• Journal of Korean Foot and Ankle Society
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• v.17 no.2
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• pp.121-129
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• 2013

Purpose: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. Materials and Methods: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, $1^{st}-2^{nd}$ intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of $1^{st}-2^{nd}$ metatarsal declination angle and distance between the $1^{st}-2^{nd}$ metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). Results: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-$1^{st}$ metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the $2^{nd}$ metatarsal and distance between the $1^{st}-2^{nd}$ metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). Conclusion: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length, metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.64-70
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• 2004

Purpose: We compared the result of a proximal metatarsal closed wedge osteotomy and soft tissue procedure with a modified chevron osteotomy and soft tissue procedure in the treatment of hallux valgus. Materials and Methods: Between March 1999 and February 2003, we performed proximal metatarsal closed wedge osteotomy and soft tissue procedure on 17 feet (12 patients), and modified chevron osteotomy and soft tissue procedure on 12 feet (9 patients). Results: According to Mayo clinic forefoot scoring system (FFSS), group 1, with proximal metatarsal closed wedge osteotomy, shows 67.2 points postoperatively and group 2, with modified chevron osteotomy, shows 68.5 points postoperatively. In group 1, the average correction of hallux valgus angle and intermetatarsal angle was 20.8 degrees and 4.8 degrees, respectively. In group 2, the average correction of hallux valgus angle and intermetatarsal angle was 19.9 degrees and 4.7 degrees, respectively. The average shortening was 3.15 mm in group 1 and 1.38 mm in group 2. Conclusion: We obtained relatively good clinical and radiographic result in this study. The effect on shortening of the first metatarsal was greater in the proximal metatarsal closed wedge osteotomy than modified chevron osteotomy, but the metatarsal shortening did not related with metatarsalgia. So, both techniques seems optimal surgical treatment for hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.115-118
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• 2003

Purpose: We are going to present a report from clinical and radiographic results of hallux valgus done only by soft-tissue procedure, when intermetatarsal joint is totally unfit under mild to moderate deformity. Materials and Methods: As a retrospective study, among all the patients who went under the surgery for hallux valgus, and of those who were possible to follow up,(excluding those whose intermetatarsal joint is fit) it was done over 28 cases (18 patients). the soft-tissue procedure was all done by Modified Mc Bride. Results: Hallux valgus angle and intermetatarsal angle each showed correction of $19.4^{\circ}$ and $5.2^{\circ}$, and from the final follow up, they were each decreased by $5.1^{\circ}$ and $1.5^{\circ}$. 21% (6case) were recurred, in one case, the intermetatarsal angle decreasing 120 and the other 5 case all decreased by $13^{\circ}$. Conclusion: when the intermetatarsal joint is unfit and there is no degenerative change, and, if the intermetatarsal angle is not large, moderate hallux valgus can show a good result, just by the distal soft-tissue procedure. a critical indication and a well through out preparation can reduce unneccessary surgeries.

• The Journal of Korean Physical Therapy
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• v.23 no.5
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• pp.57-63
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• 2011

Purpose: The aim of this research is to determine whether there is a significant correlation between the angle of the hallux valgus and dorsi-flexion of the 1st metatarsophalangeal joint (1st MPJ) as a physical factor that has a significant influence on healthy human walking. Methods: The subjects of this research were 65 female adults (130 feet) and the methods used included recording of real measurements and conducting a questionnaire. The acquired data is analyzed by the 'Simple Pearson Correlation Analysis' and 'Repeated Measures Analysis' methods. Results: The research result shows that the left area of -0.74706 and the right area of -0.76 have a relatively high negative correlation (p<0.00). Also, after conducting the 'Repeated Measures Analysis of Variance' of the angles of the hallux valgus and dorsi-flexion of the 1st metatarsophalangeal joint (1st MPJ), the result also shows that the left and right areas of -0.75 have a relatively high negative correlation. Conclusion: The present study was performed for the identification of a significant correlation between the angle of the hallux valgus and dorsi-flexion of the 1st MPJ. From the results of this study, we confirmed that there is a clear tendency for the average distribution rates of Hallux Valgus and Hallux Rigidus (Hallux Limitus) of women to show a higher increase in proportion to age.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.36-40
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• 2003

