• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.151-157
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• 2005

Purpose: To present our experience of distal chevron osteotomy utilizing one BOLD $screw^{(R)}$ as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. Materials and Methods: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD $screw^{(R)}$ fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. Results: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. Conclusion: We demonstrated that distal chevron osteotomy with one BOLD $screw^{(R)}$ fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.

• Journal of Korean Foot and Ankle Society
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• v.24 no.3
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• pp.107-112
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• 2020

Purpose: Hallux valgus (HV) is a common foot deformity that causes pain in the first metatarsophalangeal joint. Distal metatarsal osteotomies are commonly performed as a treatment. This retrospective study compared the clinical and radiological results of bioabsorbable magnesium (Mg) versus titanium (Ti) screw fixation for modified distal chevron osteotomy in HV. Materials and Methods: Forty-nine patients, who underwent modified distal chevron osteotomy for HV in 2018 and 2019, were reviewed retrospectively. Bioabsorbable Mg screw fixation was applied in 20 patients (22 feet), and a traditional Ti compression screw was applied in 29 patients (40 feet). The patients were followed up for at least six months. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). The hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured before, after surgery, and at the six months follow-up. Results: The AOFAS-MTP-IP scale and VAS points were improved in both groups, with no significant difference between them. At the six-month follow-up, HVA, IMA, and DMAA were similar. Bone union was confirmed in both groups, and there were no significant major complications in both groups. Four people in the Ti screw group underwent implant removal surgery. Conclusion: Bioabsorbable Mg screws showed comparable clinical, radiologic results to Ti standard screws six months after distal modified chevron osteotomy. These screws are an alternative fixation material that can be used safely and avoid the need for implant removal operations.

• Journal of Korean Foot and Ankle Society
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• v.24 no.4
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• pp.135-141
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• 2020

Purpose: This study evaluated the results of two groups-the early group and midterm group-comparatively in the treatment of hallux valgus using a scarf osteotomy. Materials and Methods: From January 2005 to December 2009 (Group 1) and from January 2010 to December 2013 (Group 2), this study compared hallux valgus cases treated by a scarf osteotomy by a single surgeon with at least a five-year follow-up. Results: The average ages of Group 1 and Group 2 were 50.5 and 51.7 years old, respectively. The average follow-up of Groups 1 and 2 were 7.4 and 6.2 years, respectively. Groups 1 and 2 had 86 cases (53 patients) and 93 cases (64 patients) with at least a five-year follow-up, respectively. The average hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA) of Group 1 were improved from 31.3° and 13.9° preoperatively to 11.3° and 6.8° at the final follow-up, respectively (p<0.001). The average HVA and 1-2 IMA of Group 2 were improved from 31.7° and 13.4° preoperatively to 8.9° and 6.6° at the final follow-up, respectively (p<0.001). The mean American Orthopaedic Foot and Ankle Society (AOFAS) score of both groups increased from 48.5 and 45.0 points preoperatively to 73.7 and 82.4 points at the final follow-up, respectively. The numbers of patient-assessed subjective satisfaction of Groups 1 and 2 at the final follow-ups were as follows: excellent, 27 and 36 (31.4%, 38.7%); good, 34 and 49 (39.5%, 52.7%); fair, 13 and 5 (15.1%, 5.4%); poor, 12 and 3 (13.9%, 3.2%); respectively. Neither troughing nor stress fractures occurred in both groups. Conclusion: Scarf osteotomy for treating hallux valgus is an excellent surgical method with a relatively low incidence of complications. The results in Group 2 were better than those in Group 1, showing that more surgical experience and evolution of the techniques provided better results.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.11
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• pp.5211-5217
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• 2012

This study was to evaluate the effects of foot strengthening exercise to improve hallux valgus in young of hallux valgus with flexible flatfoot. Subjects 28 people were randomly divided by the foot strength group(n=14) and control group(n=14). In a period of 8 weeks, they put on I.D.W. Experimental group took foot strengthening exercise for 20 minutes 3 times a week during 8 weeks. Foot structure and max pressure were evaluated by hallux angle, 1~2 metatarsal angle, navicular height, 1st phalange, 2~5phalange, 1st metatarsal, 2nd metatarsal, 3rd metatarsal, 4th metatarsal, 5th metatarsal, mid foot, medial hind foot, lateral hind foot. There were significantly increased by exercise group in outcomes of the structural and plantar foot pressure from hallux angle, 1~2 metatarsal angle, 1st phalange, 1st metatarsal, 2nd metatarsal, 3rd metatarsal, mid foot. The result suggest that foot strengthening exercise is feasible and suitable for individuals with hallux valgus with flexible flatfoot.

• Journal of Korean Physical Therapy Science
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• v.24 no.3
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• pp.18-29
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• 2017

Purpose: The purpose of this study was to identify the effect of hallux valgus (HV) correction taping on the foot arch and balance of young adults with HV of the big toe. Methods: Forty-eight adults volunteered to participate in this study; of them, the 37 feet (11 men, 26 women) with ${\geq}15^{\circ}$ lateral bending of the metatarsophalangeal joint of the big toe, on a goniometer, were selected as the target foot. Non-elastic correction tape was applied to the foot with HV, while the target foot was used to evaluate the changes, before versus after taping, in the lateral bending angle of the big toe, navicular drop level, Clarke angle, and static balance using a Gaitview system. Each measurement was performed three times, and the average of each set was used in the analysis. The patients'general characteristics were compared by using an independent t-test, and the measurement values were analyzed by using a paired t-test. Results: After taping, the lateral bending angle of the toe significantly decreased (p<.05), difference in navicular drop level significantly decreased (p<.05), the Clarke angle significantly increased (p<.05), and static balance significantly improved (p<.05). Conclusion: We showed that HV taping resulted in an immediately improved HV angle, arch, and single-leg standing balance on the foot with HV. However, further studies should investigate the correlation between HV and foot arch.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.31-38
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• 2004

