• 대한족부족관절학회지
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• 제8권2호
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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.

• 한국전문물리치료학회지
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• 제27권4호
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• pp.227-232
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• 2020

Background: Hallux valgus (HV) is a foot deformity developed by mediolateral deviation of the first metatarsophalangeal joint. Although various foot-toe orthoses were used to correct the HV angle, verification of the effects of kinetics variables such as ground reaction force (GRF) through three-dimensional (3D) gait analysis according to the various type of orthoses for HV is insufficient. Objects: This study aimed to investigate the effect of soft and hard types of foot and toe orthoses to correct HV deformity on the GRF in individuals with HV using 3D motion analysis system during walking. Methods: Twenty-six subjects participated in the experiment. Participants had HV angle of more than 15° in both feet. Two force platforms were used to obtain 3D GRF data for both feet and a 3D motion capture system with six infrared cameras was used to measure exact stance phase point such as heel strike or toe off period. Total walk trials of each participant were 8 to 10, the walkway length was 6 m. Two-way repeated measures ANOVA was used to determine the effects of each orthosis condition on the various GRF values. Results: The late anteroposterior maximal force and a first vertical peak force of the GRF showed that the hard type orthosis condition significantly increased GRF compared to the other orthosis conditions (p < 0.05). Conclusion: There were significant effects in GRF values when wearing the hard type foot orthosis. However, the hard type foot orthosis was uncomfortable to wear during walking. Therefore, it is necessary to develop a new foot-toe orthosis that can compensate for these disadvantages.

• 대한족부족관절학회지
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• 제21권1호
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• pp.1-6
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• 2017

Purpose: The purpose of this study was to analyze the clinical results of medial horizontal suture fixation of Akin osteotomy in hallux valgus and present its advantages. Materials and Methods: This study was based on 48 cases of 35 patients with Akin osteotomy, who underwent surgery of hallux valgus between December 2014 and July 2015, and with at least 12 months of follow-up. The mean age of patients was 46.9 years (range, 16~71 years). The mean follow-up duration was 15.9 months (range, 12~18 months). Clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS hallux metatarsophalangeal interphalangeal scale) score, and satisfaction score. Weightbearing anteroposterior radiographs were taken to measure the distal articular set angle (DASA) of the hallux. Radiographic bone union at 6 months follow-up was regarded as a success, while a loss of reduction and nonunion was regarded as a failure. Results: The mean pre- and postoperative pain VAS scores were 4.27 and 1.67, respectively (p<0.05). The mean AOFAS score improved from 59.7 to 80.5 (p<0.05). The DASA was improved from 8.15 to -2.57 (p<0.05). There was no case of skin irritation, cortical breakage, inflammation from the knot, and infection. All patients showed union without fixation failure. Conclusion: The clinical and radiological evaluations in this study demonstrate reliable results without complication. The medial horizontal suture fixation of the Akin osteotomy was effective, and the advantage of this procedure was unnecessity of the material removal, preservation of the joint, and no skin irritation.

• 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.

• 대한족부족관절학회지
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• 제15권2호
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• pp.68-71
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• 2011

Purpose: To analyze relation between age or parameters measured before operation and cartilage erosion of the first metatarsal head measured during operation. Materials and Methods: The study was targeted at 56 patients and 79 feet, who underwent Scarf osteotomy or Scarf and Akin osteotomy from November 2009 through November 2010, and whose cartilage lesion of the first metatarsal head referred to the cartilage grade III or IV of the International Cartilage Repair Society. The measurement parameters were age, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle. The cartilage erosion of the first metatarsal head was measured by one surgeon using cellophane. Occupancy rate and frequent involved sites of the cartilage erosion were recorded using Auto$CAD^{(R)}$ and adobe Illustrator CS4 program. SPSS correlation test and T-test were used for statistical analysis of the parameters and the cartilage erosion. Results: The cartilage erosion was incurred frequently in the sagittal groove and the site where subluxation or dislocation of the tibial sesamoild bone occurred but frequent involved sites had no statistical significance with cartilage erosion. The age showed a statistical significance with the cartilage erosion in the correlation test (p=0.003). Especially, the group of over 51 year old patients was turned out to have association with the cartilage erosion, compared to the group of below 51 (p=0.007). But, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle were no statistical significance with the cartilage erosion. Conclusion: We found the more the age of patients increased (especially above 51), the more cartilage erosion increased. And it is thought that we pay attention to reduce tibial sesamoid bone.

• 대한족부족관절학회지
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• 제11권1호
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• pp.23-27
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• 2007