Purpose: To investigate the relationship between radiographic parameters of the forefoot and plantar pressure in patients with hallux valgus. Materials and Methods: Plantar pressures of 21 patients with hallux valgus were examined with EMED-ST system. The data were compared with the parameters on the simple weightbearing dorsoplantar radiographs of the feet. The radiographic parameters that were measured were hallux valgus angle, 1-2 intermetatarsal angle, relative lengths of the metatarsals which were measured with the methods described by Maestro et al. and Okuda et al. Results: Statistically significant correlation was found between peak pressures under 2, 3 metatarsal heads and the relative lengths of 2, 3 metatarsals which were measured with the method described by Maestro et al. However they could explain only 13% of the pressures under the 2, 3 metatarsal heads by multivariate analysis. Conclusion: These results suggest that we cannot predict the plantar pressures under the foot with the parameters on the simple weightbearing dorsoplantar radiographs of the feet.

• Journal of Korean Foot and Ankle Society
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• v.17 no.4
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• pp.272-276
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• 2013

Purpose: Recurrence is one of the most common complications after primary correction for hallux valgus deformities. The purpose of this study was to evaluate the usefulness of Scarf osteotomy with axial decompression in the treatment of recurrent hallux valgus. Materials and Methods: From April 2006 to April 2011, 14 cases (12 patients) of recurrent hallux valgus were managed with shortening Scarf osteotomy. Preoperative and postoperative radiographs were reviewed for the measurement of the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the amount of the $1^{st}$ metatarsal shortening. Clinical outcomes including the visual analogue scale (VAS), the AOFAS score, and the range of motion [ROM] of the 1st metatarsophalangeal (MTP) joint were evaluated. Results: The mean HVA decreased from 27.9 degrees to 5.2 and the mean IMA decreased from 12.9 to 3.4. The mean VAS improved from 5.3 to 0.3 and the mean AOFAS score improved from 41 to 90. The mean amount of the 1st metatarsal shortening was 3.4 mm (2-5). The mean ROM of the $1^{st}$ MTP joint improved from 22 degrees (15-35) to 68 (55-75). Conclusion: Scarf osteotomy associated with axial decompression can be a useful revision procedure for the treatment of recurrent hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.5 no.2
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• pp.142-148
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• 2001

Purpose: To investigate the short term result of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of rheumatoid arthritis, using a lag screw and dorsal mini-plate. Materials and Methods: From December 1999 to September 2001, The first metatarsophalangeal arthrodesis of 14 cases (9 patients) was underwent, using a lag screw and dorsal mini-plate. The follow-up period was averaged in 14.6 months. The subjective findings with respect to pain, functional aspect of ability to stand and walk, and to shoe-wearing were evaluated. The objective findings, such as the gross alignment and the radiological measurements for the hallux valgus angle, 1,2 intermetatarsal angle, and dorsiflexion angle were also studied. Results: After the arthrodesis of the first metatarsophalangeal joint, the subjective improvement in pain, function and alignment was graded as excellent in seven (50%) feet, good in seven (50%) feet, and fair or poor in none. The hallux valgus angle and 1,2 intermetatarsal angle were reduced from $44.1{\pm}7.1$ and $15.5{\pm}6.2$ degrees to $13.6{\pm}2.6$ and $10.2{\pm}2.2$ degrees respectively. The dorsiflexion angle was measured in $20.3{\pm}3.7$ degrees after the fusion. The radiological fusion was observed at average 8 weeks after the operation in all cases. The overall complication of the procedure was few, except the delayed wound healing in one. Conclusion: The arthrodesis of the first metatarsophalangeal joint using a lag screw and dorsal mini-plate was regarded as an excellent method of various operative modalities to correct the rheumatoid hallux valgus deformity.

