OBJECTIVE: To review the research progress on correction of severe foot and ankle deformities with digital hexapod external fixators. METHODS: The relevant research literature on digital hexapod external fixators at home and abroad in recent years was reviewed and analyzed. Taking Taylor spatial frame (TSF) as a representative, this article elaborates on the research progress of this technology in the treatment of severe foot and ankle deformities from aspects such as device principle, technical characteristics, clinical application, complication management, and controversial perspectives, aiming to provide theoretical references for clinical application. RESULTS: The treatment of severe foot and ankle deformities is a complex challenge in orthopedics, often involving multiple plane alignment abnormalities, muscle weakness, soft tissue contractures, and joint dysfunction. The digital hexapod external fixators (such as TSF), based on the principle of six degrees of freedom motion and combined with computer-assisted technology, enables precise correction of multi-dimensional deformities. CONCLUSION The digital hexapod external fixators provides a minimally invasive and efficient option for the treatment of severe foot and ankle deformities, and shows significant advantages in the treatment of complex post-traumatic deformities, neuromuscular deformities, diabetes Charcot arthropathy, and other diseases.
Humans ; External Fixators ; Foot Deformities/surgery* ; Ankle Joint/abnormalities* ; Ankle/abnormalities* ; Equipment Design

Ankle arthrodesis is a common and standard treatment for patients with end-stage ankle arthritis. The surgical goals of ankle arthrodesis are to obtain bony union between the tibia and talus with adequate alignment, and provide a pain-free plantigrade foot for weightbearing activities. To achieve successful fusion, the surgeon should closely examine the patient's factors before surgery, particularly the following: adjacent arthritis and deformity, infection, avascular necrosis of talus, Charcot arthropathy, and rheumatoid arthritis. Recently, ankle arthroplasty has been reported to provide satisfactory clinical results. On the other hand, long-term follow-up results are still lacking, and considering the various complications of arthroplasty, ankle arthrodesis is still the primary surgical treatment for advanced arthritis of the ankle joint.
Ankle Joint ; Ankle* ; Arthritis ; Arthritis, Rheumatoid ; Arthrodesis* ; Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hand ; Humans ; Necrosis ; Talus ; Tibia ; Weight-Bearing

BACKGROUND: We developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies. METHODS: Between December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated. RESULTS: The mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of 32.2° and 14.3°, respectively, to an average of 12.5° and 8.6°, respectively. The distal metatarsal articular angle improved from an average of 18.7° to 12.4°. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of 4.1° to 7.1°. CONCLUSIONS: The modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.
Ankle ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Orthopedics ; Osteotomy* ; Range of Motion, Articular

PURPOSE: The purpose of this study was to evaluate changes in the coronal alignment of the knee and ankle joints after open wedge high tibial osteotomy (OWHTO) to determine factors related to the recurrence (R) of the varus deformity by serial analysis. MATERIALS AND METHODS: Sixty-four OWHTOs were enrolled in this study. The weight bearing line (WBL) ratio, joint line convergence angle (JLCA), knee joint inclination, mechanical axis-tibial plateau angle, talar inclination (TI), and distal tibia articular angle (DTAA) were serially assessed. Serial correlation analysis between all parameters was performed. Patients were divided into R group and no recurrence (NR) group according to the WBL ratio (55%) at postoperative one year. RESULTS: The preoperative WBL ratio showed significantly negative correlation with serial changes of JLCA, TI, and DTAA (p < 0.05). The JLCA, TI, and DTAA as well as WBL ratio showed a significantly larger degree of varus alignment in the R group than in NR group at postoperative 6 weeks and 1 year after OWHTO (p < 0.05). CONCLUSIONS: Sufficient correction of the WBL and restoration of the JLCA during OWHTO are essential to prevention of the R of varus deformity after the surgery because they are the only modifiable factors during surgery. LEVEL OF EVIDENCE: IV, Case series
Ankle Joint ; Ankle ; Congenital Abnormalities ; Humans ; Joints ; Knee Joint ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Tibia ; Weight-Bearing

Stroke is a leading cause of disability in the elderly. Among complications of stroke, musculoskeletal problems are common, thereby causing improper gait biomechanics, development of pain, and limitation in performing activities of daily living. Post-stroke hip fractures and greater trochanteric pain syndrome are common complication near hip joint. Knee osteoarthritis can be accelerated by altered biomechanics of post-stroke period, that is associated with ambulation levels. Stiff knee gait and genu recurvatum can be developed after stroke and usually contribute to abnormal gait patterns, due to weakness or spasticity of various muscles, and they need to control or compensate affected muscle activities. In case of ankle and foot problems, foot varus deformity is caused by imbalance between muscles that control ankle movement, while claw toes and the persistent extension of the great toe are mainly due to overactivity of muscles that moves toes, and mainstay of treatment is to control inappropriate activities of affected muscles. It is important to make the exact therapeutic decision and establish the rehabilitation plan through the early evaluation of lower extremity musculoskeletal problems that affect the mobility and ambulation.
Activities of Daily Living ; Aged ; Ankle ; Congenital Abnormalities ; Femur ; Foot ; Gait ; Hammer Toe Syndrome ; Hip Fractures ; Hip Joint ; Humans ; Knee ; Lower Extremity* ; Muscle Spasticity ; Muscles ; Osteoarthritis, Knee ; Rehabilitation ; Stroke* ; Toes ; Walking

