• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.1-6
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• 2009

Purpose: To study the reliability of intra- and interobserver reliability in angular measurement of hallux valgus deformity by assessing hallux valgus angle (HVA) and the 1st to 2nd intermetatarsal angle (1-2 IMA) through using computerized system. Materials and Methods: 20 cases of moderate to severe hallux valgus patients were included in this study. With the standing anteroposterior view of foot, the HVA and 1-2 IMA were calculated by computerized measurement system of Infinity cooperation, called ${\pi}$-view, with its software tools. Using the statistical software program, SPSS (version 12th), we interpreted the results which were measured by two independent observers. Results: In the intraobserver measurement, the HVA of observer A showed reliability ($32.5^{\circ}{\pm}6.9$ and $33.1^{\circ}{\pm}6.8$)(p<0.05). 1-2 IMA in observer A was not regarded as reliable ($16.9^{\circ}{\pm}2.8$ and $17.1^{\circ}{\pm}2.8$)(p>0.05). In the results of observer B, HVAs were measured as $35.7^{\circ}{\pm}7.6$ and $36.2^{\circ}{\pm}7.7$, and were not reliable (p>0.05). 1-2 IMA in observer B was not reliable as well ($17.0^{\circ}{\pm}0.8$ and $20.8^{\circ}{\pm}1.5$)(p>0.05). In the interobservers' measurements, the first and the second results of HVA were $3.2^{\circ}{\pm}3.6$ and $3.1^{\circ}{\pm}3.1$, reliable within the 95% confidence interval (p<0.05). 1-2 IMAs were $0.1^{\circ}{\pm}1.9$ and $3.73^{\circ}{\pm}1.3$, which were not reliable (p>0.05). Conclusion: In the angular measurement of the hallux valgus by computerized system, the HVA and 1-2 IMA showed less error range in the interobserver's results, compared with the previous studies about the manual measurement. However, our results failed to show the statistical reliability of intra- and interobserver's measuring. Therefore, even the computerized angular measurements in the severity of hallux valgus require development of the measuring methods and software tools.

• Journal of Korean Foot and Ankle Society
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• v.17 no.2
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• pp.93-99
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• 2013

Purpose: Proximal metatarsal chevron osteotomy for hallux valgus is followed by significant amount of postoperative pain. Periarticular multimodal drug local injection can be an option for pain control. This study was attempted to evaluate the efficacy of the morphine as multimodal drug and to confirm the effect of periarticular multimodal drug local injection on controlling early postoperative pain. Materials and Methods: Between March 2012 and June 2012, 22 patients received proximal metatarsal chevron osteotomy for the correction of hallux valgus deformity. 10 patients (Group A) received periarticular injection of the test solution made with morphine, ropivacaine, ephinephrine and ketorolac. 12 patients (Group B) received periarticular injection of the test solution without morphine. The visual analog scale (VAS) was checked at 2, 4, 6, 8 hours, 1 day and 2 days each after surgery. Results: The VAS score at postoperative 2 hours to 1 day between two groups showed no significant difference, but the VAS score at postoperative 2 days was significantly higher in Group A compared to the VAS score of group B. The amount of additional pain control (tramadol HCL) between two groups showed no significant difference for 3 days after surgery. Conclusion: Periarticular multimodal drug local injection was effective in reducing pain after hallux valgus surgery regardless of mixing with morphine.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.154-158
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• 2019

Purpose: This study compared the radiographic and clinical outcomes of simultaneous bilateral short scarf osteotomy with those of unilateral short scarf osteotomy in hallux valgus patients. Materials and Methods: The authors undertook a retrospective chart and radiographic review between January 2015 and June 2017 to identify 15 patients (30 cases, group A) who underwent a simultaneous bilateral short scarf osteotomy. The patients were matched with 30 patients (30 cases, group B) with a unilateral short scarf osteotomy. No significant preoperative differences were observed between the two groups in terms of age, gender, American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and radiographic parameters. The clinical and radiographic follow-up was carried out at three months and one year. Results: Hallux valgus angles in groups A and B were reduced from the mean preoperative values of 32.5° and 34.7° to 12.5° and 12.2° at 12 months, respectively. The first-second intermetatarsal angles in groups A and B were also reduced from the mean preoperative values of 14.2° and 16.5° to 7.4° and 7.3° at 12 months, respectively. No significant inter-group differences in radiographic outcomes were observed. After three months, the patients in group A reported significantly worse mean pain and functional scores than group B. The mean AOFAS hallux score was higher in group B at the three-month follow-up, but this difference disappeared at the one-year followup. Conclusion: Simultaneous bilateral surgery can be offered to patients with a hallux valgus deformity requiring correction. On the other hand, they should be informed of the long recovery period.

• 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.129-134
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• 2020

Purpose: This study compared the results of proximal and distal chevron osteotomy in patients with severe hallux valgus. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include severe hallux valgus. Materials and Methods: This study analyzed 127 severe hallux valgus surgeries. Of these, 76 patients (76 feet) were excluded for lack of adequate follow-up and additional procedures (Akin procedure), leaving 51 patients (51 feet) in the study. The mean age of the patients was 58 years (21~83 years), and the mean follow-up duration was 18 months (12~32 months). The patients were divided into two groups. Group 1 underwent distal chevron osteotomy, and group 2 underwent proximal chevron osteotomy performed sequentially by a single surgeon. The patients were interviewed for the American Orthopaedic Foot and Ankle Society (AOFAS) score before and one year after surgery. The anteroposterior weight-bearing radiography of the foot was taken before and one year after surgery. Results: There were no significant differences in pain and function after one year in either group. Both groups experienced significant pain reduction and an increase in the AOFAS score. Significant improvement of the hallux valgus and intermetatarsal angle corrections was observed in both groups, and the sesamoid position was similar in each group. More improvement in radiographic correction of intermetatarsal angle was noted in group 2. Both procedures gave similar good clinical and radiological outcomes. Conclusion: This study suggests that a distal chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting severe hallux valgus as a proximal chevron osteotomy with a distal soft-tissue procedure.

• Journal of Korean Foot and Ankle Society
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• v.22 no.4
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• pp.181-183
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• 2018

Hallux valgus is a deformity that causes pain in the first metatarsophalangeal joint. Surgical methods are quite diverse and a range of osteotomies are used at the proximal and distal part of the metatarsal bone and proximal phalange. Fixation methods, such as plate, screw, K-wire, and others have been used in various ways. The fixation device is often removed with various side effects due to the fixation devices. In the case of instruments that are absorbed in vivo, these procedures are not necessary to remove and there is an advantage of not performing the second operation. Three patients were treated, in which a proximal chevron osteotomy was used with a bioabsorbable screw (K-$MET^{TM}$; U&I Corporation).

• Journal of Korean Foot and Ankle Society
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• v.21 no.3
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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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• v.24 no.4
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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.

• 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.