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patient. ANOVA test and Student t-test were done for statistical analysis. Results: Mean follow up period was 43.8 months (range: 12~82 months). Preoperative mean IMA was $16.4{\pm}3.5$, $17.7{\pm}11.3$, $17.3{\pm}5.9$ and $16.6{\pm}2.3$ degrees in respectively group A, B, C, D. Immediate postoperative mean IMA was $5.6{\pm}3.4$, $7.3{\pm}4.4$, $7.6{\pm}4.4$ and $6.7{\pm}2.8$ degrees in respectively group A, B, C, D. The final mean IMA was $8.9{\pm}4.5$, $15.2{\pm}7.5$, $10.3{\pm}4.4$ and D $7.7{\pm}3.5$ degrees in respectively group A, B, C, D. There were significant statistical increase in final mean IMA of group B and C (p<0.05). Conclusion: The IMA was significantly increased in the group which used one or two cannulated screw for fixation on follow up, therefore more caution should be needed when using one or two cannulated screw fixation technique after proximal chevron osteotomy.

• 한국전문물리치료학회지
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• 제23권3호
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• pp.21-28
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• 2016

Background: The toe-spread-out (TSO) exercise has been introduced as a strengthening exercise for the abductor hallucis muscle in subjects with hallux valgus. Visual biofeedback using ultrasound imaging during exercise, may increase the ability to selectively contract the abductor hallucis muscle, compared with exercise alone. Objects: The aim of this study was to investigate the effects of ultrasound imaging visual feedback during the TSO exercise with respect to its influence on the angle of the first metatarsophalangeal joint (1st MPJ) and the cross-sectional area (CSA) of the abductor hallucis muscle in subjects with hallux valgus. Methods: Twenty-five healthy young subjects with a mean average age of 22.5 years, and a standard deviation of 2.3 years, were recruited for this study. Hallux valgus was defined as an angles greater than $15^{\circ}$ angle of 1st MPJ. Goniometric measurement was used to determine the angle of 1st MPJ. In addition, an ultrasound system was used to collect the CSA of the abductor hallucis muscle in each foot. The angle of the 1st MPJ and CSA of the abductor hallucis were measured in three positions; the resting position, during TSO exercise, and during TSO exercise in conjunction with real-time ultrasound imaging feedback. All data analyzed using a repeated analysis of variance with Bonferroni correction in order to compare the dependent variables in all three positions. Statistical level of significance was set up as p<.05. Results: The angle of the 1st MPJ was noted to be significantly reduced and the CSA of the abductor hallucis to be significantly greater during TSO exercise used in conjunction with ultrasound imaging visual feedback, compared to when the values were recorded during TSO exercise alone (p<.05). Conclusion: Based on these findings, it can be concluded that the application of ultrasound imaging visual feedback during TSO exercise is more effective in contracting selectively the abductor hallucis than the use of exercise alone.

• 산업융합연구
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• 제19권6호
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• pp.81-91
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• 2021

본 연구는 보수볼을 이용한 발목 근력 강화 운동과 테이핑이 엄지발가락가쪽휨증 환자의 정적과 동적 발바닥 압력에 어떠한 영향을 미치는지 알아보고자 실시하였다. 대상자는 엄지발가락가쪽휨증을 가지고 있는 20대 남녀 26명이며, 테이핑군(Taping group, TG; n=13)과 발목 강화 운동군 (Ankle strengthening group, ASG; n=13)으로 무작위로 배치하였고, 각 군은 총 4주에 걸쳐 해당 중재를 실시하였며, 중재 전과 후에 정적, 동적 발바닥 압력을 측정하였다. 집단 간 변화량의 차이를 알아보기 위해 독립 T검증을 실시하였고, 집단 내의 사전-사후값의 측정값 차이가 유의한지 알아보기 위해 대응표본 T검증을 실시하였다. 통계적 유의수준은 α= .05로 설정하였다. 발의 전체 체중에 대한 비율(Foot)은 왼쪽 발의 ASG가 TG에 비해 집단 내 변화량이 유의하게 감소하였고(p<.05), 발의 표면적(Surface area)에서는 오른쪽 발의 TG가 ASG에 비해 집단 내 변화량이 유의하게 증가하였다(p<.05). 발의 엎침 운동의 정도(MP/change ratio)는 오른발의 TG가 ASG에 비해 집단 내 변화량이 유의하게 감소하였고(p<.05), 발의 힘(Force)에서는 왼발의 TG가 ASG에 비해 집단 내 변화량이 유의하게 증가하였으며(p<.05), 집단 간의 변화에서는 TG의 변화량이 ASG의 변화량보다 유의한 차이가 나타났다(p<.05). 따라서 보수볼을 이용한 발목 강화 운동과 테이핑은 엄지발가락가쪽휨증을 가진 환자에게 효과적인 변화를 주기에는 부족하다고 할 수 있다.

