Recurrent deformity following hallux valgus surgery can be technically challenging to treat. In cases of revision surgery, a surgical technique with greater corrective power is often chosen compared to the primary surgery. Therefore, minimally invasive surgery is not commonly performed. On the other hand, minimally invasive surgery minimizes soft tissue damage and allows for greater correction of deformity compared to traditional open approaches. This paper reports four cases of recurrent hallux valgus treated with a minimally invasive distal transverse metatarsal osteotomy – Akin osteotomy (MITA), resulting in significant improvements in the clinical and radiographic outcomes.

There is no clear consensus on the optimal treatment of acute Achilles tendon rupture. Recently, studies have demonstrated the critical role of functional rehabilitation in the treatment of ruptured Achilles tendons. Hence, conservative treatment is preferred by a growing number of surgeons seeking to treat the condition without the risk of complications from surgery. However, operative treatment is still considered as a more reliable treatment option for acute Achilles tendon rupture. In this review article, we provide an overview of recent treatment strategies for acute rupture of the Achilles tendon.

Purpose: Chronic ankle instability is a very common abnormality of the ankle, but there is still controversy regarding its evaluation criteria. The stress view has difficulties in reflecting the patient’s symptoms and treatment progress. Therefore, this study examined the relationship between the center of pressure (COP) measured by a pedobarograph and the symptoms of the patient. Materials and Methods: Thirty patients with chronic ankle instability from February to August 2018 were included. Each patient was surveyed with the foot and ankle outcome score (FAOS). The COP was measured with a foot pressure scanner, and the travel distance and ellipse area of the COP were calculated. Each patient was measured on one foot and on two feet with his or her eyes closed and open. The relationship between the COP measurement and FAOS score was analyzed using the Pearson correlation coefficient. Results: The participants were consisted of 21 male and nine female, with a mean age of 30 years, mean weight of 72 kg, and mean foot size of 259 mm. With the eyes open, the correlation coefficient between the FAOS and travel distance of the affected side was –0.394 (p<0.05) and that between the FAOS and the ellipse area of the affected side was –0.425 (p<0.05). On the other hand, no significant correlations were found between the travel distance and ellipse area of the affected side when patients closed their eyes. Conclusion Measurement of the COP using foot pressure scanner could evaluate objectively patients with chronic ankle instability, with measurements in patients with their eyes open being more significant. Based on the findings of this study, an analysis of the COP with the patients with their eyes open and standing on one foot may help determine the management strategy and assess the progress of the patients.

PURPOSE: To evaluate the efficiency of the electronic foot function index (eFFI) through a prospective, random based, multi-institutional study. MATERIALS AND METHODS: The study included 227 patients ranging in age from 20 to 79 years, visited for surgery in different 15 institutes, and agreed to volunteer. The patients were assigned randomly into a paper-based evaluated group (n=113) and tablet-based evaluated group (n=114). The evaluation was done on the day of hospital admission and the method was changed on the second day of surgery and re-evaluated. PADAS 2.0 (https://www.proscore.kr) was used as an electronic evaluation program. RESULTS: There were no differences in age and sex in both groups. The intraclass correlation coefficient (ICC) evaluation revealed an eFFI ICC of 0.924, showing that both results were similar. The evaluation time was shorter in the tablet-based group than the paper-based group (paper vs tablet, 3.7±3.8 vs 2.3±1.3 minutes). Thirty-nine patients (17.2%) preferred to use paper and 131 patients (57.7%) preferred the tablet. Fifty-seven patients (25.1%) found both ways to be acceptable. CONCLUSION: eFFI through tablet devices appears to be more constant than the paper-based program. In addition, it required a shorter amount of time and the patients tended to prefer the tablet-based program. Overall, tablet and cloud system can be beneficial to a clinical study.
Academies and Institutes ; Ankle ; Clinical Study ; Foot ; Humans ; Methods ; Prospective Studies ; Volunteers

BACKGROUND: Traditionally, conservative management with an offloading orthosis, such as total contact cast (TCC), has been the standard of care for midfoot Charcot arthropathy. Considering complications of TCC and surgery, we treated midfoot Charcot arthropathy without TCC in our patients. The purpose of this study was to report clinical and radiological outcomes of conservative management of midfoot Charcot arthropathy. METHODS: A total of 34 patients (38 feet) who were diagnosed as having midfoot Charcot arthropathy between 2006 and 2014 were included. Patients started full weight bearing ambulation in a hard-soled shoe immediately after diagnosis. Outcomes such as progression of arch collapse, bony prominence, ulcer occurrence, limb amputation, and changes in Charcot stage were evaluated. RESULTS: Of 38 feet, arch collapse was observed in four while progression of bottom bump of the midfoot was observed in five feet. Foot ulcers related to bony bumps were found in two feet. CONCLUSIONS: Conservative treatment without restriction of ambulation is recommended for midfoot Charcot arthropathy because it is rarely progressive, unlike hindfoot-ankle arthropathy. In some cases, simple bumpectomy can be required to prevent catastrophic infection.
Amputation ; Arthropathy, Neurogenic ; Diagnosis ; Extremities ; Foot ; Foot Ulcer ; Humans ; Orthotic Devices ; Shoes ; Standard of Care ; Ulcer ; Walking ; Weight-Bearing

The liver is the most common site of metastasis of neuroendocrine tumors (NETs). Gastroenteropancreatic (GEP)-NETs are rare, and the distinction between hepatocellular carcinoma (HCC) and metastatic NET can be difficult due to the similarity of their histological characteristics. Herein, we report a case of GEP-NET with hepatic metastasis, which was first misdiagnosed as HCC by liver biopsy and subsequently re-diagnosed after surgery as primary GEP-NET.

