• Journal of Korean Foot and Ankle Society
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• v.19 no.3
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• pp.102-106
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• 2015

Purpose: We wanted to compare the results between cadaveric and radiological measurements of calcaneus. Materials and Methods: Sixty three calcaneus of 33 cadavers donated between December 2012 and December 2014 were actually measured. Computed tomography (CT) images of 244 calcaneus in 122 patients of the same age group with cadavers were radiologically measured. Maximum length, maximum width, maximum height, $B{\ddot{o}}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were measured. Results: In cadaveric measurement, the mean maximal height, length, and width were $41.8{\pm}3.3mm$, $73.3{\pm}3.4mm$, and $40.7{\pm}2.2mm$, respectively. In radiological measurement, the mean maximal height, length, and width were $38.5{\pm}4.3mm$, $74.0{\pm}5.7mm$, and $44.7{\pm}1.4mm$, respectively. In cadaveric measurement, the mean $B\ddot{o}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were $32.1^{\circ}{\pm}6.2^{\circ}$, $110.8^{\circ}{\pm}8.1^{\circ}$, $55.8^{\circ}{\pm}6.8^{\circ}$, and $59.7^{\circ}{\pm}4.6^{\circ}$, respectively. In radiological measurement the mean $B{\ddot{o}}hler$ angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were $32.6^{\circ}{\pm}3.8^{\circ}$, $113.7^{\circ}{\pm}5.7^{\circ}$, $62.2^{\circ}{\pm}3.9^{\circ}$, and $61.6^{\circ}{\pm}6.3^{\circ}$, respectively. The mean maximal height was significantly higher in the cadaveric measurement group (p<0.001) and the mean maximal length and width were significantly higher in the radiologic measurement group (p<0.001, p<0.001). The mean Gissane angle, Fowler-Philip angle, and $B{\ddot{o}}hler$ angle were significantly higher in the CT group (p=0.001, p<0.001, p=0.016, respectively). There was no significant difference in the mean tala-articular angle (p=0.352). Conclusion: Significant differences in length parameters were observed between the cadaveric measurement group and the radiologic measurement group. However, no significant differences in angular measurements were observed between the two groups. The authors carefully conclude that radiological measurement values may be different from actual values in the calcaneus.

• Journal of Korean Foot and Ankle Society
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• v.24 no.2
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• pp.87-93
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• 2020

Purpose: This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis. Materials and Methods: Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups. Results: The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months follow-up, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M. Conclusion: Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

• Journal of Korean Foot and Ankle Society
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• v.20 no.3
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• pp.112-115
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• 2016

Purpose: We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy. Materials and Methods: This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups. Results: The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0~2.11 cm) and 2.36 cm (1.60~2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group ($1.47{\pm}0.25cm$) than in the middle insertion group ($1.27{\pm}0.35cm$). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008). Conclusion: Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.

• Journal of radiological science and technology
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• v.29 no.4
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• pp.225-228
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• 2006

Purpose: Accurate clinical evaluation of the alignment of the calcaneus relative to the tibia in the coronal plane is essential in the evaluation and treatment of hindfoot pathologic condition. Previously described standard anteroposterior, lateral, and oblique radiographic methods of the foot or ankle do not demonstrate alignment of the tibia relation to the calcaneus in the coronal plane. The purpose of this study was to introduce hindfoot coronal alignment view. Material : 1) Both feet were imaged simultaneously on an elevated, radiolucent foot stand equipment. 2) Both feet stood on a radiolucent platform with equal weight on both feet. 3) Both feet are located foot axis longitudinal perpendicular to the platform. 4) Silhouette tracing around both feet are made, and line is then drawn to bisect the silhouette of the second toe and the outline of the heel. 5) The x-ray beam is angled down approximately $15^{\circ} to $20^{\circ} Result : 1) This image described tibial axis and medial, lateral tuberosity of calcaneus. 2) Calcaneus do not rotated. 3) The view is showed by talotibial joint space. Conclusion: Although computed tomographic and magnetic resonance imaging techniques are capable of demonstrating coronal hindfoot alignment, they lack usefulness in most clinical situations because the foot is imaged in a non-weight bearing position. But hindfoot coronal alignment view is obtained for evaluating position changing of inversion, eversion of the hindfoot and varus, valgus deformity of calcaneus.

• Journal of Nutrition and Health
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• v.38 no.7
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• pp.570-577
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• 2005

The purpose of this study was to investigate the effect of bone mineral density on life styles, dietary habits and nutrient intakes among the male college students. The subjects were divided into four groups; $Q_1$ (calcaneus BMD < 25 percentile, n = 117), $Q_2$ (25 percentile $\le$ calcaneus BMD < 50 percentile, n = 118), $Q_3$ (50 percentile $\le$ calcaneus BMD < 75 percentile, n = 118) $Q_4$ (calcaneus BMD $\ge$ 75 percentile, n = 116). And they were asked about general characteristics, life style, dietary habit, and nutrient intake using questionnaire and 24-hr recall method. They were measured the bone mineral density of calcaneus using quantitative ultrasound. The average age of the subjects of the study was 23.0 yews and the average height, weight, and BMI were 174.7 cm, 69.0 kg, $22.5 kg/m^2$. The bone mineral density in calcaneus was $0.43 g/cm^2$ in $Q_1,\;0.50 g/cm^2$ in $Q_2,\;0.56 g/cm^2$ in $Q_3$, and $0.69 g/cm^2$ in $Q_4$ (p < 0.001). The results showed that $Q_1$ tended to have irregular exercise compared to the other three groups. Compared with $Q_1$ and $Q_2$, the frequency of skipping breakfast was lower in $Q_3$ and $Q_4$. Also the results showed that the $Q_4$ was significantly more often to drink coffee compared with the other three groups (p < 0.01). The mean daily energy intake was 2210.6 kcal ($88.4\%$ of RDA). The intake of energy, vitamin $B_2$, calcium, and zinc did not meet the Korean RDA. Also the $Q_2$consumed significantly lower intakes of protein (p < 0.05) and plant protein (p < 0.05) compared to the $Q_3$ and $Q_4$. The $Q_1$ and $Q_2$ consumed significantly lower intakes of vitamin $B_2$ (p < 0.01) compared to the $Q_3$ and $Q_4$. In conclusion, male student in lower bone mineral density appeared to have unhealthy life styles and dietary habits in terms of irregular exercise, high frequency of skipping breakfast and lower intakes of protein, vitamin $B_2$ showing a strong need proper education on meal practices and exercise habits for the bone health.

