• 대한족부족관절학회지
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• 제1권2호
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• pp.75-80
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• 1997

정상 아동 124명에서 족부 단순방사선촬영 소견에서 편평족과 관련하여 방사선학적 계측치를 나이에 따라 비교한 결과 나이가 어릴수록 대부분이 편평족 소견을 보였고 나이가 많아짐에 따가 차츰 발아치가 형성되어 13세 이후에는 대부분의 예에서 성인과 비슷한 소견을 보였다. 따라서 아동에서는 방사선학적 계측에서 편평족 소견을 보이더라도 이를 치료할 필요가 있을지 결정하는데는 임상 소견이 더 중요할 것으로 사료된다. 본 연구는 정상아동에 대한 횡적 조사연구이므로 향후 종적 조사를 시행하면 나이에 따른 발아치의 변화를 좀 더 정확하게 파악할 수 있을 것으로 사료된다.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.232-237
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• 2013

Background Polydactyly of the foot is one of the most frequent anomalies of the limbs. However, most classification systems are based solely on morphology and tend to be inaccurate and less relevant to surgical methods and results. The purpose of this study is to present our new classification of polydactyly of the foot, which can serve as a predictor of treatment and prognosis. Methods To find a correlation between the various morphologic traits of polydactyly of the foot and the treatment plan and outcomes, we reviewed 532 cases of polydactyly of the foot in 431 patients treated in our hospital, expanding on our previous study that described polydactyly based on the importance of metatarsal bone status and varus deformity. The records of patients were evaluated and compared with previous studies at other centers. Results Unsatisfactory results were seen in 36 cases, which included 5 cases of incomplete separation due to syndactylism, 23 cases of axis deviation, and 8 cases of remnants of extradigit metatarsal bones. The locus of the polydactyly, or the digit which was involved, did not seem to affect the final postoperative outcomes in our study. Three factors-syndactylism, axis deviation, and metatarsal extension-are the major factors related to treatment strategy and prognosis. Therefore, we developed a new classification system using three characters (S, A, M) followed by three groups (0, 1, 2), to describe the complexity of polydactyly of the foot, such as $S_1A_2M_2$. Conclusions Our new classification could provide a communicable description to help determine the surgical plan and predict outcomes.

• 대한족부족관절학회지
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• 제16권4호
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• pp.235-240
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• 2012

Purpose: The aim of this study was to evaluate the radiographic and clinical results of short scarf osteotomy that has minimized longitudinal cut for moderate hallux valgus. Materials and Methods: Total 12 patients (12 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 41.5 years. The mean followup time was 21.2 months. We modified original scarf osteotomy by shortening the longitudinal cut to 15~20 mm in length. Additionally, Akin osteotomy of the first proximal phalanx was done in 7 feet and Weil osteotomy of the second metatarsal was done in 4 feet. First-second intermetatarsal and hallux valgus angles were analyzed radiographically before and after the operation. And the clinical result was assessed by AOFAS (American Orthopaedic Foot and Ankle Society) hallux score. Results: First-second intermetatarsal and hallux valgus angles were reduced from the mean preoperative values of $14.6^{\circ}$ and $32.8^{\circ}$ to $6.5^{\circ}$ and $11.2^{\circ}$, respectively. The mean AOFAS hallux score was increased from 52.4 points preoperatively to 88.2 points at followup. Three complications were found: metatarsal fracture during the operation, painful scar around second metatarsal head after Weil osteotomy and postoperative neuralgia. There was no transfer metatarsalgia or recurrence of hallux valgus during followup. Conclusion: Short scarf osteotomy would be an effective surgical procedure for moderate hallux valgus with the benefits of minimized soft tissue dissection and stable fixation.

• 대한족부족관절학회지
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• 제16권4호
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• pp.223-228
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• 2012

Purpose: To treat hallux valgus in old age patients with chevron metatarsal osteotomy and to see the subsequent clinical and radiological outcomes. Materials and Methods: 23 cases of 18 hallux valgus patients of age 60 years or older who received proximal or distal corrective osteotomy from April 2007 to August 2009 and were followed up for at least 1 year were included in the study. The mean age at operation was 65 years (range, 60~81 years), and the mean follow-up period was 2 years and 6 months (range, 1 year~3 years 6 months). Clinical outcome was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, satisfaction rate, as well as measurements and comparison of pre- and postoperative hallux valgus angles, the 1st~2nd intermetatarsal angle, and the position of hallucal medial sesamoid bone. Results: The AOFAS score was improved from preoperative average of 35.1 (range, 13-47) to average 85.1 at last follow-up (range, 75-100). Patients were satisfied about the operation in 21 cases (91.3%). Preoperative hallux valgus angle was $31.7^{\circ}$ on average (range, $19.1^{\circ}-48.9^{\circ}$), and $4.9^{\circ}$ on average at last follow-up (range, $0.3^{\circ}-21.2^{\circ}$). The 1st~2nd intermetatarsal angle was $14.4^{\circ}$on average (range, $8.7^{\circ}-25.7^{\circ}$) and $3.1^{\circ}$ on average at last follow-up (range, $0.6^{\circ}-7.5^{\circ}$). The hallucal medial sesamoid bone position was improved from preoperative average 3.5 (range, 3-4) to postoperative average 1.0 (range, 0-2). Conclusion: Proximal and distal metatarsal osteotomy treatment yielded good clinical and radiological outcomes in old age hallux valgus patients.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.479-483
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• 2018

Background: We developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies. Methods: Between December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated. Results: The mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of $32.2^{\circ}$ and $14.3^{\circ}$, respectively, to an average of $12.5^{\circ}$ and $8.6^{\circ}$, respectively. The distal metatarsal articular angle improved from an average of $18.7^{\circ}$ to $12.4^{\circ}$. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of $4.1^{\circ}$ to $7.1^{\circ}$. Conclusions: The modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.