PURPOSE: To evaluate the effect of shortening scarf osteotomy on pain relief and range of motion (ROM) of the first metatarsophalangeal joint in hallux rigidus patients. MATERIALS AND METHODS: Twenty-three cases of 19 patients who had been treated with shortening scarf osteotomy for the hallux rigidus between January 2007 and December 2013 were reviewed. The mean follow-up period was 21.4 months, and the mean age was 59.2 years. The first metatarsal bone was shortened until the ROM of the first metatarsophalangeal joint was greater than 80° or 40° of dorsiflexion. The length shortened by scarf osteotomy was measured. The authors also measured and compared the joint interval difference of the standing foot using an anteroposterior radiography. Moreover, the difference of ROM of the first metatarsophalangeal joint between the preoperative and final follow-up periods was also compared. The clinical results were evaluated and compared using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and visual analogue scale (VAS) score. RESULTS: The mean shortening length was about 6.5 mm (range, 4∼9 mm). The joint space has been increased to 1.8 mm, and the ROM of the first metatarsophalangeal joint has also been increased to 18.4° after the operation. In three cases, the postoperative ROM has been decreased to less 10°. The AOFAS score has been improved from 41.7 (range, 32∼55) to 86.2 (range, 65∼95), and the VAS score was also decreased from 3.7 (range, 3∼5) to 1.3 (range, 0∼3). Two cases have shown no decrease in pain even after the operation. CONCLUSION: Shortening scarf osteotomy was found to decrease joint pain by decompressing the pressure of the first metatarsophalangeal joint. This osteotomy also helped improve the ROM of the first metatarsophalangeal joint. Shortening scarf osteotomy can be considered one of the effective methods for joint preservation.
Ankle ; Arthralgia ; Congenital Abnormalities* ; Follow-Up Studies ; Foot ; Hallux Rigidus* ; Hallux* ; Humans ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Osteotomy* ; Radiography ; Range of Motion, Articular

PURPOSE: We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy. MATERIALS AND METHODS: This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups. RESULTS: The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0~2.11 cm) and 2.36 cm (1.60~2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group (1.47±0.25 cm) than in the middle insertion group (1.27±0.35 cm). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008). CONCLUSION: Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.
Achilles Tendon* ; Adult* ; Ankle Joint ; Calcaneus* ; Congenital Abnormalities* ; Humans ; Magnetic Resonance Imaging* ; Tendinopathy

PURPOSE: Tibiotalocalcaneal arthrodesis has been used as a treatment option for severe deformity including Charcot arthropathy, avascular necrosis of the talus, and severe osteoarthritis of the ankle and subtalar joint. The purpose of this study was to evaluate the result of the surgical outcome of tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail. MATERIALS AND METHODS: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail was performed by one surgeon in 36 cases. Clinical and radiological finding was evaluated using assessment of fusion time, 5th metatarsal-tibial angle, possibility of postoperative complication, visual analogue scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: Union was achieved in 33 cases at an average of 23 weeks (11~29 weeks). There were 3 cases of nonunion and 1 case of reoperation. Nail-tibial angle tended to be larger in nonunion cases. AOFAS score showed significantly poor outcome at malalignment (> or =5degrees), negative value of 5th metatarsal-tibial angle. CONCLUSION: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail is considered a useful treatment option for severe destruction and deformity involving ankle and subtalar joint.
Ankle ; Arthrodesis* ; Congenital Abnormalities ; Foot ; Necrosis ; Osteoarthritis ; Postoperative Complications ; Reoperation ; Subtalar Joint ; Talus

BACKGROUND: The purpose of the study was to compare and contrast ankle range of motion, functional ability, talar- tilt angle and foot injuries between high school ballet majors with and without foot deformities and to provide fundamental data about effective intervention methods for their successful performance and injury prevention. METHODS: Subjects were 18 female high school ballet dancers, eight with foot deformities and ten without foot deformities. For statistical analysis, the independent t-test (SPSS 20.0; SPSS Inc, Chicago, IL, USA) was used and the significant level of P<0.050 was selected. RESULTS: 1. Foot injuries of plantar flexion and talar tilt were significantly different between the two groups (P<0.050). 2. The deformity group displayed a higher proportion of mechanical instability compared to that of the control group. CONCLUSIONS: Foot deformities in high school students majoring in ballet can have negative effects to the ankle joint, with a strong possibility of ankle instability and foot injuries linked to tarlar tilt, and quite probably, of chronic ankle sprain.
Ankle Injuries ; Ankle Joint ; Ankle* ; Congenital Abnormalities ; Female ; Foot Deformities* ; Foot Injuries* ; Humans ; Range of Motion, Articular*

BACKGROUND: The purpose of the study was to compare and contrast ankle range of motion, functional ability, talar- tilt angle and foot injuries between high school ballet majors with and without foot deformities and to provide fundamental data about effective intervention methods for their successful performance and injury prevention. METHODS: Subjects were 18 female high school ballet dancers, eight with foot deformities and ten without foot deformities. For statistical analysis, the independent t-test (SPSS 20.0; SPSS Inc, Chicago, IL, USA) was used and the significant level of P<0.050 was selected. RESULTS: 1. Foot injuries of plantar flexion and talar tilt were significantly different between the two groups (P<0.050). 2. The deformity group displayed a higher proportion of mechanical instability compared to that of the control group. CONCLUSIONS: Foot deformities in high school students majoring in ballet can have negative effects to the ankle joint, with a strong possibility of ankle instability and foot injuries linked to tarlar tilt, and quite probably, of chronic ankle sprain.
Ankle Injuries ; Ankle Joint ; Ankle* ; Congenital Abnormalities ; Female ; Foot Deformities* ; Foot Injuries* ; Humans ; Range of Motion, Articular*