Charcot foot is a rare disease in clinic, its pathogenesis includes neurotrauma theory, neurovascular theory, comprehensive theory, and inflammatory factor theory. The disease is characterized by progressive joint and bone destruction of foot and ankle joint. Conventional X-ray examination is not sensitive to the early diagnosis of disease, the manifestation of CT and MRI of disease is characteristic and could be used to make a comprehensive evaluation of bone and soft tissue lesions of disease. It is not difficult to make a diagnosis based on characteristic findings of CT and MRI and clinical manifestations such as swelling, pain and skin temperature rising of foot and ankle. Charcot foot has multiple classification methods including anatomy, imaging and clinical classification. Improved Eichenholtz staging classification is most commonly used currently which could make a more comprehensive assessment of disease and guide treatment better. According to the stage of disease, treatment could be carried out including non-weight bearing and brace protection, drugs therapy and surgical treatment, etc. Early diagnosis, brace protection, could protect joint and delaying progression of deformity. There is no clear long-term and generally accepted conclusion about the efficacy of drug therapy. For advanced patients, surgical treatment must be actively performed to preserve a stable and functional ankle joint and reduce amputation rate.
Amputation ; Ankle Joint ; Arthropathy, Neurogenic ; Diabetic Foot ; Humans ; Radiography

Adult ; Bone and Bones ; diagnostic imaging ; injuries ; Femoral Fractures ; surgery ; therapy ; Foot Deformities, Acquired ; diagnosis ; etiology ; therapy ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; Fractures, Ununited ; diagnostic imaging ; etiology ; surgery ; Humans ; Intra-Articular Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; methods ; Reoperation ; methods ; Treatment Outcome

PURPOSE: To evaluate the clinical significance and usefulness of a bone scan in accessory navicular bone. MATERIALS AND METHODS: Eighty-five patients with foot pain and accessory navicular bone on radiography, who underwent bone scan from 2012 to 2015, were analyzed retrospectively. The subjects was divided into a symptomatic and asymptomatic group according to the presence of navicular bone tenderness. The grade of bone scan uptake was divided into 3 grades. Age, gender, grade of bone scan and size of the accessory navicular bone were analyzed. The symptomatic group were divided into a low (grade 0, 1) and high uptake (grade 2) group to determine the appropriate treatment. The low uptake group was treated conservatively for 3 months. The high uptake group was initially treated conservatively for 3 months and surgery was performed if pain persisted. For the clinical evaluation, the visual analogue scale, American Orthopaedic Foot and Ankle Society midfoot scale were evaluated in the first examination and last follow-up date. The patient's satisfaction grade was also evaluated at the last follow-up. RESULTS: The asymptomatic group mostly showed no uptake in the bone scan. On the other hand, some patients in the asymptomatic group showed an increase in uptake. In these patients, the size of accessory navicular bone was related to the grade of bone scan uptake, showing that the bone scan uptake grade can be predicted when applying different cut off values for the bone size. The symptomatic group mostly showed uptake in the bone scan and the grade of uptake had a positive correlation with the size of the accessory navicular bone (p<0.05). Age and gender were not related to the bone scan uptake. In the clinical evaluation, conservative and surgical treatment showed a good outcome. CONCLUSION: The bone scan uptake grade alone cannot be used to completely predict the symptoms. On the other hand, the size of the accessory bone can increase the bone scan uptake. Therefore, the size of the accessory bone, and patient symptoms should be considered in patients with a high uptake when deciding treatment.
Ankle ; Follow-Up Studies ; Foot ; Hand ; Humans ; Prognosis* ; Radiography ; Retrospective Studies

