Current Trends in the Treatment of Hallux Valgus: Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey / 대한족부족관절학회지

Purpose@#This study aimed to report the current trends in the management of the hallux valgus (HV) deformity over the last few decades through a survey of the Korean Foot and Ankle Society (KFAS) members. @*Materials and Methods@#A web-based questionnaire containing 34 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experience in correction in patients with an HV deformity. Answers with a prevalence of ≥50% of respondents were considered a tendency. @*Results@#One hundred and nine (19.8%) of the 550 members responded to the survey. The most common symptom for determining surgical treatment was bunion pain (68.8%), and different surgical techniques were selected according to the following radiological parameters: HV angle 30 to 40 degrees and intermetatarsal angle 15 to 20 degrees. The two procedures most preferred by the respondents were distal chevron osteotomy (55.0%), and proximal chevron osteotomy (21.1%). In an average of 71.6% of respondents, Arkin osteotomy was performed simultaneously during HV surgery. HV accompanied by an overriding deformity of the second toe was most often addressed with a combination of second metatarsal osteotomy and soft tissue rebalancing procedure (35.8%). After HV surgery, the recurrence rate of HV deformity was found to be 12.2% on average and the surgeons who had performed minimally invasive surgery (MIS) for HV comprised 34.9% of the total respondents. @*Conclusion@#This study provides updated information on the current trends in the management of the HV deformity in Korea. Both consensus and variation in the approach to patients with HV were identified by this survey study. Although MIS for HV has increased, it appears the consensus for selecting this method has not yet been established.

Patient-Reported Outcomes Measurement Information System: Translation and Linguistic Validation of Six Profile Domains for Korean Adults

Background@#The purpose of the study was to translate and linguistically validate a Korean language version of the PROMIS (K-PROMIS) for the six profile adult domains: Fatigue, Pain Intensity, Pain Interference, Physical Function, Sleep Disturbance, and Ability to Participate in Social Roles and Activities. @*Methods@#A total of 268 items were translated into Korean according to the Functional Assessment of Chronic Illness Therapy multilingual translation methodology. Participants first completed approximately 27 to 35 items and were then interviewed to evaluate the conceptual equivalence of the translation to the original English language source.The K-PROMIS items that met the a priori threshold of ≥ 20% of respondents with comprehension difficulties in the cognitive interview. @*Results@#54 of the 268 items were identified as difficult items to comprehend for at least 20% of respondents in Round 1. The most frequently identified K-PROMIS domain on difficult items to comprehend was the Physical function (24.5%). Most items with linguistic difficulties were Fatigue and Physical function. Cultural difficulties were only included the Physical function and Ability to Participate in Social Roles and Activities domains. 25 of 54 items were slightly revised, and then these revised items were tested with additional six participants in Round 2, and most participants had no problems to understand modified items. @*Conclusion@#The six profile adult domains of K-PROMIS have been linguistically validated.Further psychometric validation of the K-PROMIS items will provide additional information of meaningful outcomes for chronic disease and clinical setting.

Nonoperative Treatment of Acute Achilles Tendon Rupture / 대한족부족관절학회지

The incidence of Achilles tendon rupture is increasing as more people participate in sports and physical activities. However, whether to treat a complete rupture of the Achilles tendon, conservatively or operatively, is still controversial. Current studies show that the nonoperative treatment of acute Achilles tendon rupture with short-term immobilization for up to two weeks and subsequent accelerated functional rehabilitation with protected weight-bearing results in similar functional outcomes and re-rupture rates compared to those treated surgically. Also, nonoperative treatment does not risk any surgical morbidity such as wound problems, infection, and nerve injury. Therefore, the treatment options for acute Achilles tendon rupture should be carefully chosen in consultation with patients regarding possible clinical outcomes and complications of both treatment options.

