무지 외반증 환자의 hard insole 착용에 의한 중족지절관절 각도의 변화

임성태,김택훈,최흥식,노정석,김장환 한국전문물리치료학회 2001 한국전문물리치료학회지 Vol.8 No.2

The purpose of this study was to investigate the effect of donning of a hard insole in patients with hallux valgus. Fourteen subjects were selected from patients with foot pain at Lee Chang-Heon Foot Clinic from August 4,2000 to September 15, 2000. The hallux valgus angle and the first-second intermetatarsal angle were radiographically measured before and after donning the hard insole. Based on these two kinds of angles, a mild hallux valgus deformity group was characterized by the hallux valgus angle of less than 20 degrees, and a moderate hallux valgus deformity group was characterized by the hallux valgus angle of 20 to 40 degrees. After three weeks with the hard insole donned, the foot angles of the patients with hallux valgus were measured again. The data were analyzed by Wilcoxon signed ranks test, and the following results were obtained: 1) After the trial, both mild hallux valgus deformity group and moderate hallux valgus deformity group demonstrated that the hallux valgus angles were significantly decreased. 2) After the trial, mild hallux valgus deformity group demonstrated that the first-second intermetatarsal angle was significantly decreased. 3) After the trial, moderate hallux valgus deformity group demonstrated that the first-second intermetatarsal angle was not significantly decreased. The above findings revealed that according to donning hard insole, the hallux valgus angles of mild and moderate hallux valgus deformity groups and the first-second intermetatarsal angle of mild hallux valgus deformity group were significantly decreased. The results of this study have some limitation for generalization due to the limited number of subjects. Further studies are needed to evaluate the effect of hard insole on hallux valgus with more precise laboratory equipments and measurements in patients with hallux valgus.

Between-side Comparisons of Iliotibial Band Flexibility and the Tibial Torsion Angle in Subjects with an Asymmetric Hallux Valgus Angle

김수정,유광준,정도영 KEMA학회 2018 근골격계과학기술학회 Vol.2 No.1

Background Recent studies have used kinematic chain theory to establish a relationship between the hallux valgus and the lower limb joints and bones. This theory suggests that movement at one joint of a lower extremity may affect all other joints via a chain reaction. Purpose We examined the hip joint range of motion and muscle strength in subjects with asymmetric hallux valgus angles. Study design A cross-sectional study. Methods Fifteen participants with asymmetric hallux valgus angles were recruited. Two exami-ners measured the hallux valgus, intermetatarsal and tibial torsion angles, and the iliotibial band flexibility. The independent t-test was used to compare the differences between the two sides. Results The side with the greater hallux valgus angle also had a larger intermetatarsal angle. The iliotibial band was significantly less flexible on this side. The tibial torsion angles did not differ significantly between the two sides. Conclusions We suggest that the hallux valgus angle is associated with iliotibial band flexibility. Therefore, stretching of the iliotibial band should be considered during rehabilitation of the hallux valgus. Background Recent studies have used kinematic chain theory to establish a relationship between the hallux valgus and the lower limb joints and bones. This theory suggests that movement at one joint of a lower extremity may affect all other joints via a chain reaction. Purpose We examined the hip joint range of motion and muscle strength in subjects with asymmetric hallux valgus angles. Study design A cross-sectional study. Methods Fifteen participants with asymmetric hallux valgus angles were recruited. Two exami-ners measured the hallux valgus, intermetatarsal and tibial torsion angles, and the iliotibial band flexibility. The independent t-test was used to compare the differences between the two sides. Results The side with the greater hallux valgus angle also had a larger intermetatarsal angle. The iliotibial band was significantly less flexible on this side. The tibial torsion angles did not differ significantly between the two sides. Conclusions We suggest that the hallux valgus angle is associated with iliotibial band flexibility. Therefore, stretching of the iliotibial band should be considered during rehabilitation of the hallux valgus.

