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Malik M, Kwiatkowski J, Gądek A, Lechowska-Liszka A, Liszka H. Utility of Weight-Bearing Computed Tomography in the Postoperative Assessment of Ankle Fractures. Diagnostics (Basel) 2025; 15:750. [PMID: 40150092 PMCID: PMC11941084 DOI: 10.3390/diagnostics15060750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 03/10/2025] [Accepted: 03/15/2025] [Indexed: 03/29/2025] Open
Abstract
Background: Ankle fractures are among the most common injuries requiring surgical intervention. Standard radiographs are typically used for postoperative assessment; however, some patients continue to experience residual symptoms despite satisfactory radiographic outcomes. Weight-bearing computed tomography (WBCT), though not yet widely integrated into clinical practice, offers potential advantages in evaluating lower-limb deformities, injuries, and arthritis. This study explores the utility of WBCT for the midterm assessment following ankle fracture fixation and compares its findings with those obtained from standard radiographs. Methods: In this retrospective case study, we analyzed the correlations between the functional outcome scores approximately one year post-surgery and parameters assessed using WBCT. Pearson's correlation coefficient was used to evaluate these correlations, and a t-test was performed to assess their statistical significance, with a threshold p-value of 0.05. Additionally, Spearman's rank correlation coefficient was calculated as a supplementary descriptive measure, without significance testing. These correlations were then compared with those obtained from standard ankle radiographic views (anteroposterior, lateral, and mortise). Results: Several correlations were identified between WBCT parameters and functional scales, with certain parameters demonstrating high statistical significance (p < 0.05). Overall, the correlations observed for WBCT were stronger than those for standard radiographs. Conclusions: Although the study cohort was limited, the findings suggest that WBCT may provide additional insights beyond conventional radiography. Further research with larger patient groups is needed to establish its clinical relevance.
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Affiliation(s)
- Mateusz Malik
- Department of Orthopedics and Traumatology, University Hospital in Cracow, 30-688 Cracow, Poland; (M.M.); (J.K.); (A.G.)
| | - Jakub Kwiatkowski
- Department of Orthopedics and Traumatology, University Hospital in Cracow, 30-688 Cracow, Poland; (M.M.); (J.K.); (A.G.)
| | - Artur Gądek
- Department of Orthopedics and Traumatology, University Hospital in Cracow, 30-688 Cracow, Poland; (M.M.); (J.K.); (A.G.)
- Department of Orthopedics and Physiotherapy, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Agnieszka Lechowska-Liszka
- Institute of Applied Sciences, Faculty of Motor Rehabilitation, University of Physical Education in Krakow, 31-571 Cracow, Poland;
| | - Henryk Liszka
- Department of Orthopedics and Traumatology, University Hospital in Cracow, 30-688 Cracow, Poland; (M.M.); (J.K.); (A.G.)
- Department of Orthopedics and Physiotherapy, Jagiellonian University Medical College, 30-688 Cracow, Poland
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Park YU, Lee JW, Chung JY, Choi WS, Kim T, Seo YW. Intraoperative assessment of hindfoot alignment using C-arm fluoroscopy. J Orthop Sci 2024; 29:1248-1254. [PMID: 37839978 DOI: 10.1016/j.jos.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/24/2023] [Accepted: 08/11/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Hindfoot malalignment can cause various foot and ankle problems. For better surgical performance and correction of hindfoot malalignments, reliable intraoperative determination of hindfoot alignment is essential. However, there is no standard method for the intraoperative assessment of hindfoot alignment. We devised an intraoperative modified Méary posteroanterior (IOPPA) view to assess intraoperative hindfoot alignment. This study aimed to compare this intraoperative method with other radiographic hindfoot alignment measurements. METHODS Thirty-seven patients (47 feet) with various foot and ankle conditions scheduled to undergo surgery were prospectively recruited. Before surgery, the Saltzman, long axial, and modified Méary views were taken in a controlled and standardized fashion. IOPPA views were obtained under simulated weight bearing conditions using C-arm fluoroscopy in the operating room before surgery. The relationship between the IOPPA view and the three radiographic hindfoot alignments was evaluated using Pearson's correlation. RESULTS The mean hindfoot alignment angle was varus 3.50° (CI, varus 1.91 to 5.08) on the Saltzman view, varus 2.00° (CI, varus 0.60 to 3.39) on the long axial view, varus 0.13° (CI, valgus 1.41 to varus 1.67) on the modified Méary view, and varus 1.32° (CI, valgus 0.02 to varus 2.65) on IOPPA view. The IOPPA view and the three other hindfoot alignment views were found to be significantly correlated (r = 0.60 for the Saltzman view, r = 0.50 for the long axial view, r = 0.71 for the modified Méary view, P < .05). The intraobserver ICC (Intraclass Correlation Coefficient) value was 0.974 and interobserver ICC (Intraclass Correlation Coefficient) value was 0.988 for the IOPPA view (P < .001). CONCLUSION There was a statistically significant correlation between the IOPPA view and the other three hindfoot alignment views. We also found that interobserver and intraobserver ICC values were excellent. This study proposes that the IOPPA view can be used as a reliable intraoperative assessment tool for hindfoot alignment. LEVEL OF EVIDENCE Prospective study.
