Controversies exist regarding the treatment options for the end-stage arthritic change in the lateral tarsometatarsal joints. Arthrodesis has been frequently performed, but has a disadvantage of sacrificing a mobile joint. Resection arthroplasty also gained its popularity, especially in the patients with Rheumatoid arthritis, but possible hypermobility can lead to deformity. We report a successful clinical outcome of a patient with Rheumatoid arthritis in the 4th, 5th tarsometatarsal joints treated with tendon interpositional arthroplasties.
Arthritis, Rheumatoid* ; Arthrodesis ; Arthroplasty* ; Congenital Abnormalities ; Humans ; Joints* ; Tendons*

Fracture of os peroneum can occur, but the fracture fragments are seldom displaced. Complete rupture of peroneus longus through the fracture of the os peroneum causing displacement of the fracture fragments is not well reported in the literature. Differential diagnosis with bipartite os peroneum or calcific tendinitis is important because misdiagnosis of the tendon rupture can lead to serious sequela including chronic pain, ankle instability, and peroneal compartment syndrome. We report a case of complete rupture of peroneus longus associated with fracture of the os peroneum with a review of the literature.
Ankle ; Chronic Pain ; Compartment Syndromes ; Diagnosis, Differential ; Diagnostic Errors ; Rupture* ; Tendinopathy ; Tendon Transfer* ; Tendons*

Xanthoma is a relatively rare soft tissue lesion on the Achilles tendon and is usually associated with hyperlipidemia (lipid metabolism abnormality), mental retardation, cataract and atherosclerotic disease. We report on a case of normolipidemic bilateral Achilles tendon xanthoma without any notable cause. We herein describe the case where we achieved a satisfactory result by subtotal resection.
Achilles Tendon* ; Cataract ; Humans ; Hyperlipidemias ; Intellectual Disability ; Metabolism ; Xanthomatosis*

It has been reported that the gap between the tendon stumps in chronic Achilles tendon rupture is filled with interposed scar tissue. If it was available to use the interposed scar tissue for reconstruction or augmentation of Achilles rupture, possible damage of normal tissues could be avoided. Our results show that direct repair method using interposed scar tissue for chronic Achilles tendon rupture can successfully relieve pain and restore function of the ruptured Achilles tendon in carefully selected patients.
Achilles Tendon* ; Cicatrix* ; Humans ; Rupture* ; Tendons

PURPOSE: The purpose of the study was to investigate five cases with chronic Achilles tendon rupture that occurred after steroid injections. MATERIALS AND METHODS: In our hospital, we experienced five cases of chronic Achilles tendon rupture from September 2010 to March 2012. All patients had got steroid injection for Achilles tendinitis at the other hospitals, and their heel pain was aggravated when they visited our outpatient department. After treatment, signs and symptoms of Achilles tendon rupture were developed and the diagnosis was confirmed by ultrasonography or magnetic resonance imaging (MRI). Surgical treatment was done for Achilles tendon rupture. RESULTS: There was difference between intra-operative findings of Achilles tendon rupture and usual chronic Achilles tendon rupture. Unlike usual findings of chronic Achilles tendon rupture whose scar tissue or tissue attenuation are found around the defect area of Achilles tendon, there were partial necrosis of tendon severe adhesion with surrounding tissue, extensive defect and longitudinal rupture on ruptured area. Also, severe inflammation of paratenon, granulation and fibrinoid deposit were found on biopsy findings in four cases. CONCLUSION: Based on review of data about relative risk and benefit of local corticosteroid injection to inflammatory lesion in Achilles tendon, it requires more attention to Achilles tendon rupture following local corticosteroid injection.
Achilles Tendon* ; Biopsy ; Cicatrix ; Diagnosis ; Heel ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Necrosis ; Outpatients ; Rupture* ; Tendinopathy* ; Tendons ; Ultrasonography

PURPOSE: To present clinical results of proximal first metatarsal opening wedge osteotomy and low profile plate fixation in hallux valgus deformity. MATERIALS AND METHODS: Thirty-two patients (39 feet) underwent surgery for hallux valgus deformity. Fourteen patients (18 feet; Group A) underwent proximal first metatarsal opening wedge osteotomy fixed with low profile titanium plate (Arthrex(R)), and 18 patients (21 feet; Group B) underwent proximal chevron osteotomy with two K-wires. Improvement in hallux valgus angle (HVA), 1, 2 intermetatarsal angle (IMA), range of motion of 1st metatarsophalangeal joint, VAS score, and the length of first metatarsal on weight-bearing radiograph were evaluated preoperatively and at final follow-up. RESULTS: HVA improved from 36.2+/-6.6 degrees to 11.7+/-5.1 degrees, and 1, 2 IMA improved from 15.7+/-2.6 degrees to 7.2+/-1.9 degrees. VAS score improved from 7.2+/-1.2 to 1.4+/-0.9. There were no significant differences clinically and radiologically. CONCLUSION: Proximal first metatarsal opening wedge osteotomy with stable fixation using low profile plate may be an effective surgical option for correction of hallux valgus deformity.
Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Osteotomy* ; Range of Motion, Articular ; Titanium ; Weight-Bearing

