Background: Radiological correction of hallux valgus deformity is the objective of operation and related to successful outcomes. Nonetheless, footwear problems related to foot width can also affect the clinical outcome. Few studies have analyzed changes in foot width, and data on clinical outcomes after correction of hallux valgus deformity are scarce. Methods: The study included 159 cases with symptomatic hallux valgus deformity who underwent proximal or distal chevron metatarsal osteotomy and were followed up for a mean of 32.8 months. Radiologically, the hallux valgus angle, intermetatarsal angle, first metatarsal head width, bony foot width, and soft-tissue foot width were analyzed. Clinically, the visual analog scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score were evaluated. Results: The preoperative hallux valgus was corrected radiologically at the last follow-up. The bony foot width was reduced by 9.4%, and the soft-tissue foot width was reduced by 7.1% (p < 0.001 for all). The mean AOFAS score improved from 51.2 preoperatively to 89.4 at the final follow-up (p < 0.001). In multiple regression, the perioperative changes of bony foot width were associated with final AOFAS score (p = 0.029). Conclusions Chevron osteotomy performed for hallux valgus deformity resulted in satisfactory radiological and clinical outcomes.Perioperative changes in bony foot width showed a significant correlation with AOFAS score. Therefore, to correct hallux valgus deformity, it is necessary to correct known radiological indicators sufficiently and make efforts simultaneously to reduce the foot width optimally.

Insoles are used to treat various foot diseases, including plantar foot, diabetic foot ulcers, and refractory plantar fasciitis. In this study, we investigated the effects of 3-dimensional image-based (3-D) insole in healthy volunteers with no foot diseases. Additionally, the comfort of the 3-D insole was compared with that of a custom-molded insole. A singlecenter, randomized, open clinical trial was conducted to address the effectiveness of insole use in a healthy population with no foot or knee disease. Two types of arch support insoles were evaluated for their effectiveness: a 3-D insole and a custom-molded insole. Fifty Korean volunteers participated in the study and were randomly allocated into the “3-D insole” (n = 40) or “custom-molding insole” (n = 10) groups. All subjects wore 3-D insoles or custommolded insoles for 2 weeks. The sense of wearing shoes (Visual Analog Scale [VAS] and score) and fatigue of the foot were used to assess the insole effects at the end of the 2-week study period. The 3-D insole groups showed significantly improved sense of wearing shoes (VAS, p = 0.0001; score, p = 0.0002) and foot fatigue (p= 0.0005) throughout the study period.Although the number of subjects was different, the custom-molding insole group showed no significant changes in the sense of wearing shoes (VAS, 0.1188; score, p = 0.1483). Foot fatigue in the 3-D insole group improved significantly (p = 0.0005), which shows that a 3-D insole might have favorable effects on foot health in a healthy population.

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.

Syndesmotic injuries are found frequently in clinical practice, and they remain controversial because of the variety of diagnostic techniques and management options. Bony avulsions or malleolar fractures are commonly associated with syndesmotic disruptions. Even unstable isolated syndesmosis injuries are associated with a latent or frank tibiofibular diastasis and should not be ignored in the early phase. A relevant instability of the syndesmosis with diastasis results from collateral ligaments tears and requires operative stabilization.The treatment involves an anatomic reduction of the distal tibiofibular articulations followed by stable fixation. Syndesmotic transfixation screws or suture button implants are being proposed as a means of fixation. Recently, suture button fixation has shown more favorable outcomes, but the outcomes can still be controversial. Syndesmotic malreduction can lead to hardware failure, adhesions, heterotopic ossification, tibiofibular synostosis, chronic instability, and posttraumatic arthritis. In particular, the correct diagnosis and evidencebased treatment options for unstable syndesmotic injury should be considered.

The Lisfranc joint complex is composed of complex bony structures, ligaments, and soft tissues and has a systematic interrelationship. Sufficient radiologic modalities should be considered for an accurate initial diagnosis. Based on an accurate understanding of normal anatomy and restoration of anatomical relationships, the diagnosis should be obtained, and more discussion is needed on detailed treatment strategies.

The open Broström procedure is considered the surgery of choice for treating chronic lateral ankle instability. The role of arthroscopy has gained popularity in the surgical treatment of chronic lateral ankle instability, partly for the ability to manage the intra-articular pathology combined with ankle instability. Arthroscopic techniques can be divided broadly into the arthroscopic-assisted Broström technique and arthroscopic all-inside ligament repair. The clinical results of these arthroscopic techniques are similar to open procedures. The arthroscopic technique may be an excellent alternative to the open Broström procedure in treating chronic lateral ankle instability when applying the appropriate indications.

