• 대한족부족관절학회지
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• 제18권2호
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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.

• 대한족부족관절학회지
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• 제16권2호
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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.

• 대한족부족관절학회지
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• 제10권1호
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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.

• 대한족부족관절학회지
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• 제16권3호
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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.

• 대한정형외과 초음파학회지
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• 제8권1호
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• pp.6-10
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• 2015

목적: 발목 및 족부 수술을 시행한 후 통증이 발생한 경우에 통증을 감소 시키기 위해 체외 충격파 치료(ESWT)를 시행하고 그 효과를 알아보고자 한다. 대상 및 방법: 2009년부터 2013년까지 시행한 족관절 주변 수술 후 통증이 발생한 환자 21명을 대상으로 하였다. 석고 고정을 제거하고 2개월이 지난 후에도 압통을 호소하고, 시각동통점수(VAS) 점수가 4점 이상인 경우에 ESWT를 4회 시행하였다. 각 회 및 최종 추시 상의 VAS 점수를 확인하였으며 ESWT 전과 최종 추시에서 미국 족부족관절학회 후족부-족관절(AOFAS) 점수를 비교하였다. 환자의 만족도 및 불편감을 확인하였다. 결과: 수술 전 VAS는 평균 4.7점이었으며 수술 후 통증이 발생한 시점은 VAS는 평균 6.0점이었다. 수술 후 ESWT를 시작한 기간은 평균 4.5개월이었으며, 시행 후 1, 2, 3주 및 최종 추시에서 VAS는 각각 4.8, 3.2, 2.3, 2.9점이었다. ESWT 시행 후 최종 추시는 평균 9.4개월있었다. VAS 점수는 최종 추시에서 수술 후 발생한 통증이 의미 있게 감소하였으며(p<0.001), ESWT 4회 시행 후보다 최종 추시에서 통증 점수가 증가하였으나 유의하지는 않았다(p=0.189). AOFAS 점수는 수술 전 평균 60점에서 최종 추시상 86점으로 회복되었다(p<0.001). 환자는 매우 만족이 12례(57%), 만족이 4례(19%), 변화 없음이 3례(14%) 및 불만족이 2례(9%)였다. 1례에서 ESWT 중 어지러움 및 오심을 호소하였다. 결론: 수술 후 발생한 통증 치료에 ESWT를 사용하여 심각한 합병증은 없이 76%에서 통증의 호전을 보았다.

• 대한족부족관절학회지
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• 제14권2호
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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.

• 대한족부족관절학회지
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• 제17권2호
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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.

• 대한정형외과학회지
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• 제52권1호
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• pp.49-58
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• 2017

목적: Sanders 4형 관절내 종골 골절에 대한 관혈적 정복술 및 내고정술과 일차성 거골하 관절 유합술의 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2003년 3월부터 2013년 11월까지 Sanders 4형 종골 골절로 진단되어 관혈적 정복술 및 내고정술을 시행한 11예와 일차성 거골하 관절 유합술을 시행한 11예를 비교 분석하였다. 평균 추시 기간은 34.6개월(18-72개월)이었다. 술 후 6, 12개월 및 최종 추시 시 American Orthopedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS) 점수 및 visual analogue scale pain (VAS) 통증 점수를 측정하였고 환자 만족도, 직장 복귀 여부 및 술 후 합병증을 조사하였다. 결과: 최종 추시 시 AOFAS 점수 및 VAS 점수는 양 군 간 의미 있는 차이는 보이지 않았으나(p>0.05) 일차성 거골하 관절 유합술을 시행한 군에서 환자의 만족도가 높았다(p=0.008). 관혈적 정복술군에서 증상을 동반한 거골하 관절염으로 이차성 거골하 관절 유합술을 5예(45.5%)에서 시행하였다. 결론: 양 군 간 임상적으로 의미 있는 결과의 차이는 보이지 않았으나 일차성 거골하 관절 유합술이 술 후 만족도가 높아 빠른 일상 복귀를 필요로 하는 환자 혹은 2차 수술이 불가피할 것으로 예상되는 경우 일차성 거골하 관절 유합술을 고려해 볼 수 있을 것으로 생각된다.

• 대한관절경학회지
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• 제6권2호
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• pp.161-170
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• 2002

목적 : 관절경을 이용한 거골 박리성 골연골염의 단순 절제술 후 그 결과를 알아보고 이차 관절경을 통하여 결손 부위의 육안 및 조직학적 변화를 알아보고자 하였다. 대상 및 방법 : 관절경으로 유리체 및 괴사 골 조직을 제거한후 출혈되는 기저부를 남겨두고 치료한 22예를 대상으로 하였으며, 임상적 및 기능적 평가를 하여 수술의 유용성을 알아보았다. 7예에서 이차 관절경을 술 후 3개월에서 8년 사이에 시행하여 병변 부위의 관찰 및 타 부위의 이차적인 병변을 관찰하였으며, 생검을 시행하여 결손부 재생 조직에 대한 조직학적 검사를 시행하였다. 추시 관찰은 평균 42개월(14개월$\~$8년) 이었다. 결과 : 최종 추시 관찰에서 Ankle-hindfoot(100점) 점수는 술 전 67점에서 술 후 82점으로 의미있는 호전을 보였고(p<0.003), 주관적 및 기능적 평가(100점)상 술 후 평균 82점으로 만족할 만한 결과를 얻었다. 이차 관절경상 결손부는 섬유성 조직으로 채워지는 양상을 보였으며, 시간의 경과에 따라 섬유성 조직보다는 섬유 연골 조직이 증가되는 소견을 보였다. 술 후 특이한 이차적인 병변의 발생은 관찰되지 않았다. 결론 : 관절경을 이용한 거골 박리성 골연골염에 대한 단순 절제술은 결손 부위를 남겨 놓고 치료하는 방법이나 이차적 병변의 발생없이 결손부가 채워지는 소견을 보여 유용한 방법으로 사료되었다.

• 대한족부족관절학회지
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• 제8권1호
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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.