• 대한족부족관절학회지
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• 제18권2호
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• pp.43-47
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• 2014

Hallux valgus is a lateral deviation of the first phalanx and medial deviation of the first metatarsal at the first metatarsophalangeal (MP) joint. Its incidence has increased due to developing footwear. The etiologies include fashion footwear, genetic causes, anatomical abnormality around the foot, rheumatoid arthritis, and neuromuscular disorders. Physiologic alignment of the first MP joint is maintained by congruent and symmetric alignment of the articular surface of the first proximal phalanx and first metatarsal head, physiologic relationship of the distal first metatarsal articular surface and the first metatarsal shaft axis, and stable balance of soft tissue around the first MP joint and stable tarsometatarsal joint. Several factors have been associated with hallux valgus, including pes planus, hypermobility of the first tarsometatarsal joint, flattened shape of the first metatarsal head, increased distal metatarsal articular angle, and deformation of the medial capsular integrity. History and physical examination are very important to diagnosis of hallux valgus. Simple radiography provides information on deformity, particularly in weight-bearing anteroposterior and lateral radiographs. Understanding the etiologies and pathophysiology is very important for success in treatment of patients with hallux valgus.

• 대한족부족관절학회지
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• 제12권1호
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• pp.20-25
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• 2008

Purpose: The purpose of this study is comparison of radiological and clinical outcomes between proximal metatarsal osteotomy and distal chevron osteotomy for the correction of hallux valgus. Materials and Methods: In this retrospective study, we included subjects who underwent the correction of hallux valgus in our institution between March 2001 and August 2006, with a minimum follow-up of 12 months. The group of proximal metatarsal osteotomy was 23 patients (34 feet); the group of distal chevron osteotomy was 20 patients (26 feet). The group of proximal metatarsal osteotomy was composed of 26 severe cases (76.5%) and 8 moderate cases (23.5%); the group of distal chevron osteotomy was composed of 13 severe cases (50.0%) and 13 moderate cases (50.0%). Results: Compared to preoperative values, the hallux valgus angle, the first-second intermetatarsal angle and the distance of first-fifth metatarsal head were significantly decreased in two groups (p<0.05). In each parameter, the hallux valgus angle was decreased 66.3% (proximal metatarsal osteotomy) versus 49.6% (distal chevron osteotomy), which were significant (p=0.037). The first-second intermetatarsal angle and the distance of first-fifth metatarsal head were not significant. Mayo clinic forefoot scoring system (FFSS) score was significantly improved in two groups (p<0.05). The ratio of improvement was not significant (p=0.762). In severe group, hallux valgus angle and the first-second intermetatarsal angle was significantly decreased in proximal metatarsal osteotomy group compared to distal chevron osteotomy group (p<0.05), but the difference of the distance of first-fifth metatarsal head and FFSS score was not significant in both groups. In moderate group, the difference of all parameters was not significant in both groups. Conclusion: Although both proximal metatarsal osteotomy and distal chevron osteotomy showed satisfactory result in FFSS, proximal metatarsal osteotomy was more proper operative technique than distal chevron osteotomy in severe group, because of superiority of correction in radiological parameters.

• 대한족부족관절학회지
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• 제17권1호
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• pp.1-10
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• 2013

The bunionette, or a 'tailor's bunion', is a lateral bony prominence of the fifth metatarsal head. A bony deformity itself rarely causes symptom but if a painful inflammation of the overlying soft tissue is accompanied, it needs treatment. Conservative care using a shoe modification, padding, or orthosis is effective in most cases. Surgical management is indicated when the conservative methods have failed to improve symptoms, and the techniques include exostectomy, metatarsal osteotomies (distal, diaphyseal, or proximal), metatarsal head resection or fifth ray resection. We reviewed the etiology, clinical features, radiographic classification, nonoperative and operative treatments of the bunionette.

• 대한족부족관절학회지
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• 제17권2호
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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.