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Affiliation(s)
- Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jong Wha Lee
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Wan-Sun Choi
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Taehun Kim
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Young Wook Seo
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea.
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Kim J, Kim J, Kim S, Yi Y. Weight-Bearing CT for Diseases around the Ankle Joint. Diagnostics (Basel) 2024; 14:1641. [PMID: 39125518 PMCID: PMC11311840 DOI: 10.3390/diagnostics14151641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/21/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Weight-bearing computed tomography (WBCT) enables acquisition of three-dimensional bony structure images in a physiological weight-bearing position, which is fundamental in understanding the pathologic lesions and deformities of the ankle joint. Over the past decade, researchers have focused on validating and developing WBCT measurements, which has significantly enhanced our knowledge of common foot and ankle diseases. Consequently, understanding the application of WBCT in clinical practice is becoming more important to produce improved outcomes in the treatment of disease around the ankle joint. This review will describe an overview of what is currently being evaluated in foot and ankle surgery using WBCT and where the course of research will be heading in the future.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Jaeyoung Kim
- Baylor University Medical Center, Dallas, TX 75246, USA;
| | - Saintpee Kim
- Department of Orthopedic Surgery, Gangbuk Etteum Hospital, Seoul 01170, Republic of Korea;
| | - Young Yi
- Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea
- Department of Orthopaedic Surgery and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, USA
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Fernández-Marín MR, González-Martín D, Herrera-Pérez M, Paulano-Godino F, Vilá-Rico J, Tejero S. Increased subtalar rotational motion in patients with symptomatic ankle instability under load and stress conditions. Knee Surg Sports Traumatol Arthrosc 2023; 31:5214-5221. [PMID: 37770749 DOI: 10.1007/s00167-023-07553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Differentiating subtalar and ankle instability in the clinical setting is challenging. This study aims to analyze the rotational laxity of the subtalar joint bilaterally in patients with asymptomatic and symptomatic ankle instability under simulated load and stress-induced position of the subtalar joint. METHODS A case-control study was conducted using an adjustable load device (ALD). Patients with chronic ankle instability and healthy volunteers were included. Each subject underwent a CT scan under mechanical stress and simulated weight-bearing conditions, maintaining maximum eversion and inversion hindfoot positions. The images were obtained in a single model, allowing calculations of the motion vector as well as the helical axis. The helical axis was defined by a rotation angle and a translation distance. RESULTS A total of 72 feet were included in the study. Thirty-one patients with unilateral symptoms and five healthy controls were selected, defining two groups: symptomatic (n = 31) and asymptomatic (n = 41). An absolute difference of 4.6º (95%CI 2-11.1) rotation angle was found on the helical axis of the symptomatic vs. asymptomatic group (p = 0.001). No significant differences were detected in the translation distance (n.s.) between the groups. Additionally, a significant positive correlation was found between the rotation angle and translation distance through the helical axis in the asymptomatic group (r = 0.397, p = 0.027). CONCLUSION Patients with chronic ankle instability suspected of having subtalar joint instability showed a wider subtalar range of laxity in terms of rotation about the helical axis. Furthermore, differences in kinematics between symptomatic and asymptomatic hindfeet was demonstrated when both feet were compared. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - David González-Martín
- Orthopedic Surgery and Traumatology Deparment, Origen, Grupo Recoletas, C. Paulina Harriet, 4-6, 47006, Valladolid, Spain.
