Three cases of fatigue fracture were experienced, whose tibia, fibula and femoral neck had been involved. The mechanism of fracture was explained as the result of repeatation of uncustomed stress mainly in lower extremities. Several authors suggested many types of predisposing factors, such as spastic flat foot, short first metatarsal bone and osteoporosis after steroid administration. Two of the cases were treated conservatively and one case with femoral neck fracture treated by open reduction and Sith-Peterson nailing.
Causality ; Femoral Neck Fractures ; Femur Neck ; Fibula ; Flatfoot ; Fractures, Stress ; Lower Extremity ; Metatarsal Bones ; Muscle Spasticity ; Osteoporosis ; Tibia

The common sites of solitary bone cyst(SBC) are humerus, femur and less common sites are tibia, calcaneus, ilium, fibula, radius and ulna. Ischium rib, scapula, spine, clavicle and patella are rare sites of solitary bone cyst. As mentioned above, SBC of patella is very rare and on view of literatures we could find only one reported case which was treated by patellectomy. We also experienced one case of SBC located at patella, so we report this case with review of literatures.
Bone Cysts ; Calcaneus ; Clavicle ; Femur ; Fibula ; Humerus ; Ilium ; Ischium ; Patella ; Radius ; Ribs ; Scapula ; Spine ; Tibia ; Ulna

PURPOSE: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. MATERIALS AND METHODS: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. RESULTS: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). CONCLUSION: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.
Arthrodesis ; Calcaneus ; Femur Neck ; Follow-Up Studies ; Foot ; Humans ; Male ; Metatarsal Bones ; Osteonecrosis ; Skin ; Tissue Donors ; Transplantation, Homologous ; Transplants

Hemiplegic gait is characterized by slow and poorly coordinated movements of the affected limb resulting from foot drop or equinus deformities. Ankle-foot orthoses(AFO) are frequently prescribed to improve the gait pattern of hemiplegics. Plastic AFO with different trimlines in controlling ankle motion can cause variable biomechanical effects. In this study, we analysed the biomechanical effect of donning AFO on hemiplegic gait and assessed whether any differences resulted when the AFO was modified. Gait events, plantar pressure, foot contact and centers of pressure(COP) parameters were measured with F-scan pressure sensitive insole system in 21 hemiplegic stroke patients with Brunnstrom's lower extremity stage 3. And those parameters were compaired in each of four different conditions: 1) before donning AFO, 2) donning AFO without any modification, 3) donning AFO with the dis tal part of metatarsal head trimmed off, 4) donning AFO with third condition and weaning a cushioned heel shoes. After donning AFO, total contact area and contact width were increased, and initial contact COP and mean COP were displaced medially. But contact length was not changed and initial contact COP and mean COP were not displaced anteroposteriorly. Anteroposterior displacement of COP, slope and velocity of COP were not also changed after donning AFO. Among various AFO adjustments, there were no significant changes of plantar pressure, foot contact and COP parameters. The results suggest that 1) AFO provides mediolateral stability, but does not provide additional functional rocker actions during stance phase and 2) There were no definite different biomechanical actions among various adjustments of plastic AFO in hemiplegic gait of Brunnstrom's lower extremity stage 3.
Ankle* ; Equinus Deformity ; Extremities ; Foot Orthoses* ; Foot* ; Gait ; Gait Disorders, Neurologic* ; Head ; Heel ; Humans ; Lower Extremity ; Metatarsal Bones ; Plastics ; Shoes ; Stroke ; Weaning

Achondrogenesis type 2 is a lethal form of congenital skeletal dysplasia characterized by severe short-limbed dwarfism, decreased vertebral ossification and normal ossification of the skull. We report an autopsy case of achondrogenesis type 2 in a female fetus terminated at 29 weeks of gestation. External morphology revealed a relatively large head, short upper and lower extremities, short neck, and distended abdomen. The x-ray finding showed normal calvarial ossification, hypoplastic ilium and unossified ischium, and metaphyseal flares of the femur and tibia. Histologically, chondrocytes were large and irregular with increased vascularity.
Abdomen ; Autopsy* ; Chondrocytes ; Dwarfism ; Female ; Femur ; Fetus ; Head ; Humans ; Ilium ; Ischium ; Lower Extremity ; Neck ; Pregnancy ; Skull ; Tibia

There were 21 cases of tibial pilon fractures in total: type I-2 cases, type II-14 cases, type III-5 cases according to Rued's classification. In type I and II, ring fixators were applied to tibia and foot and closed reduction was performed monitoring the quality of the reduction with an image intensifier. When the quality of the reduction was questionable, we rechecked it using arthroscopy and if neces- sary, the reduction was readjusted. Instead of using plate and screws, we used olive stop wires to achieve stable fixation. In type III, a limited open reduction was performed in the place of arthroscopy. Approximately at the eighth week after operation, we removed the fixation of calcaneus, metatarsal and foot mounting. Between 16 and 28 weeks, we removed the foot mounting after achieving bony union in all cases except one case(20 cases). In the follow-up cases of 2 years and more, we obtained the fine functional results of 15 good, 4 fair and 2 poor cases. Fewer major complications were observed except 8 cases of pin tract infection(grade 1) and 1 case of reduction loss. Using ring fixators and arthroscopy, we had fewer surgical complications.
Arthroscopy ; Calcaneus ; Classification ; Follow-Up Studies ; Foot ; Metatarsal Bones ; Olea ; Tibia