• 대한족부족관절학회지
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• 제8권2호
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• pp.142-148
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• 2004

Purpose: We compared the results of three surgical procedures of the old neglected Freiberg's disease that was managed with metatarsal head reshaping, metatarsal head resection, and dorsal closing wedge osteotomy. Materials and Methods: From march 1996 to July 2002, five cases in six patients whose metatarsal head collapse already progressed underwent operative treatment. We compared the operative results in the view point of the radiographic follow-up and lesser toe metatrasophalangeal joint scale of AOFAS. Results: There were no further joint destruction and loose body formation. Also, lesser toe metatrasophalangeal joint scale of AOFAS improved from average score, 38.5 (range $22{\sim}49$) of preoperative one to average score, 86.6 (range, $72{\sim}100$). Especially, the 2 cases that underwent dorsal closing wedge osteotomy showed most favorable result and the 2 cases with metatarsal resection showed next favorable result. The 2 cases with intra-articular loose body removal and metatarsal reshaping showed the least effective result among three operative methods. Conclusion: Our Operative experiences of old neglected Freiberg's disease were all satisfactory irrespective of operative options and dorsal closing wedge osteotomy was thought to be most effective method.

• 대한관절경학회지
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• 제11권1호
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• pp.59-62
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• 2007

Freiberg 병은 비교적 드문 골연골증으로 주로 사춘기 여자의 제2 중족골 두에서 발생한다. 그 치료는 다양하여 관절내 유리체 제거술, 골두 절골술 또는 골두 절제술 등의 수술이 시도되고 있다. 관절경을 이용한 치료는 회복 기간을 단축시키는 동시에 술후 발생하는 강직을 감소시키는 장점이 있다. 저자들은 초기의 Freiberg 병에 대해 중족지 관절경을 이용하여 유리체 제거술 및 변연절제술을 시행하고 그 결과를 보고하고자 한다.

• 대한족부족관절학회지
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• 제14권1호
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• pp.31-35
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• 2010

Purpose: Painful plantar callosities under the second, third or fourth metatarsal head have been controverted about its treatment mordalities. We performed the vertical chevron osteotomy in patients with painful callosities on the second and third metatarsal head, and evaluated the outcome clinically. Materials and Methods: Fourteen cases from 10 patients who had plantar keratosis were operated by vertical chevron osteotomy from March 2005 to October 2008. We used K-wire fixation for all cases. We evaluated the clinical results by the patients' satisfaction and disappearance of plantar lesion. Results: The plantar keratosis was completely disappeared in 8 cases and partially in 5 cases. In 2 cases, patients expresses their pain caused by constant metatarsalgia that was suspected to be dorsal incisional pain and joint capsulitis. Transmetatarsalgia was not appeared. Conclusion: We consider vertical chevron osteotomy as a good surgical method for treatment of plantar keratosis.

• 대한족부족관절학회지
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• 제17권2호
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• pp.154-160
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• 2013

The treatment of open, traumatic intraarticular injuries to the metatarsophalangeal joint with severe articular comminution and cartilage defect of metatarsal head is a challenge to the foot surgeon. We report the joint reconstruction treating the injured joint by autogenic costal osteochondral graft with satisfactory outcome.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2005년도 추계학술대회 논문집
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• pp.260-263
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• 2005

In this study, we analyzed the plantar shear stress and pressure of diabetic foot patients during walking by using in-shoe local shear force and plantar pressure measurement system. Twelve normal subjects and three diabetic foot patients with diabetic neuropathy in lateral heel were participated in this study. The center of pressure in diabetic foot patients moved more medially and directed toward 1st, 2nd metatarsal heads and hallux during late stance period, making pressure at the medial heel and 2nd metatarsal head significantly higher than in the normal. Shear stress at the heel were changed significantly in early stance and the magnitude of shear stresses in each metatarsal head were also changed. Further studies would be very helpful to design foot orthoses in patients with diabetic neuropathy or other diseases.

• 대한족부족관절학회:학술대회논문집
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• 대한족부족관절학회 2009년도 춘계학술대회
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• pp.8-8
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• 2009