Patient-Reported Outcomes Measurement Information System: Translation and Linguistic Validation of Six Profile Domains for Korean Adults

Background@#The purpose of the study was to translate and linguistically validate a Korean language version of the PROMIS (K-PROMIS) for the six profile adult domains: Fatigue, Pain Intensity, Pain Interference, Physical Function, Sleep Disturbance, and Ability to Participate in Social Roles and Activities. @*Methods@#A total of 268 items were translated into Korean according to the Functional Assessment of Chronic Illness Therapy multilingual translation methodology. Participants first completed approximately 27 to 35 items and were then interviewed to evaluate the conceptual equivalence of the translation to the original English language source.The K-PROMIS items that met the a priori threshold of ≥ 20% of respondents with comprehension difficulties in the cognitive interview. @*Results@#54 of the 268 items were identified as difficult items to comprehend for at least 20% of respondents in Round 1. The most frequently identified K-PROMIS domain on difficult items to comprehend was the Physical function (24.5%). Most items with linguistic difficulties were Fatigue and Physical function. Cultural difficulties were only included the Physical function and Ability to Participate in Social Roles and Activities domains. 25 of 54 items were slightly revised, and then these revised items were tested with additional six participants in Round 2, and most participants had no problems to understand modified items. @*Conclusion@#The six profile adult domains of K-PROMIS have been linguistically validated.Further psychometric validation of the K-PROMIS items will provide additional information of meaningful outcomes for chronic disease and clinical setting.

Nonoperative Treatment of Acute Achilles Tendon Rupture / 대한족부족관절학회지

The incidence of Achilles tendon rupture is increasing as more people participate in sports and physical activities. However, whether to treat a complete rupture of the Achilles tendon, conservatively or operatively, is still controversial. Current studies show that the nonoperative treatment of acute Achilles tendon rupture with short-term immobilization for up to two weeks and subsequent accelerated functional rehabilitation with protected weight-bearing results in similar functional outcomes and re-rupture rates compared to those treated surgically. Also, nonoperative treatment does not risk any surgical morbidity such as wound problems, infection, and nerve injury. Therefore, the treatment options for acute Achilles tendon rupture should be carefully chosen in consultation with patients regarding possible clinical outcomes and complications of both treatment options.

If the Patient Complains Persistent Pain after the Operation, What Should We Do? / 대한족부족관절학회지

Osteochondral lesions of the talus (OLT) can heal and remain asymptomatic, or they can progress to deep ankle pain on weight bearing and the formation of subchondral cysts. Treatment varies from nonoperative treatment to open and arthroscopic procedures. Operative procedures include marrow stimulation techniques (abrasion chondroplasty, multiple drilling, microfracture), osteochondral autografts or allografts, and autologous chondrocyte implantation. Among these treatments, arthroscopic marrow stimulation techniques have been the preferred initial surgical treatment for most OLT. Despite these treatments, many patients complain of persistent pain even after surgery, and many surgeons face the challenge of determining a second line of treatments. This requires a thorough re-evaluation of the patient’s symptoms as well as radiological measures. If the primary surgical treatment has failed, multiple operative treatments are available, and relatively more invasive methods can be administered. On the other hand, it is inappropriate to draw a firm conclusion in which methods are superior.

Total ankle arthroplasty

For end-stage ankle arthritis, either arthrodesis or total ankle arthroplasty is a available surgical option. With the failure of earlier generation of arthroplasty, arthrodesis has been the gold standard. However, there are some considerable weaknesses of the arthrodesis. Current total ankle arthroplasty is presently an effective surgical treatment for endstage ankle arthritis with much improvement. The goals of surgery are to decrease pain, preserve range of motion, and eventually improve the patient’s quality of life. Recent literatures on total ankle arthroplasty havs shown successful long-term clinical results due to the innovation of second-generation implants, including more anatomic concepts and designs. For successful outcomes, a thorough evaluation of the entire lower limb alignment, deformities of the foot and ankle, and proper selection of patients are very important. Nevertheless, complications, such as wound problems, osteolysis, gutter pain or impingement, infection, loosening, and others, may occur. In this review, we provide a summary of the current research on total ankle arthroplasty.

Chronic Lateral Ankle Instability / 대한족부족관절학회지

Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified Broström operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

Corrective Osteotomies in Hallux Valgus / 대한족부족관절학회지

Hallux valgus is a deformity characterized by lateral deviation of the great toe and medial deviation of the first metatarsal. When planning an operative treatment, it is important to realize that the deformity is tridimensional and diverse. Operative techniques include medial eminence resection, distal soft tissue procedure, first metatarsal osteotomy (distal, diaphyseal, proximal, or multiple), proximal phalanx osteotomy, arthrodesis (first metatarsophalangeal or metatarsocuneiform joint), and so on. Among these techniques, osteotomy is the main procedure for correcting the hallux valgus. The objective of this article is to describe the characteristics and recent advancements made for corrective osteotomies in the hallux valgus. The pathophysiology of the hallux valgus is also described.

