• Journal of Korean Foot and Ankle Society
• /
• v.10 no.2
• /
• pp.223-229
• /
• 2006

Purpose: The purpose of this study was to analyze the results of the treatment of hallux valgus with metatarsal double osteotomy and longitudinal pin fixation. Materials and Methods: We reviewed 19 patients (21 feet) who had been treated by metatarsal double osteotomy and longitudinal pin fixation for the moderate or severe hallux valgus with increased distal metatarsal articular angle (DMAA), between 1999 and 2004. They were followed prospectively for a minimum of 20 months. Functional outcomes were measured via Hallux metatarsophalangeal-Interphalangeal (HMI) scale and Mayo clinic forefoot scoring system (FFSS). Radiographically, we assessed pre, postoperative and at the last follow-up, the hallux valgus angle (HVA), 1st and 2nd intermetararsal angle (IMA), DMAA. Results: The average preoperative HVA, IMA, DMAA measured $36.76^{\circ}$, $13.62^{\circ}$, $26.00^{\circ}$, respectively. At the last follow-up, HVA, IMA, DMAA measured $9.57^{\circ}$, $7.14^{\circ}$, $9.33^{\circ}$. The correction of HVA, IMA, DMAA were $27.19^{\circ}$, $6.48^{\circ}$, $6.67^{\circ}$. At the last follow-up, there were no recurrences and complications, except two patients complained of unsatisfactory stiffness in the 1st metatarsophalangeal joint and subjectively rated their results as fair. The others rated that as excellent or good. At the last follow-up, statistically, the mean HMI scale and FFSS improved significantly from pre-operative score. Conclusions: In the treatment of moderate or severe hallux valgus with increased DMAA by metatarsal double osteotomy and longitudinal pin fixation, we had good functional and radiological results without recurrences and significant complications. But the stiffness in the 1st metatarsophalangeal joint warrants further study.

• Journal of Korean Foot and Ankle Society
• /
• v.8 no.2
• /
• pp.121-125
• /
• 2004

Purpose: We try to retrospectively evaluated the amount of dorsal angulation angle of the first metatarsal commonly occurring as the complication of proximal dome osteotomy for hallux valgus. Materials and Methods: Between January 2004 and March 2004, 34 patients who underwent proximal dome osteotomy for moderate to severe hallux valgus. Two of 34 patients were male, and thirty-two were female. The average age was 57.6 years. We measured and compared hallux valgus angle, 1st-2nd intermetatarsal angle, dorsal angulation angle of 1st metatarsal on preoperative, postoperative, postoperative 3 weeks', postoperative 3 months' X-ray. Results: Osteotomy sites were completely united on plane X-ray in all cases. The hallux valgus angle averaged $41.2^{\circ}$ ($30{\sim}60^{\circ}$) at preoperative, $4.3^{\circ}$ ($-10{\sim}20^{\circ}$) at postoperative, $5.5^{\circ}$ ($-1{\sim}20^{\circ}$) at 3 weeks after operation, $7.8^{\circ}$ ($-2{\sim}20^{\circ}$) at 3 months after operation. The 1st-2nd intermetatarsal angle averaged $17.1^{\circ}$ ($12{\sim}24^{\circ}$) at preoperative, $6.3^{\circ}$ ($0{\sim}13^{\circ}$) at postoperative, $7.2^{\circ}$ ($0{\sim}15^{\circ}$) at 3 weeks after operation, $8.7^{\circ}$ ($0{\sim}18^{\circ}$) at 3 months after operation. The dorsal angulation angle averaged $0.4^{\circ}$ ($0{\sim}3^{\circ}$) at postoperative, $1.6^{\circ}$ ($0{\sim}7^{\circ}$) at 3 weeks after operation, $2.1^{\circ}$ ($0{\sim}8^{\circ}$) at 3 months after operation. There were no statistically correlation between increase of dorsal angulation angle of the distal segment of the first metatarsal and increase of hallux valgus angle or 1st-2nd intermetatarsal angle. Conclusion: Our results shows that the dorsal angulation of distal fragment occurring after the proximal dome osteotomy in the treatment of hallux valgus may be minimized with meticulous surgery and patient's education.

• Journal of Korean Foot and Ankle Society
• /
• v.13 no.1
• /
• pp.1-6
• /
• 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
• /
• v.21 no.3
• /
• pp.88-92
• /
• 2017

Purpose: The objective of this study was to confirm the results of the modified Lapidus procedure on moderate to severe hallux valgus patients with first tarso-metatarsal joint hypermobility. Materials and Methods: A retrospective study was conducted on 42 cases of 35 patients who underwent the modified Lapidus procedure between March 2006 and December 2014. A comparative analysis was performed on the preoperative and postoperative subjective satisfaction of patients and radiologic index. Moreover, the correlation between the follow-up time and patient's operative satisfaction, as well as between the proficiency of the operator and patient's operative satisfaction was analyzed. Complications were also evaluated. Results: Out of the total of 35 patients, 3 were male and 32 were female. The mean age was 61.3 years (range, 34~79 years), and the mean follow-up time was 22.1 months (range, 6~90 months). The overall satisfaction level was 67.6% and the mean hallux valgus angle improved from preoperative $40.5^{\circ}$ to postoperative $12.2^{\circ}$ (p<0.001). The mean 1, 2 intermetatarsal angle improved from preoperative mean of $16.9^{\circ}$ to postoperative mean of $7.6^{\circ}$ (p<0.001), and the sesamoid position improved significantly, from preoperative 2.7 to postoperative 0.9 (p<0.001). Furthermore, there was no correlation between the follow-up time and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux scale; also no correlation between the year the operation took place and the AOFAS hallux scale. In terms of complications, we observed screw irritation in 6 cases, hallux varus in 2 cases, and recurrence of hallux valgus and nonunion in one case. Conclusion: Contrary to our concerns, the level of complications was not high; however, the satisfaction level of patients was also not very high. Therefore, careful selecting of patients and sufficient consultation time is needed before surgery. In addition, since the causes of postoperative dissatisfaction still remain unclear, further studies are necessary.