PURPOSE: Blue toe syndrome consists of blue or purplish toes in the absence of a history of obvious trauma, serious cold exposure, or disorders producing generalized cyanosis. It is a life-threatening and still underrecognized disease. It can be commonly occurred by vascular surgery, invasive cutaneous procedures or anticoagulant therapy. Our case is presented of blue toe syndrome related to atheromatous embolization that was presumably triggered by angio CT. METHODS: A 69-year-old man presented with the suddenly developed pain, cyanosis and livedo reticularis of the toes in right foot. Dorsalis pedis pulses were palpable. He had been performed a diagnostic angio CT 1 month earlier. Angio CT revealed diffuse aortic atheromatous plaque in lower abdominal aorta and both common iliac artery. One month after angio CT, he visited our clinic. There was no visible distal first dorsal metatarsal artery and digital artery of right first toe in lower extremity arteriography. A diagnosis was established of blue toe syndrome. Because his symptom was aggravated, we performed the exploration of the right foot. After exposure of first dorsal metatarsal artery, microsurgical atheroembolectomy was done. RESULTS: There were no postoperative complications. After three months the patient had no clinically demonstrable problems. CONCLUSION: Patient with blue toe syndrome is at high risk of limb loss and mortality despite treatment. Blue toe syndrome produces painful, cyanosed toes with preserved pedal pulses. It needs to be aware of blue toe syndrome. Careful history should reveal the diagnosis. Treatment is controversial, however, most believe that anticoagulation therapy should be avoided.
Aged ; Angiography ; Aorta, Abdominal ; Arteries ; Blue Toe Syndrome ; Cold Temperature ; Cyanosis ; Extremities ; Foot ; Humans ; Iliac Artery ; Livedo Reticularis ; Lower Extremity ; Metatarsal Bones ; Postoperative Complications ; Toes

Fractures of the tarsal bone, such as the navicular, cuboid, and cuneiform, are very rare. These injuries can lead to serious walking difficulties due to pain and deformity of the foot with delayed diagnosis of tarsal bone fractures during an injury to multiple lower extremities. The diagnosis can be done on simple radiographs. Sometime weight bearing radiographs or stress radiographs may be needed for further evaluation. Computed tomography is the most widely available diagnostic tool. Navicular and cuneiform account for the medial column of the foot, whereas cuboid for the lateral column. The treatment of tarsal bone fractures is primarily conservative management, but operative treatment is recommended for intra-articular displacement, dislocation, or shortening of the medial or lateral column of the foot. The operative treatments include screw fixation, plate fixation, or external fixation. Complications include malunion, nonunion, posttraumatic arthritis, avascular necrosis, and deformity of the foot. Tarsal bone fracture has to be evaluated carefully to prevent serious complications.
Arthritis ; Congenital Abnormalities ; Delayed Diagnosis ; Diagnosis ; Dislocations ; Foot ; Lower Extremity ; Necrosis ; Tarsal Bones* ; Walking ; Weight-Bearing

Tarsal tunnel syndrome is often misdiagnosed it shares clinical features with other diseases of the lower extremity such as lumbar radiculopathy and arthritis. Failure to diagnose and treat neuropathies effectively can cause permanent neuropathic pain. We report a case of a ganglion cyst detected early using ultrasonography and MRI in a 51-year-old man who complained of rapidly aggravating pain, numbness and paresthesia on the great toe and the first metatarsal area in the sole, symptoms that resembled tarsal tunnel syndrome. Surgical treatment could be performed early with no permanent sequelae. We could also avoid repeated steroid injections or prescription medications.
Arthritis ; Ganglion Cysts ; Humans ; Hypesthesia ; Lower Extremity ; Metatarsal Bones ; Middle Aged ; Neuralgia ; Paresthesia ; Prescriptions ; Radiculopathy ; Tarsal Tunnel Syndrome ; Toes

The author has studied 33 cases of Korean embryos of Carnegie stage 11 ~23 and 18 cases of fetuses to demonstrate the development of the hip joint. The external feature of the lower extremity was observed by stereoscope and digital camera, and the internal structures were studied by light microscopic observation. The results obtained were as follows: In stage 13 lowerlimb buds were appeared. In stage 17 mesenchymal condensation for femur and hip bone, and one -layered interzone were observed. In stage 18 cartilage models for ilium and ischium were visible. In stage 22 three -layered interzone between the head of femur and hip bone was formed. In stage 23 acetabular labrum and distinct three -layered interzone was visible. In the 9th weeks mesenchymal ligamentum capitis femoris and transverse acetabular ligament are appeared, and acetabular labrum was reacted tracely to trichrome stain. In the 10th week the joint space was formed between the femoral head and hip bone, and shallow depression in acetabulum is found. In the 12th week the articular capsule was directed lateral to acetabular labrum, and numerous blood vessels were found in acetabular fossa and ligamentum capitis femoris, and cartilage canal were developed in femoral neck. In the 14th week cartilage canal was found in middle of femoral head, and synovial fold were developed, and ligamentum capitis femoris was shown strongly positive reaction. In the 16th week cartilage canals were more found, and numerous blood vessels were observed in fovea capitis. In the 18nd week the neck of femur was narrow, and femoral head was lied deeply in acetabulum with acetabular labrum. Consequently the lower extremity of Korean embryos and fetuses was first appeared in stage 13, and hip joint development was started at stage 17. The articular cavity was first formed at the 9th week of development, the acetabulum labrum was developed at stage 23. The mesenchymal ligamentum capitis femoris was appeared at the 9th week. At the same time the transverse acetabular ligament fully encircled the femoral head. The articular capsule has lined the articular cavity at the 12th week, and synovium was formed at the 14th week of development. At the 18th week the hip joint has attained its final shape.
Acetabulum ; Blood Vessels ; Cartilage ; Depression ; Embryonic Structures* ; Femur ; Femur Neck ; Fetus* ; Head ; Hip Joint* ; Hip* ; Humans* ; Ilium ; Ischium ; Joint Capsule ; Joints ; Ligaments ; Lower Extremity ; Neck ; Synovial Membrane