• Title/Summary/Keyword: Ankle-Hindfoot score

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Analysis of Clinical and Radiographic Outcome of the Reconstructive Surgery for the Cavovarus Foot Deformity (요내반족 변형에 대한 재건수술의 임상적 및 방사선학적 결과 분석)

  • Jung, Hong-Geun;Park, Jae-Yong;Lee, Dong-Oh;Eom, Joon-Sang;Chung, Seung-Hee
    • Journal of Korean Foot and Ankle Society
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    • v.18 no.2
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    • pp.62-67
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    • 2014
  • Purpose: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. Materials and Methods: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. Results: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from $27.5^{\circ}$ to $46.7^{\circ}$. In radiographic measurements, calcaneal pitch angle improved from $19.1^{\circ}$ to $15.8^{\circ}$, Meary angle from $13.0^{\circ}$ to $9.3^{\circ}$, Hibb's angle from $44.3^{\circ}$ to $37.0^{\circ}$, and tibio-calcaneal axis angle from varus $17.5^{\circ}$ to varus $1.5^{\circ}$ Conclusion: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

Comparison of Posterior Fixation Technique and Anterior-Posterior Fixation Technique in Subtalar Arthrodesis (거골하 유합술 시 전방 및 후방 관절면 고정술식과 후방 관절면 단독 고정술식의 비교)

  • Jung, Hong-Geun;Cho, Hyeoung-Woen;Park, Hyun-Woo;Park, Jong-Tae
    • Journal of Korean Foot and Ankle Society
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    • v.16 no.2
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    • pp.116-122
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    • 2012
  • Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94 points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68) to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.

Limited Open Repair Technique of Achilles Tendon Ruptures - Operative Technique and Early Results - (최소 절개 봉합술을 이용한 아킬레스건 파열의 치료 - 수술 방법 및 초기 결과 -)

  • Lee, Keun-Bae;Park, Yu-Bok;Kim, Byung-Soo;Choi, Jin;Jung, Sung-Taek
    • Journal of Korean Foot and Ankle Society
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    • v.10 no.1
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    • pp.37-41
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    • 2006
  • Purpose: To investigate the early results of limited open repair technique of Achilles tendon ruptures, and to describe the surgical technique. Materials and Methods: From October 2004 to February 2005, a total of 10 patients with Achilles tendon rupture underwent limited open repair. The average age of the patients was 39.3 years, and the average follow-up period was 9 months. The causes of injury were sports injuries in 8 cases, and slip down in 2. The mean interval between the injury and the operation was 9 days. The clinical results were assessed by patient's satisfaction, incision length, hospitalization, the ankle-hindfoot scale of American Foot and Ankle Society (AOFAS), and complications. Results: Of 10 patients, 8 were very satisfied, and the remaining 2 were satisfied. The mean incision length was 2.0 cm, and the mean hospitalization was 2 days. The mean AOFAS score was 97 points, and there was no complications such as infection, rerupture, or nerve injury. All patients returned to work at approximately 2 months, and resumed light exercise such as jogging at approximately 3 months. Conclusion: Limited open repair technique of Achilles tendon ruptures is provided for better cosmetic results, high patient's satisfaction, and functionally successful results without postoperative complications.

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Comparison of F Calcaneal Plate and Locking Calcaneal Plate Fixation Using an Lateral Extensile Approach to Intra-articular Calcaneal Fractures (종골의 관절 내 골절에서 외측 광범위 도달법을 이용한 F형 금속판 고정술과 잠김 금속판 고정술의 비교)

  • Lee, Yun-Tae;Oh, Hyun-Cheol;Yoon, Han-Kook;Jang, Jae-Won;Jang, Ki-Jun
    • Journal of Korean Foot and Ankle Society
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    • v.16 no.3
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    • pp.175-180
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    • 2012
  • Purpose: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture Materials and Methods: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. Results: Radiollogically, the mean Bohler angle was improved from $5.5^{\circ}$ preoperatively to $20.1^{\circ}$ postoperatively and $18.8^{\circ}$ at the last follow up in group 1 and $8.6^{\circ}$ preoperatively, $21.4^{\circ}$ postoperatively and $20.3^{\circ}$ at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. Conclusion: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.