• Journal of Korean Foot and Ankle Society
• /
• v.9 no.1
• /
• pp.64-68
• /
• 2005

Purpose: The purpose of this study was to evaluate the outcome of Ludloff osteotomy for treatment of hallux valgus with regard to patient satisfaction and clinical and radiological results. Materials and Methods: 43 feet of 28 patients underwent Ludloff osteotomy between January 2003 and August 2003. 21 patients (32 feet) who were available for follow up for more than one year were enrolled in this study. Average follow up period was 16 months. All patients were female and the average age was 51 years ranging 28 years to 72 years. Patient satisfaction was assessed and VAS (Visual Analogue Scale) was used for subjective outcome, AOFAS (American Orthopaedic Foot and Ankle Society) score and presence of metatarsalgia were used for clinical outcome, and hallux valgus angle and intermetatarsal angle were used for radiological outcome assessment. Results: Patient satisfaction regarding cosmesis was excellent in 6 cases, good in 21 cases, fair in 4 cases and poor in 1 case. VAS was improved from preoperative 6 points to postoperative 2 points and AOFAS score was improved from preoperative 53 points to postoperative 82 points. Metatarsalgia was observed in 18 cases preoperatively and 9 cases postoperatively. HVA and IMA were 35.8 and 15.2 degrees preoperatively, 12.5 and 6.6 degrees at 3 months follow up, and 13.2 and 7.1 degrees at last follow up respectively. At the last follow up, loss of angle of correction for HVA was 0.7 degrees and for IMA was 0.5 degrees. Conclusion: Ludloff osteotomy is an appropriate surgery of moderate to severe hallux valgus.

• Journal of Korean Foot and Ankle Society
• /
• v.12 no.1
• /
• pp.26-30
• /
• 2008

Purpose: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 59 patients (81 feet) 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. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. Results: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was $3.21{\pm}1.7$ and group B $1.76{\pm}1.0$. Preoperative mean AOFAS score of group A was $45.61{\pm}8.3$, group B $44.41{\pm}8.9$, the final mean score of group A was $88.87{\pm}8.3$ and group B $92.47{\pm}4.4$. Preoperative mean HVA was $30.82{\pm}6.6$ degrees in group A and $32.88{\pm}14.5$ degrees in group B, the final mean angle of group A was $14.89{\pm}8.3$ degrees and group B $17{\pm}4.4$ degrees. The preoperative mean IMA of group A was $13.69{\pm}3.6 $degrees and group B $12.35{\pm}5.2$, the final mean angle of group A was $9.26{\pm}3.6$ degrees and group B $12.35{\pm}5.8$ degrees. Conclusion: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.

• Journal of Korean Foot and Ankle Society
• /
• v.15 no.2
• /
• pp.62-67
• /
• 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.

• Journal of Korean Foot and Ankle Society
• /
• v.8 no.1
• /
• pp.31-38
• /
• 2004

Purpose: The purpose of the study was to identify the subtypes of idiopathic osteoarthritis of the tarsometatarsal joints based on accompanying hindfoot, midfoot, or foot deformities and their corresponding surgical options and also to evaluate the overall clinical results. Materials and Methods: The study included 59 patients (67 feet) with idiopathic tarsometatarsal joint osteoarthritis. Tarsometatarsal fusion was performed for tarsometatarsal joint and accompanied secondary change was divided into subtypes and various bony reconstruction was carried out. The patients were evaluated with the AOFAS midfoot score and FFI. The average patient age was 60.2 years with 40.6 months follow-up. Fifty-four feet (80.6%) had been treated with realignment fusion. Twenty-six feet had first and second tarsometatarsal joint fusion, and 20 feet had first tarsometatarsal fusion only. Six subtypes were identified based on associated foot deformities: 1) in-situ without deformities (18%), 2) pes planovalgus (45%), 3) rockerbottom (15%), 4) cavus foot (1%), 5) hallux valgus (12%), and 6) hallux valgus with pes planovalgus or rockerbottom (9%). Plantar-medial closing-wedge resection was used in 10 feet to correct rockerbottom. For pes planovalgus, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Hallux valgus was corrected with the Lapidus procedure (85.7%). Results: AOFAS midfoot scores improved from preoperative 34.1 points to postoperative 83.9 points (p<0.05). The Foot Function Index postoperatively also showed significant improvement (p<0.05), with a high satisfaction rate (86.6%). There were 29 complications, most commonly sesamoid pain. Conclusion: Idiopathic tarsometatarsal OA feet can be classified into six categories. Pes planovalgus feet should be treated with medial sliding calcaneal osteotomy, lateral column lengthening, or triple arthrodesis in addition to tarsometatarsal joint realignment fusion. Rockerbottom and hallux valgus deformities should also be addressed.

• Journal of Korean Foot and Ankle Society
• /
• v.9 no.1
• /
• pp.74-80
• /
• 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.

• Journal of Korean Foot and Ankle Society
• /
• v.9 no.1
• /
• pp.87-93
• /
• 2005

Purpose: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. Materials and Methods: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. Results: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was $23.8^{\circ}$ and $6.6^{\circ}$, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. Conclusion: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.