중등도 이상의 무지 외반증에서 최소 절개를 이용한 원위 중족골 절골술의 결과

허정욱,은일수,고영철,박만준,박숙현,Huh, Jung-Wook,Eun, Il-Soo,Ko, Young-Chul,Park, Man-Jun,Park, Sook-Hyun 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.2

Purpose: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. Materials and Methods: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. Results: The mean hallux valgus angle measured at preoperation was $37.7^{\circ}$ and $15.9^{\circ}$ at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were $15.2^{\circ}$ and $8.3^{\circ}$. The mean distal metatarsal articular angle changed from $12.6^{\circ}$ at preoperation to $7.8^{\circ}$ at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was $37^{\circ}$ and 13o, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. Conclusion: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under $37^{\circ}$ and distal metatarsal articular angle under $13^{\circ}$ can lead to good clinical results without recurrence.

무지 외반증과 동반된 소족지 기형에 대한 수술적 교정치료가 임상 결과에 미치는 영향

박지강,김용민,김동수,박경진,조병기,정호승,Park, Ji-Kang,Kim, Yong-Min,Kim, Dong-Soo,Park, Kyoung-Jin,Cho, Byung-Ki,Jeong, Ho-Seung 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.3

Purpose: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. Materials and Methods: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. Results: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. Conclusion: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.

고도의 무지 외반증에서 역갈매기형 중족골 절골술 및 Akin 절골술의 치료

정홍근,오정환,김태훈,박재용,강민석,Jung, Hong-Geun,Oh, Jeong-Hwan,Kim, Tae-Hoon,Park, Jae-Yong,Kang, Min-Seok 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.1

Purpose: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. Materials and Methods: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle ${\geq}40^{\circ}$ or intermetatarsal angle ${\geq}18^{\circ}$) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal-interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. Results: AOFAS Hallux Metatarsophalangeal-interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from $43.3^{\circ}(31-58^{\circ})$ preoperatively to $6.8^{\circ}(-8-27^{\circ})$ postoperatively. The intermetatarsal angle was decreased from $18.4^{\circ}(11-24)^{\circ}$ preoperatively to $5.3^{\circ}(1-12^{\circ})$postoperatively. The sesamoid subluxation was improved from $2.8{\pm}0.4$ preoperatively to $0.4{\pm}0.6$ postoperatively. Conclusion: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

무지외반증 환자의 족관절 수동적 족배 굴곡과 기능장애에 대한 고찰

이정호 ( Jung Ho Lee ),박지훈 ( Ji Hoon Park ),송미영 ( Mi Young Song ),김호준 ( Ho Jun Kim ),이명종 ( Myeong Jong Lee ) 한방재활의학과학회 2006 한방재활의학과학회지 Vol.16 No.2

Objectives : I tried to examine the hypothesis that the mobility of passive dorsi flexion of the ankle joint is associated with degree of the hallux valgus angle in appearance. I began this study in order to grope for the possibility of the acupuncture therapy for musculation disorder of the hallux valgus. Methods : 15 patients with hallux valgus deformity who attended Dept. of Oriental Rehabilitation Medicine, College of Oriental Medicine, Dongguk University from August to November 2005, were involved in the investigation. We measured passive range of dorsi flexion of both ankle joints. I considered mordern concepts in the aetiology and pathogenesis of hallux valgus and found causative factors in aspect of the movability of left and right ankle joints. Results : I made a comparison between degree of hallux valgus angle in appearance and range of dorsi flexion in each single person. In the event, larger degrees of hallux valgus angle in appearance were measured better in portion to the mobility of passive dorsi flexion(P<0.01). Conclusions : My interpretation of this results based upon Van Buskirk`s nociceptive model is that shortening and dysfunction of the dorsi flexor muscles, especially anterior tibialis muscle and extensor hallucis longus muscle are likely to be causative component in some cases of hallux valgus.

제 2 족지 전이술 후 무지 외반증이 발생하는가?