• 대한족부족관절학회지
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• 제21권1호
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• pp.7-11
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• 2017

Purpose: We retrospectively analyzed the radiographic and clinical results after the first ray of forefoot osteotomy using low profile wedge plate without additional cancellous bone grafting for pes planus correction. Materials and Methods: Twenty-four patients were enrolled in this study. Medial cuneiform opening wedge osteotomy was performed in 12 patients (Cotton osteotomy, group C) and first metatarsal base osteotomy was performed in 12 patients (group MT). Results: On average, the wedge size was 5.61 mm (5~6 mm). The mean time to radiographic union was 3.18 and 3.27 months in groups C and MT, respectively. Postoperative talonavicular coverage angle, talo-first metatarsal angle (anteroposterior), talo-first metatarsal angle (lateral), talo-calcaneal angle (lateral), medial cuneiform height, and American orthopaedic foot, as well as ankle society midfoot scale were significantly improved in both groups. Nonunion, delayed union or fixation failure was not presented in our series. Conclusion: We have shown that low profile wedge plate was effective in the case of first ray forefoot osteotomy for pes planus correction without any additional cancellous bone grafting.

• 한국운동역학회지
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• 제14권2호
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• pp.105-119
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• 2004

To enhance our understanding of the loads on the foot during treadmill running, we have used a pressure-sensitive insole system to determine pressure, rate of loading and impulse distributions on the plantar surface during treadmill running, both in minimally cushioned footwear and in cushioned shoes. This report includes pressure, rate of loading, impulse and contact time data from a study of ten subjects running on a treadmill at 4.0m/s. Among heel-toe runners, the highest peak pressures and highest rates of loading were observed under the centre of the heel and in the medial forefoot. The arch regions were only lightly loaded. Contact time was greater in the forefoot than in the heel. Two-thirds of the impulse recorded during the step was the result of forces applied through the forefoot, mostly in the region of the metatarsal heads. The distribution of loads in the shoe suggests that the load distributing properties of the cushioning system are most important in the centre of the heel, under the metatarsal heads and great toe. Shock attenuation is primarily required under the centre of the heel and to lesser extent under the metatarsal heads. Some energy dissipation may be desirable in the heel region because it causes shock to be absorbed with less force. All the 'propulsive' effort is applied through the forefoot. Therefore, this region should as resilient as possible.

• 대한족부족관절학회지
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• 제3권1호
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• pp.53-57
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• 1999

Polydactyly is the most common congenital deformity of the foot. The authors present an unusal case of polydactyly of the foot in an otherwise healthy adult male. The patient has an mixed type of polydactyly composed of polysyndactyly of the first toe, Y shaped second metatarsal and polysyndactyly with the fusion to the forth toe of the fifth toe. Meticulous. preoperative plan was prepared and performed at the operation. Main procedures were as follows : 1) Excision of extradigit of first toe and first metatarsocuneiform joint fusion. 2) Excision of lateral bud of second metatarsal and plantar-medial osteotomy of the medial bud. 3) Metatarsal head resection arthroplasty of third & forth metatarsophalangeal joint and 4) Excision of medial polydactyly of the fifth toe and syndactyly release and split thickness skin graft. Postoperatively, The forefoot width was reduced from 11.5 to 9.5cm and the pain was relieved.

• 한국전문물리치료학회지
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• 제9권1호
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• pp.63-68
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• 2002

Foot ulceration results in substantial morbidity in patients with peripheral neuropathy. The purpose of this study was to find the relationship of plantar foot pressures during walking to plantar ulceration in patients with Hansen's disease. The subjects were recuruited from two Welfare Clinic for Hansen's disease in Wonju and Uiwang city. Ten subjects (5 females, 5 males) with plantar ulceration and a mean age of 63 years were evaluated in this study. The mean duration of Hansen's disease in these subjects was 30 years. Plantar pressures were measured during self-selected comfortable walking speed by using MatScan system. Three subjects had plantar ulceration under the first metatarsal head. Five subjects had plantar ulceration under the second and third metatarsal head. Two subjects had plantar ulcers under the fifth metatarsal head. Eight of 10 subjects had plantar ulceration at highest pressure point that measured during walking. This result suggests that the abnormal high plantar pressure could be related factor to plantar ulceration in patients with Hansen's disease. Also the foot pressure measurement may be useful to evaluate the risk of plantar ulceration in patients with Hansen's disease.

• 대한족부족관절학회지
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• 제10권2호
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• pp.156-162
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• 2006

Purpose: To evaluate the results and effectiveness of distal chevron osteotomy combined with lateral soft tissue release for the correction of hallux valgus deformity. Materials and Methods: 31 patients who underwent distal chevron osteotomy with lateral soft tissue release between July 2002 and June 2003, were analyzed in terms of hallux valgus angle, intermetatarsal angle, subluxation of sesamoid, AOFAS score and the occurrence of avascular necrosis of the first metatarsal head. Results: The mean amount of the correction of hallux valgus angle was $26.3^{\circ}$. The mean amount of the correction of intermetatarsal angle was $6.6^{\circ}$. The mean amount of the correction of sesamoid subluxation was 1.2 points. The mean improvement of AOFAS score was 25.8 points. Avascular necrosis of the first metatarsal head was not found in any cases. Conclusion: For correction of hallux valgus deformity, distal chevron osteotomy with lateral soft tissue release showed improvement of hallux valgus angle, sesamoid subluxation and AOFAS score with no evidence of avascular necrosis of the first metatarsal head.