The Results of Modified Lapidus Procedure on Moderate-to-Severe Hallux Valgus with First Tarso-Metatarsal Joint Hypermobility / 대한족부족관절학회지

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° to postoperative 12.2° (p<0.001). The mean 1, 2 intermetatarsal angle improved from preoperative mean of 16.9° to postoperative mean of 7.6° (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.

Unilateral Talonavicular Coalition: A Case Report / 대한족부족관절학회지

Tarsal coalition is an abnormal union between two or more bones of the hind- and mid-feet, which can occur at various rates from cartilaginous to osseous union. Talonavicular coalition is reported less frequently than calcaneonavicular or talocalcaneal coalition and has been associated with various abnormalities, including symphalangism, clinodactyly, ray anomaly, clubfoot, other tarsal coalitions, and a ball-and-socket ankle joint. Patients with talonavicular coalitions are usually asymptomatic and rarely require surgical treatment. We review the literature and report on a case of 59-year-old male patient with talonavicular coalition.

Lisfranc Joint Injuries: Diagnosis and Treatment

Injuries to the Lisfranc joint are relatively rare, but they are often misdiagnosed or inadequately treated, resulting in poor long-term outcomes. Understanding of anatomical structure and injury mechanism, careful clinical and radiographic evaluations are needed to recognize and treat Lisfranc joint injuries. In this article, we review the anatomy, biomechanics, injury mechanisms, injury classification, clinical presentation, radiographic evaluation, treatment, outcome, and complications of Lisfranc joint injuries.

Ankle Sprains: Epidemiology, Anatomy and Injury Mechanism / 대한정형외과학회잡지

Ankle sprain is one of the most common musculoskeletal injuries, nearly half of all ankle sprains occur during athletic activity. With a high incidence, as many as 40% of patients may experience residual discomfort including pain and instability, underscoring the importance of proper treatment and effective strategies for prevention. The stability of the ankle joint is maintained by both bony structure and ligamentous complex. The anterior talofibular ligament is the primary restraint of internal rotation and adduction of the talus with the ankle joint unloaded, while both bony mortise structure and calcaneofibular ligament restrict adduction of the talus with the ankle joint loaded. Plantar flexion and inversion is the most common mechanism of ankle sprains, which lead to injury of the anterior talofibular ligament followed by calcaneofibular ligament. Ligament injuries are classified according to three grades based on the extent of rupture and the severity of clinical features. Associated injuries with lateral ankle sprain include peroneus tendon rupture, osteochondral fracture, deltoid ligament injury, syndesmosis injury, and nerve traction injuries.

Acquired Adult Flatfoot: Pathophysiology, Diagnosis, and Nonoperative Treatment / 대한족부족관절학회지

Acquired adult flatfoot is a deformity characterized by a decreased medial longitudinal arch and a hindfoot valgus with or without forefoot abduction. The etiologies of this deformity include posterior tibial tendon dysfunction, rheumatoid arthritis, trauma, Charcot's joint, neurologic deficit, and damage to the medial spring ligament complex or plantar fascia. Among these, posterior tibial tendon dysfunction is the most well-known cause. Although posterior tibial tendon dysfunction has been regarded as a synonym of acquired adult acquired flatfoot, failure of the ligaments supporting the arch can also result in progressive deformity even without a posterior tibial tendon problem. The authors describe the pathophysiology, diagnosis, and nonoperative treatment of acquired adult flatfoot, focusing on posterior tibial tendon dysfunction.

Selection and Recommended Usage Guide of Temporary External Fixator

No abstract available.