PURPOSE: Pes planovalgus is one of the most common foot deformities among pediatric orthopedic diseases and is divided into idiopathic and neuromuscular planovalgus according to its etiology. This study evaluated the radiologic and pedobarographic outcomes of the treatment for pes planovalgus in children treated with lateral column lengthening, compared the outcomes according to the etiology, and investigated the correlation between the radiologic and pedobarographic findings. MATERIALS AND METHODS: Sixty-three patients (97 feet), who underwent lateral column lengthening, were divided into groups of 30 patients (47 feet) with neuromuscular disease and 33 patients (50 feet) with idiopathic etiology. The preoperative, immediately postoperative, 1 year, and 3 year follow-up radiographic measurements on the plain radiograph antero-posterior (AP) and lateral view were compared. In pedobarography, the foot pressures were subdivided into 4 areas to measure the contact time, contact area, peak pressure, and maximum force. The pre- and postoperative pedobarographic measurements were compared and the correlations between the radiographic and pedobarographic measurements were evaluated. RESULTS: The radiographic index at the 1st postoperative year and 3rd postoperative follow-up did not show significant differences according to the etiology. In pedobarography, idiopathic planovalgus showed a significant increase in the maximum force in the hindfoot and forefoot. The correlation between the radiologic findings and pedobarographic findings was statistically significant between the tibiocalcaneal angle in the lateral view and the maximum force, and the contact area of hindfoot on pedobarography, between tibiocalcaneal angle in the lateral view and the contact area of the toes in idiopathic planovalgus. In neuromuscular planovalgus, the peak pressure in the hindfoot had a strong negative correlation with talonavicular coverage angle in the AP view and talo-1st metatarsal angle, and the talohorizontal angle in the lateral view. CONCLUSION: Lateral column lengthening is an effective surgical procedure for flatfoot patients. On the other hand, the radiographic examination has limitations for accurate assessments of the postoperative results and prognosis. Qualitative and quantitative evaluations are available by pedobarography and it is a useful instrument for an evaluation of planovalgus when used in conjunction with radiography.
Child ; Evaluation Studies as Topic ; Flatfoot ; Follow-Up Studies ; Foot ; Foot Deformities ; Hand ; Humans ; Metatarsal Bones ; Neuromuscular Diseases ; Orthopedics ; Prognosis ; Radiography ; Toes

PURPOSE: We aimed to evaluate the magnetic resonance imaging (MRI) findings of congenital postaxial polydactyly of the foot. MATERIALS AND METHODS: Three-hundred and forty-seven feet of 288 patients who underwent congenital postaxial polydactyly or polysyndactyly correction were divided into five subtypes according to the radiographic shapes of deformity origins (widened metatarsal head, bifid, fused duplicated, incompletely duplicated, or completely duplicated). MRIs were assessed to determine whether they unrevealed areas were fused or separated. MRI was also used to assess cases with radiographic phalangeal aplasia. RESULTS: Huge variations were noted in MRIs. Fusion or separation at the base or head between original and extra digits were observed, and MRI effectively depicted phalangeal aplastic areas. CONCLUSION: MRI evaluations of congenital postaxial polydactyly of the foot are useful for determining the anatomical statuses which were not visualized by plain radiography (level of evidence: 3).
Congenital Abnormalities ; Foot* ; Head ; Humans ; Magnetic Resonance Imaging ; Metatarsal Bones ; Polydactyly* ; Radiography ; Syndactyly

Most common peripheral neuropathy around foot and ankle is diabetic neuropathy, but there are another cause of peripheral neuropathy, such as rheumatoid arthritis, metabolic disease, genetic disease, toxic material, and so on. The main symptom of peripheral neuropathy is pain. The disturbance of sensory and balancing, weakness of muscle, deformity of foot and neuropathic arthropathy are also the symptoms of the peripheral neuropathy. History taking is most important to identify the cause of peripheral neuropathy. Neurological exam have to include the pin prick test, vibration test, 10 g-monofilamant test and ankle reflex test. Simple radiography is essential to observe the deformities or neuropathic arthropathy at foot and ankle. The presence of peripheral neuropathy, involvement and severity can be identified from nerve conduction study. The study of occlusive arteritis is essential for diabetic neuropathy. The medical treatment of associated disease is important but the pain of peripheral neuropathy should be controlled simultaneously. Medicine include the antidepressants, anticonvulsants, opioids and topical agents. The surgical treatment of peripheral neuropathy include lengthening of Achilles tendon, correction of deformity, the total contact cast and arthrodesis. Surgical decompression of specific nerve might helpful in pain control of peripheral neuropathy.
Achilles Tendon ; Analgesics, Opioid ; Ankle* ; Anticonvulsants ; Antidepressive Agents ; Arteritis ; Arthritis, Rheumatoid ; Arthrodesis ; Congenital Abnormalities ; Decompression, Surgical ; Diabetic Neuropathies ; Diagnosis ; Foot* ; Metabolic Diseases ; Neural Conduction ; Peripheral Nervous System Diseases* ; Radiography ; Reflex ; Somatoform Disorders* ; Vibration

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

INTRODUCTIONAnatomical markers can help to guide lag screw placement during surgery for internal fixation of fifth metatarsal base fractures. This study aimed to identify the optimal anatomical markers and thus reduce radiation exposure.