김상호,황소민,김기태,김종현,배용찬 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.2

Second toe transfer is widely used to reconstruct digital defects or deformities. But it could cause any potentials for occurrence of hallux valgus. So the authors has evaluated the occurrence of hallux valgus after second toe transfer. The authors retrospectively analysed the results of 20 cases of second toe transfer which were performed from July 1997 to June 2001 in Pusan National University Hospital. To evaluate the occurrence of hallux valgus, we compared preoperative hallux valgus angles and first-second intermetatarsal angles with those of postoperative results. Also the clinical evaluation of patients' subjective assessment and foot pressure meter was used to compare the donor foot with normal foot after operation. Although hallux valgus angle and intermetatarsal angle were increased to a few degrees after second toe harvesting, but there were no statistical significances(p>.05). According to the patients' subjective assessment, none of the patients showed clinically significant valgus deformities. By a foot pressure meter, no specific different results were detected between donor foot and normal foot. In conclusion, the second toe can be harvested safely without fear of causing hallux valgus in the donor foot if the metatarsal bone is not involved in harvesting.

변형 Scarf 및 Akin 절골술 후 무지외반변형 재발의 방사선학적 위험인자 연구

서재완,김성현,박현우 대한족부족관절학회 2019 대한족부족관절학회지 Vol.23 No.4

Purpose: This study investigated the recurrence rate after performing hallux valgus correction using scarf and Akin osteotomy, and also identified the correlation and cut-off values of both the preoperative and postoperative radiographic parameters as risk factors for the recurrence of hallux valgus. Materials and Methods: We reviewed 87 hallux valgus patients (122 feet) who received scarf and Akin osteotomy from January 2007 to August 2015. The clinical outcomes were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The radiological outcome measures included the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) as determined on the serial weight bearing radiographs. Recurrence was defined as more than 20 degrees of HVA noted on the final follow-up radiograph. Those radiological factors associated with recurrence were evaluated and analyzed. Results: The mean follow-up duration was 20.6 months (12.0∼46.5 months) and the mean age was 44 years (13∼80 years). The VAS and AOFAS scores were significantly improved at the time of the final follow-up (7.0 to 2.0, p<0.001; 78.0 to 92.0, p<0.001; respectively). Significant corrections in the HVA, IMA, and DMAA were obtained (p<0.001). Eleven (9.0%: 11/122) cases experienced recurrent hallux valgus deformity. The postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at the final follow-up (Pearson correlation coefficient: 0.44, 0.70, and 0.88, respectively; p<0.001). Postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees showed statistically significant correlation with radiological recurrence at the last follow-up, and the odds ratio of each variable was high in order. Conclusion: Our radiographic results indicated that postoperative HVA>16.7 degrees, postoperative DMAA>13.9 degrees, and postoperative IMA>8.2 degrees can be risk factors for hallux valgus recurrence. These risk factors may be helpful for modifying surgical procedures and preventing the recurrence of hallux valgus.

제 2 족지 전이술 후 무지 외반증이 발행하는가?

김상호,황소민,김기택,김종현,배용찬 大韓成形外科學會 2004 Archives of Plastic Surgery Vol.31 No.2

The Effects of D.I.Y Transverse Arch Orthosis on Hallux Valgus Angle and Pain in Adults with Hallux Valgus

Min Gyun Ko,Dami Choi,Juyeon Seo 물리치료재활과학회 2023 Physical therapy rehabilitation science Vol.12 No.4

Objective: The purpose of this study was to investigate the effects of prefabricated orthoses which were a combination of a toespacer and a transverse arch orthosis of young adults with hallux valgus on the hallux valgus angle and pain. Design: A randomized controlled trial. Methods: A total of twenty-two young adults with hallux valgus have voluntarily participated in the study. The participants were randomized to the Do-it-yourselftransversearch orthosis (DTO) group (n1=12), and the control group(n2=11) that used a toespacer orthosis. The intervention was applied to each group wearing orthoses 5 times a week for more than 7 hours during the4-week period. All subjects were measured for hallux valgus angle and pain at before-after intervention. Results: In the comparison of the effects within the groups, the effect of the intervention on the HV angle was significantlydecreased in each group (p<0.05). The DTO group significantly decreased the pain in the lumbar, knee, and foot(p<0.05). Thecontrol group significantly decreased the pain in only the foot(p<0.05). In the comparison of the effects between the groups, theDTO group was found to significantly decrease the pain in the lumbar and knee than the control group (p<0.05). Conclusions: The results of this study confirmed that DTO is an effective method for hallux valgus. It is thought that can be used as basic data and to develop programs for effective non-surgical intervention in patients with mild HV.