Purpose: Scarf osteotomy can provide the simultaneous correction of the hallux valgus angle (HVA), 1-2 intermetatarsal angle ($IMA_{1-2}$), DMAA and the plantar displacement of the fragment. The study was conducted to understand the multi-dimensional correction of the hallux valgus. Materials and Methods: Fourty eight patients who had undergone Scarf osteotomy with hallux valgus at more than $30^{\circ}$ of HVA and more than $15^{\circ}$ of $IMA_{1-2}$ were studied. Before an osteotomy, a reference K-wire was inserted to the 1st metatarsal head. After the osteotomy, the plantar fragment was moved laterally and the proximal end of the fragment was forced beyond the distal end which resulted in an internal rotation of the head fragment to correct the DMAA. Results: The HVA improved an average of $33.3^{\circ}$ to $7.7^{\circ}$ with the IMA1-2 respectively from $15.4^{\circ}$ to $6.5^{\circ}$. The DMAA improved an average of $19.5^{\circ}$ ($5.2-30.9^{\circ}$) to $4.5^{\circ}$ ($0.4-13.8^{\circ}$). By checking the angle, which was at an average of $25^{\circ}$ between the plantar surface of the foot and the osteotomy plane, the average distance of 1.9 mm (1.18-3.1 mm) of plantar displacement was measured using the value of sine (sin 25 = 0.422). Conclusions: It is possible to correct the HVA, IMA1-2 and DMAA simultaneously with one osteotomy making the lateral shift, the internal rotation and the plantar displacement of the plantar head fragment as desired. Despite the technicality and difficulty of the Scarf osteotomy, once familiarized through myriad procedures, all disadvantages are outweighed by the success and satisfaction of both patient and surgeon.

• 대한족부족관절학회지
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• 제10권2호
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• pp.230-233
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• 2006

Purpose: The distal chevron osteotomy has gained popularity for the mild to moderate hallux valgus, but necessity of fixation is controversy. No fixation of distal chevron osteotomy cause instability, but fixation has problem which has pin site infection and irritability, extension of operation time, discomfort of rehabilitation. So, the author was going to analyse and compare with and without in the fixation of distal chevron osteotomy. Materials and Methods: Between 2004 and 2005, a total 18 patients (20 feet) following with and without in fixation of distal chevron osteotomies. The fixation group (A) was performed for the treatment of 10 patients (10 feet) and no fixation group (B) was done to 8 patients (10 feet). Results: On group A, the mean first MTP (metatarsophalangeal) angle corrected $17^{\circ}$ pre-operatively to average $29^{\circ}$ (range; $20-37^{\circ}$) and the mean first IM (intermetatarsal) angle corrected $10^{\circ}$ pre-operatively to average $15^{\circ}$ (range; $9-18^{\circ}$). On Group B, the mean first MTP angle corrected $16^{\circ}$ pre-operatively to average $29^{\circ}$ (range; $18-33^{\circ}$) and the mean first IM angle corrected $7^{\circ}$ pre-operatively to average $13^{\circ}$ (range; $9-16^{\circ}$) (P>0.05). Clinical results, based on AOFAS score showed an improvement in the overall results. Conclusions: Comparing the clinical and radiographic results of the distal chevron osteotomies no difference in with and without fixation of distal chevron osteotomies.

• The Journal of Korean Physical Therapy
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• 제24권4호
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• pp.276-281
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• 2012

Purpose: The purpose of this study is to compare the kinematic motion of the first metatarsophalangeal (MTP) joint during an electrical stimulation of abductor hallucis (AbdH) muscle, between the normal group and the hallux valgus (HV) group. Methods: A total of twenty subjects (normal group=10 and HV group=10) participated in this study. The kinematic motions of first MTP joint was measured by using 3-dimensional motion analysis during an electrical stimulation in the sitting position. The intensity of an electrical stimulation was set to be tolerated in each subject, and the data of kinematic motions were collected in three trials of 5 seconds. An independent t-test was used to compare the angle of flexion and abduction of the first MTP joint and proximal phalanx in frontal plane, between the normal and HV groups. Results: Participants showed that the angle of flexion was significantly greater in the HV group ($13.12{\pm}10.61^{\circ}$), compared to that of the normal group ($10.17{\pm}2.31^{\circ}$); and the angle of abduction was significantly smaller in the HV group ($10.61{\pm}4.99^{\circ}$) than that of the normal group. Also, the angle of the proximal phalanx in frontal plane was significantly smaller, compared to the normal group ($53.42{\pm}10.70^{\circ}$) (p<0.05). Conclusion: These findings suggest that dysfunction of AbdH muscle is apparent in HV deformity and provide insight into potential risk factors for the development of HV deformity.

• 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.

• Physical Therapy Rehabilitation Science
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• 제9권1호
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• pp.10-17
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• 2020

Objective: Hallux valgus (HV) is a common musculoskeletal deformity that is accompanied with pain and continues to decrease one's quality of life and ability to perform daily life activities by affecting gait and static stability. Therefore, this study aimed to investigate the effect of the angle of HV (HVA) and to compare the one-legged stance and gait parameters in young adults with less HV and severe HV. Design: Cross-sectional study. Methods: Forty young adults were divided into two groups, where HVA ≥15° (n=20) was defined as HV, and HVA <15° (n=20) was defined as normal. For balance ability, the center of pressure (COP) path, velocity, length of axis of the COP path, deviation of the x-axis and y-axis, and percentage of foot pressure were measured, and gait, the foot rotation angle, step length, percentage of each phase of the gait cycle, time change from the heel to forefoot, and maximum pressure of the forefoot and midfoot were measured. Results: Significant differences were found in sway length and time change from heel to forefoot during walking between the normal and HV groups (p<0.05). Most parameters were not associated with the HVA, but parameters such as length of axis and time to change from heel to forefoot were significantly associated with the HVA (p<0.05). Conclusions: These results suggest that most one-legged stance and gait parameters were not significantly affected by the HVA in young adults; therefore, future studies are needed in order to address other dynamic parameters and other methods of gait analysis for detecting clinically meaningful conditions.