METHODSA total of 50 patients in Huashan Hospital, Shanghai, China, who underwent oblique foot radiography in the lateral position were randomly selected. The angles between the fifth metatarsal axis and cuboid articular surface were measured to determine the optimal lag screw placement relative to anatomical markers.

RESULTSThe line connecting the styloid process of the fifth metatarsal base with the second metatarsophalangeal (MTP) joint intersected with the fifth metatarsal base fracture line at an angle of 86.85° ± 5.44°. The line connecting the fifth metatarsal base styloid with the third and fourth MTP joints intersected with the fracture line at angles of 93.28° ± 5.24° and 100.95° ± 5.00°, respectively. The proximal articular surface of the fifth metatarsal base intersected with the line connecting the styloid process of the fifth metatarsal base with the second, third and fourth MTP joints at angles of 24.02° ± 4.77°, 30.79° ± 4.53° and 38.08° ± 4.54°, respectively.

CONCLUSIONThe fifth metatarsal base styloid and third MTP joint can be used as anatomical markers for lag screw placement in fractures involving the fifth tarsometatarsal joint. The connection line, which is normally perpendicular to the fracture line, provides sufficient mechanical stability to facilitate accurate screw placement. The use of these anatomical markers could help to reduce unnecessary radiation exposure for patients and medical staff.

Bone Screws ; China ; Foot ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Metatarsal Bones ; radiation effects ; surgery ; Patient Positioning ; Radiation Exposure ; Radiography ; Stress, Mechanical

PURPOSE: The purpose of this study is to provide Korean data on heel pad thickness according to age, gender, underlying disease, occupation, and body mass index (BMI). MATERIALS AND METHODS: A retrospective study was conducted on 670 patients who underwent foot lateral plain radiography and magnetic resonance imaging (MRI) between January 2010 and July 2014. Through measurements of heel pad thickness, the usefulness and accuracy of foot lateral plain radiography was evaluated, and the mean Korean heel pad thickness in the weight-bearing and non-weight-bearing conditions was also evaluated according to age, gender, underlying disease, occupation, and BMI. RESULTS: The 670 subjects with a mean age of 44 years (range, 12 to 84 years) consisted of 420 males and 250 females. The difference in heel pad thickness between non-weight-bearing foot lateral plain radiography and MRI was 0.69 mm. The heel pad thickness did not show a significant difference with age (p=0.08) and the presence of diabetes (p=0.09). With the increase in the Tegner score, the thickness of the heel pad increased (p=0.035), and subjects with a higher BMI had a thicker heel pad (p=0.03). The compressibility of the heel pad thickness showed no correlation with gender, diabetes, and Tegner score. Compressibility also increased with the increase in age and body weight. CONCLUSION: The mean Korean heel pad thickness measured through non-weight-bearing foot lateral plain radiography was 18.79 mm. The heel pad thickness increased with increasing BMI; however, age and diabetes did not show significant correlation. The compressibility of heel pad increased with the increase in age.
Body Mass Index ; Body Weight ; Female ; Foot ; Heel* ; Humans ; Magnetic Resonance Imaging ; Male ; Occupations ; Radiography ; Retrospective Studies ; Weight-Bearing

PURPOSE: The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. MATERIALS AND METHODS: We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. RESULTS: Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1+/-2.7degrees in group A and 6.0+/-2.1degrees in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2+/-8.2degrees; distance, 25.1+/-0.2 mm) compared to group A (HVA, 20.9+/-7.7degrees; distance, 28.1+/-0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005). CONCLUSION: Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes.
Adult ; Aged ; Bone Plates ; Epiphyses/surgery ; Ethnic Groups ; Female ; Foot ; Fracture Fixation, Internal/*instrumentation ; Hallux Valgus/radiography/*surgery ; Humans ; Lower Extremity ; Male ; Metatarsal Bones/*radiography/*surgery ; Middle Aged ; Osteotomy/*methods ; Range of Motion, Articular ; Retrospective Studies ; Treatment Outcome ; Upper Extremity