Pseudoaneurysm of Anterior Tibial Artery after Ankle Arthroscopy / 대한족부족관절학회지

Pseudoaneurysm is extremely rare complication after ankle arthroscopy with standard anteromedial and anterolateral portals. We report a case of a pseudoaneurysm of the anterior tibial artery detected at 3 months after ankle arthroscopy in a 16-year-old male. He had sustained painful swelling of his right ankle after the arthroscopic surgery, and referred to our hospital with an MRI checked postoperatively. We failed to make the diagnosis of pseudoaneurysm with the postoperative MRI, thus the patient underwent another arthroscopy which revealed massive hemarthrosis within the joint. The diagnosis was confirmed with an angiography, and the vascular lesion was ligated.

Subcutaneous Phaeohyphomycosis Caused by Exophiala salmonis

We report a case of subcutaneous infection in a 55-yr-old Korean diabetic patient who presented with a cystic mass of the ankle. Black fungal colonies were observed after culturing on blood and Sabouraud dextrose agar. On microscopic observation, septated ellipsoidal or cylindrical conidia accumulating on an annellide were visualized after staining with lactophenol cotton blue. The organism was identified as Exophiala salmonis by sequencing of the ribosomal DNA internal transcribed spacer region. Phaeohyphomycosis is a heterogeneous group of mycotic infections caused by dematiaceous fungi and is commonly associated with immunocompromised patients. The most common clinical manifestations of subcutaneous lesions are abscesses or cystic masses. To the best of our knowledge, this is the first reported case in Korea of subcutaneous phaeohyphomycosis caused by E. salmonis that was confirmed by molecular analysis and identification of morphological characteristics. This case suggests that E. salmonis infections are no longer restricted to fish.

Ankle Arthroscopy: Anatomy, Portals and Instrument / 대한족부족관절학회지

Major technologic advances in fiberoptic light transmission, video cameras, and instrumentation have allowed great advances in small-joint arthroscopy. Arthroscopy in particular is now well established procedure for accurate diagnosis and operative management of certain ankle disorders. The small size of the ankle and significant periarticular soft tissue structures make placement and advancement of the arthroscope and instrumentation more difficult than in larger joints. Successful arthroscopy of the ankle requires knowledge of the regional anatomy and a familiarity with the available arthroscopic portals. This review article is going to describe the gross and arthroscopic anatomy of the ankle as it relates to current arthroscopic techniques. Particular emphasis is placed on the anatomic relations of the important osseous and soft tissue structures for a safe, reproducible approach to arthroscopic treatment of ankle pathology. Also, current arthroscopic equipment and instruments are included.

Anterior Impingement Syndrome of the Ankle / 대한족부족관절학회지

Impingement syndrome of the ankle is defined as painful mechanical limitation of full ankle movement secondary to osseous and/or soft tissue abnormality. These conditions occur more commonly in active people and athletes probably because recurrent subclinical injury is an important factor in development of the syndrome. Impingement syndromes of the ankle are categorized according to their anatomical site around the ankle joint. Anterolateral, anterior and posterior impingement has been extensively described in the orthopaedic literature. The purpose of this article is to review the clinical feature and management of anterior impingement syndrome of the ankle.

Surgical Outcome of Reconstruction of Neglected Chronic Achilles Tendon Ruptures / 대한족부족관절학회지

PURPOSE: The purpose of this study was to report the surgical outcome of reconstruction of neglected chronic Achilles tendon ruptures with various methods including Achilles tendon allograft. MATERIALS AND METHODS: Between October 2003 and November 2008, 8 consecutive neglected chronic Achilles tendon ruptures with the defect gap of more than 4 cm underwent surgical reconstruction including V-Y advancement, gastrocnemius fascial turn-down flap, flexor hallucis longus transfer and Achilles tendon allograft. There were 7 males and 1 female who were evaluated at more than 18 months after surgery. At the time of followup, all patients were assessed with regard to postoperative complications, their self-reported level of satisfaction, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, 10 repetitive single heel rise, single leg hopping test, and ankle range of motion. RESULTS: The AOFAS score increased from average 71.4 (50-87) to 96.4 (86-100). All patients were able to perform 10-repetitive single heel raise and single leg hopping at the latest follow up. No patient experienced wound complications and deep infection. Six patients were rated as 'excellent' and the other two as 'good'. CONCLUSION: Neglected chronic Achilles tendon ruptures could be successfully treated with careful selection of the reconstruction method according to the amount of defect gap. With an extensive defect, Achilles tendon allograft can be a good option when the reconstruction is not feasible otherwise.