Chronic lateral ankle instability occurs in 10% to 20% of individuals after acute ankle sprain. The management of chronic lateral ankle instability is traditionally conservative treatment in the acute phase. On the other hand, surgical intervention is considered if conservative treatment fails and the symptoms are ongoing. This review focuses on the surgical approaches to treatment of chronic lateral ankle instability, including Broström surgical techniques, with a review of the traditional procedure and newer techniques.
Ankle Injuries ; Ankle* ; Hand ; Ligaments*

Ankle osteoarthritis is a debilitating condition that causes severe pain associated with functional impairment and decreased activity. Ankle osteoarthritis, unlike that of the knee or hip joint, is rare in primary arthritis. Most cases are traumatic arthritis that occur after ankle sprain or fractures or chronic ankle instability. Although ankle fusion has been regarded as the standard treatment of ankle osteoarthritis in the past, total ankle arthroplasty (TAA) is increasing due to the development of the implant design and surgical techniques. TAA is biomechanically superior to ankle fusion by preserving the movement of the ankle joint. In particular, it is functionally superior to ankle fusion because it enables normal joint motion during gait. In addition, there is an advantage of preserving the movement of the hindfoot and reducing the abnormal stress applied to the adjacent joints after ankle fusion to prevent the occurrence of long-term adjacent joint arthritis. Although the short-term and mid-term results of TAA have been reported to be excellent, long-term follow-up has a relatively low survival rate and high complication rate compared to total knee or hip arthroplasty. Therefore, continuous and further research is needed.
Ankle Injuries ; Ankle Joint ; Ankle* ; Arthritis ; Arthroplasty* ; Follow-Up Studies ; Gait ; Hip ; Hip Joint ; Joints ; Knee ; Osteoarthritis* ; Survival Rate

Ankle injury is one of the most common injuries, and osteochondral lesions of the talus occur in up to 70% of acute ankle sprains or fractures. The number of sports injuries have increased due to the increase in leisure activities, and the development of diagnostic techniques to evaluate the cartilage status leads to a higher prevalence of osteochondral lesions of the talus. Although osteochondral lesions of the talus with no symptoms can be treated conservatively, adult patients are usually treated by surgery because they are more likely to fail after non-surgical management. Recovery to normal cartilage is important, but there has been no surgical treatment established for effective cartilage regeneration. Bone marrow stimulation, such as arthroscopic microfracture, is a commonly used surgical procedure and an effective treatment for lesions that are small or failed after non-operative treatment. In addition, there are treatments, such as osteochondral autograft transplantation, osteochondral allograft transplantation and autologous chondrocyte implantation. The selection of the methods depends on the size and location of the lesion, the presence of subchondral cysts, and the results of previous surgery. Many surgical procedures have shown good results in short and mid-term follow-up studies but the results of long-term follow-up have been unclear. Various treatment methods, such as hyaluronan, platelet-rich plasma, mesenchymal stem cells, and bone marrow aspirate concentrate, have been available recently due to the development of various biological agents.
Adult ; Allografts ; Ankle Injuries ; Athletic Injuries ; Autografts ; Biological Factors ; Bone Cysts ; Bone Marrow ; Cartilage ; Chondrocytes ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Leisure Activities ; Mesenchymal Stromal Cells ; Platelet-Rich Plasma ; Prevalence ; Regeneration ; Talus*

PURPOSE: To treat hallux valgus in old age patients with chevron metatarsal osteotomy and to see the subsequent clinical and radiological outcomes. MATERIALS AND METHODS: 23 cases of 18 hallux valgus patients of age 60 years or older who received proximal or distal corrective osteotomy from April 2007 to August 2009 and were followed up for at least 1 year were included in the study. The mean age at operation was 65 years (range, 60~81 years), and the mean follow-up period was 2 years and 6 months (range, 1 year~3 years 6 months). Clinical outcome was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, satisfaction rate, as well as measurements and comparison of pre- and postoperative hallux valgus angles, the 1st~2nd intermetatarsal angle, and the position of hallucal medial sesamoid bone. RESULTS: The AOFAS score was improved from preoperative average of 35.1 (range, 13-47) to average 85.1 at last follow-up (range, 75-100). Patients were satisfied about the operation in 21 cases (91.3%). Preoperative hallux valgus angle was 31.7degrees on average (range, 19.1degrees-48.9degrees), and 4.9degrees on average at last follow-up (range, 0.3degrees-21.2degrees). The 1st~2nd intermetatarsal angle was 14.4degrees on average (range, 8.7degrees-25.7degrees) and 3.1degrees on average at last follow-up (range, 0.6degrees-7.5degrees). The hallucal medial sesamoid bone position was improved from preoperative average 3.5 (range, 3-4) to postoperative average 1.0 (range, 0-2). CONCLUSION: Proximal and distal metatarsal osteotomy treatment yielded good clinical and radiological outcomes in old age hallux valgus patients.
Animals ; Ankle ; Follow-Up Studies ; Foot ; Hallux ; Hallux Valgus ; Humans ; Metatarsal Bones ; Osteotomy ; Sesamoid Bones