Extracorporeal Shock Wave Therapy for Postoperative Pain after Ankle Surgery (족관절 수술 후 발생한 통증에 대한 체외충격파의 치료 효과)

  • Young, Ki Won;Kim, Jin Su;Jeon, Sung Han;Lee, Do Hyun
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.8 no.1
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    • pp.6-10
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    • 2015
  • Purpose: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for postoperative pain after surgery around ankle. Materials and Methods: We included 21 patients who performed an operation around ankle from 2009 to 2013. 4 times ESWT were applied to the patients who have tenderness more than visual analog scale (VAS) point 4. We evaluated the VAS at each sessions and final follow-up, and American Orthopedic Foot and Ankle Society ankle-hindfoot score (AFOAS) was checked at preoperative and final follow-up. Patient's satisfaction and complications were surveyed. Results: Preoperative VAS was mean 4.7, postoperative pain VAS was mean 6.0 at 4.5 months follow-up. The VAS after ESWT each session at 1, 2, 3 weeks and final follow-up were 4.8, 3.2, 2.3, 2.9, respectively. Mean final follow-up period was 9.4 months. Final VAS were significantly decreased (p<0.001). Final VAS were increased from VAS at last session of ESWT, however, not significant (p=0.189). AOFAS significantly improved from preoperative 60 to final follow-up 86 (p<0.001). Excellent was 12 patients (57%), good was 4 patients (19%), no change was 3 patients (14%) and poor was 2 patients (9%). 1 patient complained a dizziness and nausea during ESWT. Conclusion: ESWT for postoperative pain after ankle surgery shows satisfactory pain reduction in 76% of all patients without severe complication.

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Operative Treatment of Tongue Type Intra-articular Calcaneal Fractures: Comparison of the Open Reduction and Essex-Lopresti Technique (관절면을 침범한 설상형 종골골절의 수술적 치료: 관혈적 및 Essex-Lopresti 술식에 따른 비교)

  • Shin, Dong-Eun;Yoon, Hyung-Ku;Han, Soo-Hong;Choi, Woo-Jin;Ahn, Chang-Soo;Ok, Hyun-Soo
    • Journal of Korean Foot and Ankle Society
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    • v.14 no.2
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    • pp.151-156
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    • 2010
  • Purpose: To analyze the clinical and radiological results of operative treatment in patients with tongue type intra-articular calcaneal fracture, and to compare the open reduction and Essex-Lopresti technique. Materials and Methods: We examined a consecutive series of 42 patients who received surgical treatment for tongue type calcaneal fracture (24 cases of the open reduction and 18 cases of the Essex-Lopresti technique) and the postoperative data was compared with a minimum 1 year follow-up. The clinical outcome was analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and Salama's criteria. The preoperative, postoperative, and last follow-up changes in the Bohler angle was radiologically analyzed. Results: There were no significant differences between the two groups in terms of the clinical and radiological results at the last follow-up. However, for the Sander's type 3 and 4 fractures, the open reduction group showed more improvement of AOFAS score and less reduction loss in the Bohler angle. Conclusion: Although the clinical results were good irrespective of surgical technique, the open reduction and internal fixation can improve clinical outcome and reduce the reduction loss as compared with the Essex-Lopresti technique in the comminuted tongue type calcaneal fracture.

Radiographic Characteristics and the Clinical Results of the Operative Treatment of M$\ddot{u}$ller-Weiss Disease (뮐러-와이스 병의 방사선학적 특징 및 수술적 치료의 결과)