• Journal of Korean Foot and Ankle Society
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• v.5 no.2
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• pp.156-159
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• 2001

Unicameral bone cysts are benign solitary lesions that occur in the first two decades of life and with a greater frequency in the humerus and femur. The cyst is usually asymptomatic unless a fracture or impending fracture is present. The traditional method of treating unicameral cysts has been curettage with bone graft or steroid injection. Also, pathologic fractures in the calcaneus, unlike in other bones, are reported especially in the children to be nonexistent. In general, closed treatment was recommended for most of the calcaneal fractures in children, but suggested open reduction when joint displacement was severe. We report a case of displaced intraarticular fracture of the calcaneus with unicameral bone cyst in a child treated by classic curettage, allograft and open reduction with screw fixation.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.157-160
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• 2010

Purpose: The purpose of this study is to find out the correlation factors for prognosis of calcaneal fractures. Materials and Methods: 120 cases (feet) of calcaneal fractures, all of them followed up for more than 1 year after surgical procedures, consisted of 101 men (105 feet) and 13 women (15 feet) were reviewed retrospectively. The collected clinical data were as follows : injury mechanism, surgical procedures, time to procedure, time to work and the radiologic data: Bohler angle, heel width, displacement of posterior facet. AOFAS hindfoot score and VAS score were checked. With ANOVA test and multiple regression analysis, the data processed statistically. Results: According Sanders classification, type II was 37 cases (31%), type III 66 cases (55%), and type IV 17 cases (14%). On plane radiography, the Bohler angle improved to average 28.4 degree from 5.6 degree, and the displacement of posterior facet was corrected to average 1.2 mm. AOFAS hindfoot score was checked average 81.7 points postoperatively, and the meaningful difference existed between types of Sanders classification. The Bohler angle represented the outline of the calcaneus had the better correlation with the clinical outcome of calcaneal fractures rather than the anatomical reduction of the posterior facet did. And the width of calcaneus had good correlation with the clinical score. Conclusion: We should also concern about the outline of calcaneus, the width of calcaneus and the Bohler angle representing anatomical reduction, not only the acute reduction of the posterior facet.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.168-173
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• 2008

Purpose: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular joint depression type fracture of calcaneus. Materials and Methods: Thirteen cases with intra-articular joint depression type fracture of calcaneus, from September 2004 to March 2006, were reviewed. There were 9 males and 4 females with 52.5 years old mean age (range: $31{\sim}74$ years old). The average follow-up period was 18 months (range: $8{\sim}32$ months). Steinmann pins and Freers were used for closed reduction. After closed reduction, Acutrak screws and K-wires were inserted. The patients were evaluated with Creighton-Nebraska health foundation assessment sheet for calcaneal fracture, the extent of recovery of Bohler angle, fragment size, and state of subtalar joint. Results: Clinical results according to Creighton-Nebraska health foundation assessment sheet for calcaneal fracture were excellent in 6 cases (46%), good in 4 cases (30%), fair in 2 cases (15%), and poor in 1 case (7%). Average preoperative Bohler angle was $7.6^{\circ}$ (range: $2^{\circ}{\sim}13^{\circ}$). Average postoperative Bohler angle was $24.4^{\circ}$ (range: $4^{\circ}{\sim}33^{\circ}$). There were no soft tissue complications. There were one mild subtalar arthritis and one moderate subtalar arthritis. Conclusion: We think that closed reduction and percutaneous Acutrak screw fixation with or without K-wire is a good option for joint depression type fracture of calcaneus.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.60-67
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• 2009

Purpose: This study was designed to investigate the usefulness of extensile lateral approach for accurate reduction and rigid internal fixation in comminuted intraarticular fractures of calcaneus. Materials and Methods: From October 2002 to May 2007, we managed 55 patients (62 cases) with open reduction and internal fixation using extensile lateral approach. Among these, 38 patients (43 cases) who underwent preoperative and postoperative CT scan were enrolled. All patients were evaluated over 24 months after surgery. Bohler angle and Gissane angle on plain X-ray, displacement and step-off of articular surface of calcaneus on CT scan were measured and we compared the difference between preoperative and postoperative value of them. Clinical results were assessed by using AOFAS Ankle-Hindfoot Scale. Results: The average Bohler angle was restored from $6.8^{\circ}$ to $23.5^{\circ}$ and Gissane angle was improved from $116.4^{\circ}$ to $113.5^{\circ}$ after operation. The average distance of displacement was restored from 4.2 mm to 1.4 mm and step-off of articular surface was recovered from 5.1 mm to 1.3 mm. Clinical results were excellent in 17 cases, good in 18 cases, fair in 3 cases, and poor in 5 cases. 10 cases developed postoperative complications such as skin necrosis, heel pain, limitation of motion of ankle and subtalar arthritis. Conclusion: The extensile lateral approach is valuable for the comminuted intraarticular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.49-54
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• 2009

Purpose: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. Materials and Methods: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. Results: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. Conclusion: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.