PURPOSE: To report the clinical outcomes and complications of flexor hallucis longus (FHL) tendoscopy using 3 portals. MATERIALS AND METHODS: Between January 2012 and April 2013, 10 patients (10 ankles) received tendoscopic surgery for the treatment of FHL tenosynovitis. Patients complaining of pain and tenderness along the course of FHL despite over 6 months of conservative treatments were indicated for surgery. The mean age was 41.7 years (range: 18-57) and the follow up period was 12.7 months (range: 6-20). Tendoscopy was performed using posteromedial, posterolateral, and plantar portals. Clinical evaluations included preoperative and postoperative visual analogue scale (VAS), American orthopaedic foot and ankle society (AOFAS) score, and patients' satisfaction. RESULTS: Tendoscopic findings included tenosynovitis in 10 cases, degenerated vinculae in 6 cases, stenosis of the tendon at its entrance into the fibro-osseous tunnel in 5 cases, and degenerative partial tendon tear in 3 cases. Two cases had associated symptomatic os trigonum and 3 cases had posterior ankle impingement syndrome. Preoperative pain decreased from median VAS 6 (range: 4-10) to 2.1 (range: 1-5) at the last follow up and AOFAS score improved from 50.1 (range: 36-63) to 82.1 (range: 61-89) (p<0.05). Nine patients were satisfied or very satisfied with the outcome. Injury of the lateral plantar nerve occurred in one case. CONCLUSION: FHL tendoscopy using 3 portals is a feasible and useful minimal invasive surgical technique for the management of FHL tenosynovitis.
Ankle ; Constriction, Pathologic ; Follow-Up Studies ; Foot ; Humans ; Talus ; Tendons ; Tenosynovitis*

PURPOSE: Number of arthroscopic surgery is gradually increasing with development of its equipment and technique. Arthroscopic ankle surgery performed with the traction device has various complications and need more time for preparation. We investigated whether the complication rate increased when surgery was performed without the traction device, and compared the complication rate of arthroscopic surgery with the traction device. MATERIALS AND METHODS: From January 2009 to June 2012, arthroscopic ankle surgery was performed without the traction device in four hundred eleven cases. There were two hundred sixty-one males and one hundred fifty females. The average age at operation was 35 years (range, 17-56), and the average follow up period was 28 months (range, 12-41). Postoperative symptoms and complications were checked. RESULTS: There were difficulties performing arthroscopic surgery without the traction device in five cases with severe traumatic osteoarthritis. However, after burring and shaving, we had enough space to work on. Superficial peroneal nerve symptom was found in two cases, grooving of talus was found in 11, and saphenous vein injury was found in five. Since preparing for the traction device was unnecessary, we were able to save time with the mean duration of surgery of 50 minutes (range, 30-120). CONCLUSION: With only manual traction, we could explore the entire ankle joint without damage on cartilage. Yet, skilled arthroscopic technique will be necessary for arthroscopic surgery without the traction device.
Ankle Joint* ; Ankle* ; Arthroscopy* ; Cartilage ; Female ; Follow-Up Studies ; Humans ; Male ; Osteoarthritis ; Peroneal Nerve ; Saphenous Vein ; Talus ; Traction*

Postpoliomyelitis syndrome is a common neurological disorder that occurs in patients who have experienced paralytic poliomyelitis. Recently, as a result of vaccination against poliovirus, incidence of poliomyelitis is exceedingly low. However, many patients with postpolio syndrome may encounter anesthesia when undergoing surgery, such as for correction of foot deformity and other operations. We report on a 45-year-old woman who experienced paralysis of her contralateral limb after operation on the left foot under spinal anesthesia. Postoperative electromyography/nerve conduction study (EMG/NCS) was performed in order to determine the cause of paralysis. Motor power of the sequelae involved leg showed improvement with time and recovered fully to the preoperative level at six months after the index operation. A precise evaluation, including a physical examination and EMG/NCS, should be performed preoperatively when spinal anesthesia is planned for postpolio syndrome patients.
Anesthesia ; Anesthesia, Spinal ; Congenital Abnormalities* ; Extremities* ; Female ; Foot Deformities ; Foot* ; Humans ; Incidence ; Leg ; Middle Aged ; Nervous System Diseases ; Paralysis ; Physical Examination ; Poliomyelitis* ; Poliovirus ; Postpoliomyelitis Syndrome ; Vaccination

Occurrence of pseudoaneurysm in the foot and ankle is rare, and is usually caused by traumatic injury or by iatrogenic intervention. Iatrogenic pseudoaneurysms in the foot and ankle have been observed after rearfoot and ankle fusions, ankle arthroscopy, endoscopic and open plantar fasciotomy, tibial osteotomy with limb lengthening, midfoot amputation, and Lapidus procedure. We report on a patient who developed a pseudoaneurysm of the dorsal metatarsal artery following correction of hallux valgus. The patient underwent proximal chevron osteotomy and Akin phalangeal osteotomy. The feeding artery was ligated and the pseudoaneurysm was excised.
Amputation ; Aneurysm, False* ; Ankle ; Arteries ; Arthroscopy ; Extremities ; Foot ; Hallux Valgus* ; Humans ; Metatarsal Bones* ; Osteotomy*