• The Journal of Korean Physical Therapy
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• v.28 no.6
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• pp.381-384
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• 2016

Purpose: Previous studies reported changes in the first metatarsophalangeal (MTP) joint angle in relation with and without weight bearing, but it is unclear whether sesamoid bone of the great toe changes in weight bearing conditions particularly in subjects with hallux valgus (HV). To investigate how weight bearing conditions can affect the position of the medial sesamoid bone (MSB), first MTP joint angle, and second intermetatarsal angle (IMA) in the recruited subjects. Methods: Subjects were recruited 24 with HV and 21 without HV in study. X-rays were taken in the weight bearing and non-weight bearing conditions. The distance of the MSB, first MTP joint angle, and second IMA were measured from the radiographs. Data were analyzed by paired and Independent t-test. The statistical significance level was p<0.05. Results: In both groups, the first MTP joint angles and the distance of the MSB were significantly smaller, while the second IMA was significantly greater in the weight bearing condition. The difference in the distance of the MSB between the two postures was significantly greater in the group with HV. Conclusion: Weight bearing can affect the first MTP joint angle, second IMA, and position of the MSB; the change in the position of the MSB in weight bearing was greater in the group with hallux valgus. The difference in these variables between weight bearing and non-weight bearing conditions may be considered when measuring HV.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.140-144
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• 2008

Purpose: The purpose of this study is to compare the treatment outcomes of distal chevron osteotomy with those of proximal metatarsal closing wedge osteotomy in patients with moderate severity hallux valgus. Materials and Methods: Forty-two patients (51 feet) who were underwent either distal chevron osteotomy (Group I, 22 patients, 27 feet) or proximal metatarsal closing wedge osteotomy (Group II, 20 patients, 24 feet) for the correction of moderate hallux valgus deformity were evaluated retrospectively. We assessed the radiographic results with several parameters including hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). And clinical results with modified AOFAS score at last follow-up. Results: There were no significant differences in IMA, HVA and DMAA between two groups preoperatively. We can achieve the good results with both procedures, but mean HVA and IMA of group II was significantly lower than those of group I. There was some loss of correction in group I at the last follow-up. There was no significant difference in clinical results according to modified AOFAS scoring between two groups at the last follow-up. Conclusion: The proximal metatarsal closing wedge osteotomy for the hallux valgus with moderate severity is better treatment option to achieve better radiographic correction and to prevent loss of correction or recurrence than distal chevron osteotomy.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.53-57
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• 2012

Purpose: To study computerized measurements of angular parameters on 100% and 150% resized digital radiography of hallux valgus deformity Materials and Methods: 30 digital radiography of standing foot anteroposterior view of hallux valgus patients were included. Two observers(A, B) independently measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) in two times on both 100%-size and 150% magnified images respectively, using computerized measurement software tools. The results were interpreted with the statistical software program, Statistical Analysis System, version 9.2. Results: In repeated measurements of each observer, measurements on 150% magnified image showed no differences of all three parameters and with 100%-size image, there were differences of HVA (observer A) and 1-2 IMA (observer B) (p>0.05). When testing interobserver reliability, both observers showed differences in measurement of HVA and DMAA (p<0.05), but no differences in measurement of 1-2 IMA in both images. Within the 95% confidence interval, limits of error of measurements between two observers on HVA, IMA and DMAA were $2.7^{\circ}$ $1.4^{\circ}$ and $5.0^{\circ}$ respectively in 100%-size images, and $2.6^{\circ}$, $1.6^{\circ}$ and $4.7^{\circ}$ respectively in 150% magnified images. Conclusion: In computerized measurements for angular parameters of hallux valgus with digital radiography, 150% magnified images showed intraobserver reliability. Both 100% and 150% magnified images failed to show interobserver reliability. Measurement of 1-2 IMA in both 100% and 150% images showed less interobserver error.