• 한국운동역학회지
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• 제21권4호
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• pp.397-403
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• 2011

The purpose of this study is to analyze the immediate effects of five toed shoes on foot structure. Subjects consisted of 26 college-aged women with pes planus. X-ray analysis of student feet were performed both barefooted and with five toed shoes. Dependent variables were hallux valgus angle, calcaneal inclination angle, 1st metatarsal declination angle, and intermetartarsal angle. Independent t-test was used for statistical analysis along with SAS. Overall, there were statistically significant changes of test subject's dependent variables when wearing five toed shoes. Specifically, the hallux valgus angle decreased, the calcaneal inclination angle and 1st metatarsal inclination angle increased, and intermetatasal angles both increased and decreased, shifting towards normal range. In every case the dependent variables shifted towards a more normal range while subjects wore five toed shoes. This study only examined the immediate corrective effects of five toed shoes on foot structure, but long-term studies are needed to understand the prolonged effects of five toed shoes on foot structure.

• 대한족부족관절학회지
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• 제4권2호
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• pp.55-60
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• 2000

Purpose: To investigate the effect of heel elevation on the radiographic parameters of the forefoot. Materials and Methods: Forty feet in twenty-one adults were studied. Weight bearing dorsoplantar radiograph was taken with the foot on a flat surface and with the heel of the foot elevated by 5cm. Various parameters were measured and compared between the results with and without heel elevation. Result: The hallux valgus angle was increased by $5.0{\pm}3.5$ degrees with heel elevation and the change was statistically significant(p<0.01). There was no statistically significant changes in the other parameters. Conclusion: The results of this study suggest that high-heeled shoes might contribute in causing or aggravating the degrees of the hallux valgus.

• 대한족부족관절학회지
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• 제19권4호
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• pp.197-200
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• 2015

The Akin osteotomy is a complimentary procedure in hallux valgus surgery. Surgical techniques may vary depending on the operators or fixation devices. Suture fixation, for which a removal procedure is not necessary, can often be recommended. However, there is a risk of failure due to the thin cortex of the phalanx. We describe a new technique using Ethibond suture fixation in Akin osteotomy, which can lower the risk of phalangeal cortical failure and articular cartilage irritation. First, the Akin osteotomy was performed on the proximal phalanx 5 to 6 mm distal to the first metatarsophalangeal joint. Then bone holes were drilled from dorsum to plantar parallel to osteotomy with the Kirschner wire. The final procedure involved passing the Ethibond sutures connected to a straight needle through the holes and tying it. This fixation method offers an effective and easy technique for performance of Akin osteotomy.

