• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.484-490
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• 2021

Purpose: A rheumatoid forefoot deformity includes severe hallux valgus and claw toe of the four lateral toes. The authors intended to analyze the mid-term results of the modified Hoffman procedure for a rheumatoid forefoot deformity. Materials and Methods: Twenty-two feet of eighteen patients were followed up for more than two years after the modified Hoffman procedure. The mean age was 54.7 years, and the mean follow-up period was three years and four months. Clinically visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) MP-IP score were analyzed preoperatively and postoperatively. The postoperative complications, the satisfaction of patients, and the presence of plantar callosity were also analyzed. Radiographically, the hallux valgus angle, the 1st intermetatarsal angle, the 1st interphalangeal angle, the 1st interphalangeal joint arthritic change after the operation, and the dorsiflexion angle and the time to union of the 1st metatarsophalangeal joint were analyzed. Results: Clinically, the VAS and AOFAS score were respectively improved from 7.1 points and 30.3 points preoperatively to 1.5 points and 83.1 points postoperatively (p<0.001). All patients were satisfied with the results. Plantar callosity disappeared in all cases. Radiographically, the mean hallux valgus angle, the 1st intermetatarsal angle, and the 1st interphalangeal angle changed from 52.8°, 13.3°, and 7.5° preoperatively to 16.2°, 8.7°, and 14.6° postoperatively (p<0.001). The mean dorsiflexion angle of the 1st metatarsophalangeal joint was 17.2° postoperatively. The mean time to radiographic union of the 1st metatarsophalangeal joint was 11.1 weeks. There were two cock-up deformities of the lesser toe, one wound problem, and two hallux interphalangeal joint arthritis as a complication. There were no cases of nonunion of the 1st metatarsophalangeal joint. Conclusion: The modified Hoffman procedure appears to be a safe and satisfactory procedure for a rheumatoid forefoot deformity.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.142-145
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• 2009

Purpose: The aim of this study was to retrospectively evaluate the clinical and radiological results of the first metatarsophalangeal joint arthrodesis with two crossed screws fixation. Materials and Methods: We treated 23 patients (24 cases) with arthrodesis of the first metatarsophalangeal joint using two crossed screws fixation between December 2000 and May 2005. There were 3 male patients and 20 female patients. Ages ranged from 28 to 74 years (mean, 50 years). Follow-up ranged from 4.1 to 8.2 years (mean, 6.5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) score and their satisfaction was evaluated clinically, foot anteroposterior and lateral radiograph, radiologically. Results: Of the 24 cases, 6 had surgery for dorsal plate and screws fixation because of failure to acquire firm fixation with two crossed screws fixation. All 6 cases acquired bony union. Fusion of the hallux first metatarsophalangeal joint occurred in 16/18 cases (89%). Nonunion occurred in 2 cases (11%) and was asymptomatic. At last follow-up, hallux valgus angle ranged from 11 to 25 degrees(mean, 17.7 degrees), dorsiflexion ranged from 15 to 25 degrees (mean, 22 degrees).The mean preoperative AOFAS score of 37 points(range, 28 to 45 points) improved to a mean of 77 points (range, 65~90 points) postoperatively. The result of the procedure as rated subjectively by the patient was excellent for 5 cases, good for 11 cases and fair for 2. Conclusion: Comparatively, the arthrodesis of the first metatarsophalangeal joint with crossed screws fixation showed a satisfactory clinical results, we thought that require technical attention for firm fixation in operation.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.1-8
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• 2008

Purpose: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. Materials and Methods: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. Results: The mean preoperative HVA and IMA were $40.4^{\circ}$, $17.4^{\circ}$ and the mean amounts of correction were $31.2^{\circ}$ and $11.5^{\circ}$. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. Conclusion: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.31-35
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• 2008