The liver is the most common site of metastasis of neuroendocrine tumors (NETs). Gastroenteropancreatic (GEP)-NETs are rare, and the distinction between hepatocellular carcinoma (HCC) and metastatic NET can be difficult due to the similarity of their histological characteristics. Herein, we report a case of GEP-NET with hepatic metastasis, which was first misdiagnosed as HCC by liver biopsy and subsequently re-diagnosed after surgery as primary GEP-NET.
Biopsy ; Carcinoma, Hepatocellular ; Diagnostic Errors ; Liver ; Neoplasm Metastasis ; Neuroendocrine Tumors

BACKGROUND/AIMS: As the prevalence of diabetes mellitus and its complications increase rapidly, diabetic foot ulcers (DFUs), which are a major diabetic complication, are expected to increase. For prevention and effective treatment, it is important to understand the clinical course of DFUs. The aim of this study was to investigate the natural course and predictors of amputation in patients with DFUs who required hospitalization. METHODS: A total of 209 patients with type 2 diabetes, aged 30 to 85 years, who visited emergency department or needed hospitalization due to DFUs were consecutively enrolled from May 2012 to January 2016, by retrospective medical record review. The main outcome was lower extremity amputation (LEA). RESULTS: Among 192 patients who completed follow-up, 113 patients (58.9%) required LEAs. Compared to patients without amputation, baseline levels of white blood cell counts and C-reactive protein were higher in patients with amputation. In addition, bone and joint involvement was more frequently observed in patients with amputation. Multivariable regression analysis revealed that combined infection (odds ratio [OR], 11.39; 95% confidence interval [CI], 2.55 to 50.93; p = 0.001) and bone or joint involvement (OR, 3.74; 95% CI, 1.10 to 12.70; p = 0.035) were significantly associated with an increased risk of LEA. CONCLUSIONS: The depth of the wound and combined infection of DFU, rather than the extent of the wound, were significant prognostic factors of LEAs in patients with type 2 diabetes.
Amputation* ; C-Reactive Protein ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Foot* ; Emergency Service, Hospital ; Follow-Up Studies ; Hospitalization ; Humans ; Joints ; Leukocyte Count ; Lower Extremity* ; Medical Records ; Prevalence ; Prognosis ; Retrospective Studies ; Ulcer* ; Wounds and Injuries

STUDY DESIGN: This was a retrospective cohort study. PURPOSE: We evaluated the predictive value of the Spinal Instability Neoplastic Score (SINS) system for spinal adverse events (SAEs) in patients with single spinal metastatic tumor. OVERVIEW OF LITERATURE: The SINS system was developed to assess spinal instability in patients with single metastatic spinal tumor. However, the system’s potential predictive value for SAEs has been partially studied. METHODS: This system was applied to a retrospective cohort of 78 patients with single spinal metastatic tumors. The patients underwent surgical treatment and were postoperatively followed up for at least 2 years or until death. The attribution of each score and total SINS to SAE (vertebral compression fracture [VCF] and spinal cord compression [SCC]) occurrence was assessed using the Cox proportional hazards model. RESULTS: SAEs occurred on average 7 months after diagnosis of spinal metastasis. The mean survival rate post diagnosis was 43 months. Multivariate analysis using the Cox proportional hazards model revealed that the pain (p=0.029) and spinal alignment (p=0.001) scores were significantly related to VCF occurrence, whereas the pain (p=0.008) and posterolateral involvement (p=0.009) scores were related to SCC occurrence. CONCLUSIONS: Among the components of the SINS system, while pain and spinal alignment showed a significant association with VCF occurrence, pain and posterolateral involvement showed association with SCC occurrence.
Cohort Studies ; Diagnosis ; Fractures, Compression ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Spinal Cord Compression ; Survival Rate

PURPOSE: To evaluate the clinical outcome of an operation with early rehabilitation from ankle fracture in accordance with the injury type. MATERIALS AND METHODS: A total of 136 patients (70 males and 66 females) who underwent surgery and early rehabilitation for ankle fractures between December 2008 and December 2013 were retrospectively reviewed. The average age was 47.9 years, with a range of 18~79 years. The mean follow-up period was 28.7 months, with a range of 24~102 months. All patients were classified in accordance with the Lauge Hansen classification and anatomic fracture site. Moreover, the presence of ligament injuries were documented. A short-leg cast was applied postoperatively for two weeks; thereafter, patients began the range-of-motion exercises after cast removal. Full weightbearing was allowed at 2 weeks postoperatively. Each patient was assessed radiologically and clinically based on the Olerud-Molander score, visual analogue scale (VAS) for pain, joint stiffness, and capability of single heel raising. RESULTS: Seventeen patients (12.5%) complained of postoperative pain (VAS score 1~3), and the incidence was higher in patients with trimalleolar fractures or associated ligament injuries. Twenty-three patients (16.9%) complained of postoperative ankle stiffness. The mean Olerud-Molander score was 75.4/80 (range, 55~80). Olerud-Molander scores were lower in patients with ligament injuries than in those with fracture alone. There was no nonunion or fracture displacement even after early weightbearing walking. CONCLUSION: In this retrospective series, early rehabilitation after surgical restoration of ankle mortise by anatomical reduction and stabilization was shown to be successful. Earlier motion exercise and weightbearing walking can minimize fracture complications like joint stiffness or weakness in ankle fracture.
Ankle Fractures* ; Ankle* ; Arthralgia ; Classification ; Exercise ; Follow-Up Studies ; Heel ; Humans ; Incidence ; Joints ; Ligaments ; Male ; Pain, Postoperative ; Rehabilitation* ; Retrospective Studies ; Walking ; Weight-Bearing