• 대한족부족관절학회지
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• 제21권3호
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• pp.93-97
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• 2017

Purpose: The aim of this study was to evaluate the radiological and clinical outcomes of scarf osteotomy for hallux valgus (HV) deformity in elderly patient with osteoporosis. Materials and Methods: A total of 58 elderly patients (mean age, 72.6 years) underwent scarf osteotomy for HV deformity between 2008 and 2015. The mean follow-up period was 24.4 months. Of the 58 patients, 42 were diagnosed with osteoporosis and 16 were diagnosed as normal. The radiological and clinical outcomes were assessed preoperatively, postoperatively, and at final follow-up, including HV angle, intermetatarsal (IM) angle, American Orthopaedic Foot and Ankle Society (AOFAS) score, patient satisfaction, visual analogue scale (VAS), and complication. Results: There was no significant difference in HV angle and IM angle between the osteoporosis group and normal bone mineral densitometry group at all time points, preoperative, postoperative, and final follow-up. Moreover, there was no statistically significant difference between the two groups with respect to the AOFAS score and VAS evaluations. In the osteoporosis group, the mean HV angle improved from $36.7^{\circ}$ preoperatively to $11.3^{\circ}$ at the time of final follow-up, and the mean IM angle improved from $13.2^{\circ}$ to $5.7^{\circ}$. The mean AOFAS score improved from 52.6 preoperatively to 89.1 at the time of final follow-up. With respect to satisfaction, 83.4% of patients were very satisfied or satisfied. There were no serious complications, and all cases showed complete union at the osteotomy site. Conclusion: We believed that scarf osteotomy is a safe, effective procedure for the correction of elderly patients with osteoporosis.

• The Journal of Korean Physical Therapy
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• 제28권2호
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• pp.124-127
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• 2016

Purpose: The flexor hallucis longus stretch test can determine the shortness of the flexor hallucis longus muscle by measuring the angle of extension in the first metatarsophalangeal (MTP) joint at maximum ankle dorsiflexion. Less than 30 degrees of the first MTP joint at the maximal ankle dorsiflexion indicates shortness of the flexor hallucis longus muscle. The purpose of this study was to examine the intra- and inter-reliability of the flexor hallucis longus stretch test in subjects with asymmetric hallux valgus (HV) angles. Methods: Sixteen subjects with asymmetric HV angles participated in this study. In sitting position, dorsiflexion angles of the first MTP joint were measured with maximum ankle dorsiflexion on each side. ICC (3,1) and ICC (3,k) models were used, respectively, to assess the intra-reliability and inter-reliability of the flexor hallucis longus stretch test. The paired-t test was used to compare the dorsiflexion angle of the first MTP joint on the side with the smaller HV angle with that of the side with the larger HV angle. Results: The results of the study showed that both intra- and inter-reliability were more than 0.95 of the coefficient. Dorsiflexion angle of the first MTP joint was higher on the side with the smaller HV angle. Conclusion: Use of the flexor hallucis longus stretch test is acceptable in clinical settings because both intra- and inter-reliability were high in subjects with asymmetric HV angles. In addition, shortness of the flexor hallucis longus muscle is associated with HV angle. This study provides useful information for use in management of HV deformity.

• 대한족부족관절학회지
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• 제8권2호
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• pp.138-141
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• 2004

Purpose: The purpose of this study was to document the results of fixation with ethibond suture in akin osteotomy and its advantages. Materials and Methods: From May 2001 to January 2004, Akin osteotomy was performed in 218 patients. We reviewed 110 patients (114 feet) who were possible radiographic evaluation more than 6 months after operation. 110 feet had hallux valgus and 4 feet had hallux valgus interphalangeus. 105 patients were female and 5 were male. The average age was 43.8 years old (18 to 68 years old). The average follow up was 9 months (6 to 23 months). After performing the Akin osteotomy at 7 mm from the proximal articular surface of the proximal phalanx, one hole is made on either side of the osteotomy site with a K-wire. The passer was passed through the both holes and the ethibond was passed. And then, the ethibond was tied tightly. 2 sutures in 66 feet and 1 suture in 48 feet were made. Radiographic bone union at 6 months follow up was regarded as success and loss of the reduction, nonunion was regarded as failed. Results: In the radiographic evaluation, bony union were made at 6 months follow up in all feet. There was no difference between 2 sutures and 1 suture, and the knots were removed in 3 feet because of skin irritation. Conclusion: The fixation of the osteotomy site using suture material was an effective method in Akin osteotomy. The advantage of this procedure was unnecessity of the material removal.