Purpose: The authors intended to evaluate the results of symptomatic bunionette treated with a diaphyseal oblique osteotomy. Materials and Methods: Nine patients were followed for more than 1 year after diaphyseal oblique osteotomy for a bunionette deformity with plantar callosity. The mean age was 43 years (23-69 years), and the mean follow-up period was 27 months (12-70 months). As a combined disorder, 7 patients had hallux valgus, for which 3 distal metatarsal oteotomies, 3 proximal osteotomies, and 1 double osteotomy were performed. Clinically, preoperative and postoperative AOFAS MP-IP scale, patient's satisfaction, postoperative complications were analyzed. Radiologically, the 4th intermetatarsal angle and the 5th metatarso-phalangeal angle were analyzed. Results: Clinically, AOFAS MP-IP scale was increased from 59 points preoperatively to 93 points postoperatively, and all patients were satisfied with the results. The plantar callosity had all disappeared at the final follow up. The 4th intermetatarsal angle was decreased from $12.6^{\circ}$ preoperatively to $4.3^{\circ}$ postoperatively, and the 5th metatarsophalangeal angle was decreased from $21.9^{\circ}$ preoperatively to $2.4^{\circ}$ postoperatively. There were no significant postoperative complications. Conclusion: Diaphyseal oblique osteotomy of the 5th metatarsal appears to be safe and satisfactory procedure for the treatment of a symptomatic bunionette with plantar callosity.

• Journal of Korean Foot and Ankle Society
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• v.18 no.1
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• pp.19-23
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• 2014

Purpose: The purpose of this study is to evaluate the clinical and radiographic results of symptomatic bunionette treated with a diaphyseal oblique osteotomy. Materials and Methods: We retrospectively reviewed 12 feet of nine patients diagnosed as symptomatic bunionette and treated with diaphyseal oblique osteotomy. All patients were female and the average age at the time of surgery was 48 years. We checked the foot standing anteroposterior, oblique, and lateral images pre- and post-operatively. We measured the fourth intermetatarsal angle and fifth metatarsophalangeal angle and evaluated the clinical results using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scale preoperatively and six months postoperatively. Results: Of the nine patients, hallux valgus was combined with symptomatic bunionette in seven feet of five patients. In all of our cases, the average AOFAS lesser MTP-IP scale showed improvement after surgery. Painful callosity around the fifth metatarsophalangeal joint disappeared after surgery in all of our cases. The fourth intermetatarsal angle improved from $12.7^{\circ}$ to $3.1^{\circ}$ and the fifth metatarsophalangeal angle improved from $16.6^{\circ}$ to $2.3^{\circ}$. Conclusion: Diaphyseal oblique osteotomy of the fifth metatarsal appears to be a safe and satisfactory surgical procedure for treatment of symptomatic bunionette.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.1-8
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• 2005

Purpose: We compared the bony arrangements of the forefoot in 2 different years, 1982 and 2004, to determine any changes with time period of 22 years. Materials and Methods: The radiographs of 200 normal Korean adults, 100 male and 100 female volunteers, were evaluated both in 1982 and 2004. The radiographic results were evaluated with as follows; hallux valgus angle (HVA), intermetatarsal angle (IMA), morphology of metatarsal head and relative anterior protrusion of the metatarsals and the phalanges. The mean ages were 38 years (23-52years) in 1982, and 37 years (24-50years) in 2004. Results: The mean of HVA decreased from 15.6 degrees in 1982 to 14.3 degrees in 2004 (p=0.047), and the mean of IMA increased from 8.0 degrees in 1982 to 9.4 degrees in 2004 (p=0.031). The morphology of metatarsal head and relative anterior protrusion of the metatarsals and the phalanges were not different between the two study years. Conclusion: Comparing with those of 1982 measurements, we found an increase of IMA and a decrease of HVA. A prospective study may be needed to illuminate course of the changes.