Purpose: The purpose of the study was to identify the subtypes of idiopathic osteoarthritis of the tarsometatarsal joints based on accompanying hindfoot, midfoot, or foot deformities and their corresponding surgical options and also to evaluate the overall clinical results. Materials and Methods: The study included 59 patients (67 feet) with idiopathic tarsometatarsal joint osteoarthritis. Tarsometatarsal fusion was performed for tarsometatarsal joint and accompanied secondary change was divided into subtypes and various bony reconstruction was carried out. The patients were evaluated with the AOFAS midfoot score and FFI. The average patient age was 60.2 years with 40.6 months follow-up. Fifty-four feet (80.6%) had been treated with realignment fusion. Twenty-six feet had first and second tarsometatarsal joint fusion, and 20 feet had first tarsometatarsal fusion only. Six subtypes were identified based on associated foot deformities: 1) in-situ without deformities (18%), 2) pes planovalgus (45%), 3) rockerbottom (15%), 4) cavus foot (1%), 5) hallux valgus (12%), and 6) hallux valgus with pes planovalgus or rockerbottom (9%). Plantar-medial closing-wedge resection was used in 10 feet to correct rockerbottom. For pes planovalgus, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Hallux valgus was corrected with the Lapidus procedure (85.7%). Results: AOFAS midfoot scores improved from preoperative 34.1 points to postoperative 83.9 points (p<0.05). The Foot Function Index postoperatively also showed significant improvement (p<0.05), with a high satisfaction rate (86.6%). There were 29 complications, most commonly sesamoid pain. Conclusion: Idiopathic tarsometatarsal OA feet can be classified into six categories. Pes planovalgus feet should be treated with medial sliding calcaneal osteotomy, lateral column lengthening, or triple arthrodesis in addition to tarsometatarsal joint realignment fusion. Rockerbottom and hallux valgus deformities should also be addressed.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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• pp.131-137
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• 2004

Purpose: We evaluated the results of various surgical treatments for hallux valgus with and without attempting to correct sesamoid subluxation. Materials and Methods: Thirty-one cases in 26 patients were involved in this study: Group I (15 cases) - surgery performed only to correct the hallux valgus angle (HVA) and the first-second intermetatarsal angle (IMA) in AP view; Group II (16 cases) - surgery performed to correct HVA and IMA and also to reduce the subluxation of sesamoid. The degree of sesamoid subluxation was measured from a pre- and intraoperative sesamoid tangential views. For both groups, we analysed the status of the sesamoid in pre- and postoperative radiographs and performed clinical evaluation using the Mayo clinic forefoot scoring system. Results: The average amount of correction during postoperative period and loss of correction at last follow-up in the sesamoid tangential view were as follows: soft tissue procedures (5 cases) - group I: grade $1.0{\pm}0.4/1.5{\pm}0.3$ and group II: grade $2.0{\pm}0.9/0.5{\pm}0.08$; chevron osteotomy (12 cases) - group I: grade $1.0{\pm}0.5/1.2{\pm}0.3$ and group II: grade $2.2{\pm}0.7/0.9{\pm}0.2$; proximal metatarsal osteotomy (14 cases) - group I: grade $4.0{\pm}0.4/1{\pm}0.2$ and group II: grade $4.7{\pm}1.1/0.8{\pm}0.1$. In clinical evaluation, more than 93% of the feet had a good result in both groups. The analysis of these data for each treatment type did not show any statistically significant differences between groups I and II. Conclusion: The radiologic and clinical results did not validate our attempts to reduce the sesamoid during surgery.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.74-80
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• 2005

Purpose: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. Materials and Methods: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). Results: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). Conclusion: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.87-93
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• 2005

Purpose: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. Materials and Methods: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. Results: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was $23.8^{\circ}$ and $6.6^{\circ}$, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. Conclusion: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.15 no.3
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• pp.149-152
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• 2011

Purpose: The Akin osteotomy which is a closing wedge osteotomy of the proximal phalanx widely used for the correction of hallux valgus has several methods of fixation. we tried to report the effects of the fixation using an absorbable suture material during the Akin osteotomy for the hallux valgus. Materials and Methods: This study was based on 448 cases of 346 patients who were able for follow-up more than 12 months among the patients who had an Akin osteotomy together with the surgery of hallux valgus between March of 2006 and May of 2010. Absorbable suture material had been used in all cases. Radiologically displacement and union of osteotomy site were observed after the surgery, and clinically postoperative complication such as skin irritation, pain and satisfaction were investigated. Results: Radiologically all cases had showed complete union and no case had the loss of an correction due to loss of fixation. Also, any case had no skin irritation due to a knot. Three cases had a medial cortical breakage due to a strong knot, and the initial one case among them had additionally fixed the osteotomy site for four weeks using K-wire, and the remaining two cases had fixed a suture on an articular surface without any fixation of an additional wire. If a medial cortical bone was lost by carrying out an ostectomy due to proximal protrusion of proximal phalanx, three cases could show union through the fixation of suture on an articular surface. Conclusion: This study considers that the fixation of the osteotomy site using an absorbable suture material in an Akin osteotomy was effective method and the advantage of this procedure was unnecessity of the material removal and no skin irritation.