  • Choi, Hong-Joon
    • Journal of Korean Foot and Ankle Society
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    • v.17 no.2
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    • pp.100-105
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    • 2013
  • Purpose: To present radiographic characteristics and report the clinical results of the operative treatment of M$\ddot{u}$ller-Weiss disease. Materials and Methods: This is a retrospective study including 13 patients, 14 feet who had been operated for M$\ddot{u}$ller-Weiss disease between April 2006 and December 2011. Osteoarthritis of the peri-navicular joints were radiographically evaluated. Various range of peri-navicular fusion and joint-preserving surgeries according to patients' symptoms and radiographic findings were done. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). Results: On radiographs, osteoarthritic changes were presented at talonavicular joint in 11 cases, calcaneocuboid joint in 7 cases, subtalar joint in 6 cases, naviculo-cuneiform joint in 1 case. The mean anteroposterior talocalcaneal angle was 16.6 degrees. On hindfoot alignment view, 6 cases were varus, 5 cases were neutral and 3 cases were valgus alignment. Fusion comprised 6 cases in triple fusion, 1 case in talonavicular-cuneiform fusion, 2 cases in talonavicualr fusion and 1 case in talonavicular & calcaneocuboid fusion. Joint-preserving surgeries were bony fragment excision of the lateral part of navicular & medial displacement calcaneal osteotomy in 1 case, bony spur excision of talonavicular joint in 1 case and medial displacement calcaneal osteotomy in 2 cases. The postoperative AOFAS and VAS score were improved significantly (p=0.000, p=0.000). Conclusion: In cases of M$\ddot{u}$ller-Weiss disease without osteoarthritic changes at peri-navicular joints, fragment excision of navicular, bony spur excision with or without medial displacement calcaneal osteotomy were effective operative treatments.

Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type 4 Intra-Articular Calcaneal Fractures (Sanders 4형 종골 골절에 대한 관혈적 정복술 및 내고정술과 일차성 거골하 관절 유합술의 치료 결과 비교)

  • Woo, Seung Hun;Chung, Hyung-Jin;Bae, Su-Young;Kim, Sun-Kyu
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.49-58
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    • 2017
  • Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Materials and Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type 4 intra-articular calcaneal fractures were included in this study. Of these, 11 were treated with ORIF (ORIF group), and 11 were treated with ORIF and PSTA (PSTA group). The mean follow-up period was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS score), and the visual analogue scale pain score (VAS score) at 6-month, 12-month, and last follow-up. Patient satisfaction, return to previous occupation and postoperative complications were also investigated. Results: The results for ORIF did not differ from those for PSTA based on the last follow-up AOFAS scores or the VAS scores (p>0.05). However, patient satisfaction was significantly higher in the PSTA group (p=0.008). Secondary subtalar arthrodesis was conducted in five patients (45.5%) of the ORIF group within 2 years postoperatively. Conclusion: We were unable to demonstrate a significant difference in clinical outcomes between ORIF and PSTA; however, the patient satisfaction was higher in the PSTA group. PSTA may be a suitable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.

Arthroscopic Treatment of Osteochondritis Dissecans of the Talus (거골 박리성 골 연골염의 관절경적 치료)

  • Choi, Chong-Hyuk;Cheon, Yong-Min
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.2
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    • pp.161-170
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    • 2002
  • Purpose : To investigate arthroscopic simple excision for the treatment of osteochondritis dissecans of the talus and to examine gross change and histological evaluation of the defect through second look arthroscopy. Materials and Methods : This study included twenty-two patients who had osteochondritis dissecans of the talus that was treated with excision of arthroscopic loose body and necrotic bone tissue, leaving bleeding bed. In 7 cases, we performed second look arthroscopic examination for the evaluation of gross change of defects and histologic findings. Final results were evaluated with two clinical and functional protocols. Average follow up period was 42 months from 14 months to 8 years. Results : Ankle-hindfoot score (100 point) was improved significantly (p<0.003). Subjective and functional scores (100 points) averaged 82 points. The defect of lesion had a tendency of filling with fibrous tissue and fibrocartilage. Although the defect was filled with fibrocartilage, specific secondary lesion was not detected through second look arthroscopic examination. Conclusion : Arthroscopic debridement was an effective method for the treatment of osteochondritis dissecans of the talus without progression of secondary lesion even though the defect was filled with fibrocartilage.

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Surgical Treatments and Clinical Outcomes for Idiopathic Osteoarthritis of the Tarsometatarsal Joints (족근 중족 관절의 특발성 골관절염에 대한 수술적 치료 및 임상적 결과에 대한 분석)

  • Jung, Hong-Geun;Byun, Woo-Sup;Myerson, Mark S.;Schon, Lew C.
    • Journal of Korean Foot and Ankle Society
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    • v.8 no.1
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    • pp.31-38
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    • 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.

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