• The Research Journal of the Costume Culture
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• v.25 no.2
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• pp.175-191
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• 2017

The purpose of this study is to analyze the body mass index(BMI) and foot characteristics of senior-generation women and to use those values to develop a standard shoe last for producing shoes that best fit the foot of senior-generation women. In order to develop a standard shoe last that reflects the BMI and foot characteristics of senior-generation women, I analyzed the morphometric characteristics of feet by conducting descriptive statistics for each item. The foot characteristics based on BMI were analyzed by conducting ANOVA and Duncan's tests via the foot's measured values. Subsequently, I developed a standard shoe last reflecting the BMI and the foot characteristics of senior-generation women by applying all those values. Senior-generation women showed significant differences among three groups based on BMI-normal weight, overweight, and obese-in all the items except for medial ball width and toe 5 angle. Through these values, I realized that as the value of the BMI becomes higher, the size of the foot becomes larger. This suggests that as a woman's weight increases or decreases, her shoes need to be replaced as well as her clothes. Deviations in the toe-side parts of the shoe could cause deformation of the foot. If someone keeps wearing shoes produced using a shoe last with a large deviation, she risks developing foot conditions like hallux valgus. This situation points to the need for shoe manufacture that utilizes a standard shoe last that reflects the BMI and foot characteristics of the senior generation.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.2
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• pp.121-128
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• 2020

PURPOSE: This study examined the changes in the cross-sectional area (CSA) of the abductor hallucis muscle during various ankle positions while performing toespread-out (TSO) exercise. METHODS: Thirty subjects with an average age of 22.1 years were recruited for this study. All subjects were firstly measured for the angle of their first metatarsophalangeal joint using a goniometer. Those with angles greater than 15° were allocated to the HV group. The remaining subjects were placed in the normal group. The CSA of the abductor hallucis was measured by ultrasound in the resting position with no movement and three ankle positions: neutral (0°), plantarflexion (30°), and dorsiflexion (30°). All data were analyzed using a two-way mixed analysis of variance between the groups (normal and HV group) and within the groups (resting, neutral, plantarflexion, and dorsiflexion) to determine the group x position interaction effects. RESULTS: During TSO exercise in the normal group, the CSA of the abductor hallucis was significantly greater in both the plantarflexion and neutral positions compared to the resting position (p_adj < .01), and plantarflexion was significantly greater than the dorsiflexion position (p_adj < .01). During the TSO exercise in the HV group, the CSA of the abductor hallucis for plantarflexion was significantly greater than it was for the resting, neutral, and dorsiflexion positions (p_adj < .01). CONCLUSION: Based on the above results, the TSO exercise in plantarflexion is an effective rehabilitation exercise for subjects with HV.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.5-10
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• 2010

Purpose: This study was performed to compare the contact area between three different correcting angles after the proximal crescentic and Ludloff osteotomies of the first metatarsal. Materials and Methods: We used the two sawbone models. Proximal crescentic (PCO) and Ludloff osteotomies (LO) were performed and secured using K-wires under the correcting intermetatarsal angle (IMA) $5^{\circ}$, $10^{\circ}$, and $15^{\circ}$. Then each 6 osteotomized model was scanned five times and measured the contact area using the calculating program. We excluded the highest and lowest values. Results: The mean area of cutting surface was 189 $mm^2$ in PCO, 863 $mm^2$ in LO. The mean contact area (contact ratio; contact area $\times$100/area of cutting surface) of PCO was 149 $mm^2$ (79%) in $5^{\circ}$, 139.5 $mm^2$ (74%) in $10^{\circ}$, 107 $mm^2$ (57%) in $15^{\circ}$ IMA. The mean contact area (contact ratio) of LO was 711 $mm^2$ (82%) in $5^{\circ}$, 535.5 $mm^2$ (62%) in $10^{\circ}$, 330 $mm^2$ (38%) in $15^{\circ}$ IMA. Conclusion: A significant decrease in the contact area and contact ratio according to increase in correcting IMA was noticed in LO. We recommend the PCO rather than LO, when the IMA is needed to correct over $15^{\circ}$.