• Journal of Korean Foot and Ankle Society
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• v.24 no.4
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• pp.165-167
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• 2020

Failure to achieve stable fixation during surgery for a Lisfranc joint injury leads to subtle instability that causes dysfunction and posttraumatic osteoarthritis. Therefore, it is important to check for appropriate fixation during surgery. This paper reports a test that evaluates the joint instability dynamically during the open reduction of the Lisfranc joint and checks the stability after fixation. a Freer elevator was inserted into the interosseous area between the medial cuneiform and second metatarsal base, and a twisting force was applied to evaluate the dynamic instability of the Lisfranc joint. After fixation of the Lisfranc joint, the stability of the fixation could be tested by trying this maneuver with the Freer elevator. Overall, the Freer test can be considered a valuable test in open surgery for a Lisfranc joint injury.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.71-75
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• 2004

Purpose: The purpose of this study was to evaluate retrospectively the clinical results of closed reduction and percutaneous screw fixation for unstable injuries on stress radiographs in subtle injuries of Lisfranc joint. Materials and Methods: From June 1997 to March 2003, 6 cases of unstable injuries on stress radiograph in subtle injuries of Lisfranc joint were treated by percutaneous cannulated screw fixation after closed reduction. All cases were injuried by indirect force (twisting injury). The average diastasis between the 1st and 2nd metatarsal base was 3 mm (2-4 mm) on initial nonweight bearing AP radiograph. The average follow-up period was 20 months. Clinical evaluation was assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score. Results: The AOFAS midfoot score was average 86 (80-90) points. The average diastasis between 1st and 2nd metatarsal base was 2 mm (1-3 mm) on weight bearing AP radiograph in final follow up. The final diastasis was increased slightly than diastasis in initial postoperative radiographs. But the clinical results were good. There was no correlation between the degree of diastasis and the clinical results. On weight bearing lateral radiograph, the average difference with normal foot in the distance between plantar aspect of 5th metatarsus and medial cuneiform was 2 mm (0-3 mm). One case had mild arthritic change on the radiographs. Conclusion: When the Lisfranc injuries, especially in the subtle injuries were suspicious, the stress views are helpful to assess stability of the Lisfranc injuries and planning of treatment. For unstable injuries on stress radiographs in subtle injuries of Lisfranc joint, closed reduction and percutaneous screw fixation is useful method to expect good clinical results.

• Journal of Korean Foot and Ankle Society
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• v.16 no.2
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• pp.101-107
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• 2012

Purpose: The aim of this study was to investigate the radiological characteristics of the osteoarthritis of the second metatarsophalangeal (MTP) and tarsometatarsal (TMT) joint. Materials and Methods: Between January 2002 and August 2010, 27 patients (33 feet) who had second metatarsal osteoarthritis (OA) were reviewed retrospectively. Group 1 was 14 patients (17 feet) with second MTP joint OA. Group 2 was 13 patients (16 feet) with second TMT joint OA. Group 3 was 24 patients (25 feet) had hallux valgus without second metatarsal (MT) OA as control. Weight bearing foot anteroposterior (AP) and lateral view were checked, and measured hallux valgus angle, metatarsus adductus angle (MAA), second MT functional length, first and second MT length by Hardy & Clapham method on AP view, angle of second MT with horizontal plane, calcaneal pitch, talo-first MT on lateral view. Results: On weight bearing foot AP view, second MT functional length of group 1, 2, 3 was 2.4 mm, -0.1 mm, 0.7 mm and MAA of group 1, 2, 3 was $17.7^{\circ}$, $17.7^{\circ}$, $14.5^{\circ}$. Second MT functional length of group 1 was longer than control group and it was statistically significant. MAA was significant different between group 1-3 and group 2-3. Angle of second MT with horizontal plane of group 2 was smaller than control group and it was statistically significant. Other radiographic parameters have no statistical significance. Conclusion: Group 1 has long functional length of second MT and group 2 has small angle of second MT with horizontal plane.

• Asian-Australasian Journal of Animal Sciences
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• v.25 no.7
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• pp.980-987
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• 2012

In order to investigate the effect of physical forms of starter diets on performance, weaning age, nutrient digestibility and rumen biochemical factors, 24 female of neonatal Brown Swiss calves (average body weight of $39.5{\pm}1.2kg$) were randomly assigned to three treatments. Dietary treatments were mashed (MS), pelleted (PS), and texturized (TS) starter using 8 calves from birth till 90 days of age in each treatment. Diets were formulated to be iso-nitrogenous with 21% crude protein. Based on the experimental results, calves that received PS and TS diets, had significant higher average daily gain (ADG) than those receiving MS (p<0.01). Dry matter intake in calves fed PS and TS was greater than calves fed MS (p<0.05), but there was no significant difference in feed efficiency. Treatments had no effect on initiation of rumination. Weaning age of calves in MS was longer than the other two treatments (p<0.05). Crude protein and organic matter digestibility in MS treated calves were lower than other treatments (p<0.05). No differences were observed in neutral detergent fiber (NDF) and ash digestibility among treatments (p>0.05). Ruminal pH was higher (p<0.01) in MS than the other groups, but ruminal ammonia (g/dl) concentration was not different among the treatments. Body measurements such as body length, pin width, hip width, pin to hip length, size of metacarpus and metatarsus bones, hip height, wither height, stomach size and heart girth were not significantly different among the treatments. Overall, it is concluded that starter diets in the form of pellet and texture can improve performance in neonatal Brown Swiss calves compared to the mashed form.

• Archives of Reconstructive Microsurgery
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• v.1 no.1
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• pp.24-30
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• 1992

Tendocutaneous free flap transfer has been usually used to treat troublesome wounds, which had extensive defect of skin and tendons, since Daniel and Taylor had reported successful free flap transfer in 1973. Among the numerous types of free flap, the dorsalis pedis flap, which could include superficial peroneal nerve, extensor tendon and second metatarsus, was widely used as composite free flap. The authors analysed 13 cases of tendocutaneous free flap transfer from dorsum of the foot which were operated at Korea University Hospital from March 1981 to August 1991. The results were as follows: 1. The average size of these flaps was $53.7cm^2$(mazimum $82cm^2$, minimum $30cm^2)$, the average number and length of tendons were 2.9(maximum, 5, minimum 1), and 9.2cm (maximum 17cm, minimum 5cm). 2. The survival rate of flaps was 100%, and functional results by Dargan's criteria were 4 in excellent, 4 good, 3 fair and 2 poor. 3. The delayed healing on donor site could prevented by the meticulous skin graft and repair of extensor retinaculum. 4. The cases of electrical burn were more worse than the traumatic cases in functional results.

• Journal of Korean Foot and Ankle Society
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• v.1 no.2
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• pp.112-118
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• 1997

Tarsometatarsal fracture-dislocation is uncommon but severe lesion. Since this lesion is sometimes difficult to recognize by roentgenography, it is easily overlooked. Three patients were treated with open reduction and internal fixation with 3.5 mm cannulated screw and K-wire, two had treatment with open reduction and internal fixation with 3.5 mm cannulated screw only and two had treatment with dosed reduction and short leg cast only between January 1994 and May 1996. The duration of follow-up ranged from twelve to twenty-nine months after the diagnosis. Results were assessed by a subjective questiormaire, physical examination, and radiographic analysis. Multiple fixation techniques for maintaining the reduction of tarsometatarsl joint have been introduced. We recent]y used the 3.5 mm cannulated screw for internal fixation of the tarso-first and second metatarsal fracture-dislocation. We think cannulated screw fixation has several advantages; 1. The cannulated screw fixation is more rigid than the K-wire fixation. 2. There is an decreased risk of screw breakage with early weight bearing. 3. It is possible to compress the involved joints, if necessary. There were no disability in all patients. One patient who was treated with delayed open reduction and internal fixation with 3.5 mm cannulated screw and K-wire had a radiographic mild degenerative arthritis. And one patient who was treated with dosed reduction and short leg cast had a mild metatarsus adductus. But. these two patients were symptom free. There was no correlation between the severity of the diastasis and the patient s functional result.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.173-177
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• 2014

Purpose: The purpose of this study is to evaluate the characteristics of hallux valgus with severe hallux valgus angle (HVA) and moderate intermetatarsal angle (IMA) after proximal chevron osteotomy. Materials and Methods: Between January 2008 and December 2010, 41 patients (48 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic severe hallux valgus deformity ($HVA{\geq}40^{\circ}$). Patients were divided into two groups, group M (IMA< $18^{\circ}$) and group S ($IMA{\geq}18^{\circ}$). Mean age of patients was 55.7 years (34~70 years) in group M and 60.0 years (44~78 years) in group S. Mean duration of follow-up was 20.4 months (12~41 months) in group M and 18.5 months (12~35 months) in group S. Radiographic parameters, including HVA, IMA, sesamoid position, metatarsus adductus angle (MAA), and distal metatarsal articular angle (DMAA), were compared between groups. Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Recurrence rate at the last follow-up was compared between group M and group S. Results: Preoperative HVA and grade of sesamoid position did not differ between the groups. However, immediate postoperative HVA and grade of sesamoid position were significantly larger in group M. Preoperative MAA and DMAA were significantly larger in group M. No significant difference in AOFAS score and VAS was observed between the groups at the last follow-up. Ten of the 27 feet (37.0%) in group M and two of the 21 feet (9.5%) in group S showed hallux valgus recurrence at the last follow-up. Group M showed a significantly higher recurrence rate than group S. Conclusion: Recurrence rate for severe hallux valgus with moderate IMA is higher than that of severe hallux valgus with severe IMA.

• Journal of Korean Foot and Ankle Society
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• v.27 no.1
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• pp.17-23
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• 2023

Purpose: Toe-in gait is defined as a style of walking in which the foot turns inward. It may be caused by an increase in femoral bone anteversion, tibia torsion, and metatarsus adductus. There are some conservative treatment approaches used to correct this condition. This review aimed to determine the effects of the toe-in gait on joint loading, kinematics, and kinetic parameters while walking. Moreover, it sought to determine the efficiency of various conservative treatments used to correct the condition. Materials and Methods: A literature search was conducted in the following databases: PubMed, Institute for Scientific Information (ISI), Web of Science database, EBSCO, and Embase, using the following keywords in toe, toe-in, toeing, in-toe, pigeon toe, and conservative treatment published between 1950 and 2021. The quality of the studies was evaluated using the Down and Black tool. Results: A total of 13 papers on the impact of toe-in gait on joint contact force, kinematics, kinetic parameters, and conservative approaches to management were found. The quality of the studies varied between a score of 11 and 22. The toe-in gait influences the joint contact forces and kinematics of the joints, especially the hip and pelvis. The effects of conservative treatment on the toe-in gait appear to be controversial. Conclusion: As the toe-in gait influences the joint contact force, it may increase the incidence of degenerative joint diseases. Therefore, treatment is recommended. However, there is no strong evidence on the efficacy of conservative treatments, and there are no recommendations for the use of these treatments in subjects with toe-in gait.

• Journal of Veterinary Clinics
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• v.40 no.3
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• pp.215-220
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• 2023

A 3-month-old Korean native cattle (Hanwoo) calf with difficulty taking normal posture and an inability to rise was referred for a definite diagnosis and active treatment, including surgery. The calf had a history of an accident in which both hind limbs were trapped in a barn structure. After admission, a "rabbit leg" posture was observed, a typical sign of gastrocnemius muscle rupture, and both digits were knuckled downward like they were trying to grip the ground. This was considered to be a result of the superficial digital flexor not rupturing but only the gastrocnemius muscle rupturing. Physical examination revealed laceration of the metatarsus and firmness behind both stifle joints which were presumed to be the sites of gastrocnemius muscle rupture. Skeletal abnormalities, including fractures, were ruled out by radiography. Based on these findings, the patient was diagnosed with bilateral gastrocnemius muscle rupture, and surgery was performed to reconnect the head of the ruptured muscle. Because the rupture occurred perpendicular to the muscle direction, the locking loop technique, a method of suturing severed tendons, was used to reduce the tension. After surgery, the cast was used to prevent further injuries and promote voluntary rehabilitation. Follow-up was completed, with the calf showing normal posture and gait 112 days after surgery. This is the first case report in the Republic of Korea describing the successful diagnosis and treatment of bilateral gastrocnemius muscle rupture in a calf.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.38-46
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• 2012

Purpose: This study was performed retrospectively to evaluate clinical outcomes of distal metatarsal osteotomy using bio-compression screw as the joint preservation method for advanced hallux rigidus. Materials and Methods: Eleven cases were followed up for more than 1 year after distal metatarsal dorsal wedge osteotomy for advanced hallux rigidus. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction score. The range of motion, and the period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were evaluated. As the radiographic evaluation, the interval of $1^{st}$ MTP (metatarsophalangeal) joint space and the period to union were measured. Results: The AOFAS hallux score had improved significantly from preoperative average 50.7 points to 87.6 points at the last follow-up (p=0.005). The subjective satisfaction score was average 90.6 points. There were no case of subsequent fusion or additional operation, and no complication associated with bio-compression screw. The period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were average of 24.8 weeks, 20.4 weeks, 16.8 weeks, 18.5 weeks respectively. Dorsiflexion of $1^{st}$ MTP joint had improved significantly from preoperative average $17.5^{\circ}$ to $44^{\circ}$ (p<0.001). All cases achieved union of osteotomy site, and the period to union was average 10.4 weeks. The interval of $1^{st}$ MTP joint space had improved significantly from preoperative average 1.2 mm to 3.5 mm (p=0.014). Conclusion: Distal metatarsal osteotomy using bio-compression screw seems to be one of effective treatment methods for advanced hallux rigidus, because of restoration of the first MTP joint motion, and reliable pain relief, and needlessness of hardware removal.