- Universidad Europea Miguel de Cervantes, Valladolid, Spain.
| | - Mario Herrera-Pérez
- Universidad de La Laguna, La Laguna, Spain
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, Hospital Universitario de Canarias, La Laguna, Spain
| | | | - Jesús Vilá-Rico
- University Hospital 12 de Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Sergio Tejero
- Head Foot Ankle Unit, University Hospital Virgen del Rocío, Sevilla, Spain
- University of Sevilla, Sevilla, Spain
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Smolinski MP, Amadio J, Prisk V, Conti SF, Miller MC. A Comparison of Imaging Outcomes From 2 Weightbearing CT Modalities. Foot Ankle Int 2023; 44:1174-1180. [PMID: 37772818 DOI: 10.1177/10711007231198230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND The use of weightbearing images to diagnose foot and ankle injuries continues to offer hope for improved insight into pathologies, but weightbearing CT imaging has been limited by availability. The ability to apply force to the lower limb in a horizontal bore CT system may offer an adaptation to currently available imaging systems that provides access to weightbearing images without the acquisition of additional expensive imaging space or equipment. METHODS In order to determine whether a horizontal CT system could produce the same results as a standing CT, 3 images of one foot from 10 subjects was obtained and standard measures were calculated. Each subject underwent a standing CT scan, a scan in a horizontal bore CT machine while the subject pressed against a pedal with spring resistance and a finally a scan with the foot placed on the pedal but without any pressure. RESULTS No statistically significant difference between the standing and pedal-based CTs resulted. Navicular height and Meary angle (axial) were statistically different from nonweightbearing for both standing and horizontal systems. The horizontal results were statistically different from nonweightbearing in IM angle, talocalcaneal angle, and talonavicular coverage. No differences from nonweightbearing were found for either system in talar tilt, talocrural angle, or the lateral Meary angle. CONCLUSION The results in this initial study of normal control subjects suggest that a pedal-based loading mechanism may adapt a horizontal-bore CT system for the acquisition of weightbearing images. CLINICAL RELEVANCE The ability to acquire a weightbearing CT from a horizontal bore CT machine can make these images more available.
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Affiliation(s)
| | | | - Victor Prisk
- Prisk Orthopaedics and Wellness, Pittsburgh, PA, USA
| | | | - Mark Carl Miller
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
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Tejero S, Fernández-Marín R, González-Martín D, Vallejo-Márquez M, Paulano-Godino F, Herrera-Pérez M. Hindfoot motion through helical axis image-based on dynamic CT scan using an original simulated weightbearing device. Foot Ankle Surg 2023; 29:531-537. [PMID: 36792412 DOI: 10.1016/j.fas.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Determining the treatment of subtalar joint (STJ) instability requires a better understanding of the biomechanical principles underlying the condition and, a proper diagnosis. This study aimed to analyze "in vivo" the range of motion of the subtalar joint (STJ) measured on two (2D) and three dimensions (3D) image-based on CT Scan using an original device that maintains a simulated weightbearing. The secondary goal was to correlate the 2D and 3D measurement. METHODS An observational study was conducted, using an original Dynamic Simulated Weightbearing Device. Asymptomatic ankles were included. Each subject underwent a CT scan under mechanical stress and simulated weightbearing conditions, maintaining maximum eversion and inversion hindfoot positions. The images were obtained, combining both inversion and eversion positions in a single model, which allows for to calculation of the motion vector as well as the helical axis. The helical axis (rotation angle and translation distance), subtalar tilt, anterior drawer, and, subtalar and calcaneocuboid uncoverage were the determinations. RESULTS Forty asymptomatic ankles were included. The average range of motion of the STJ amounts to 31.5° ± 9.1° of rotation and 1.56 ± 0.8 mm of translation distance. The anterior drawer and subtalar uncoverage variables were statistically significantly related to each other (r = 0.57; P = 0.00001). However, these 2-D measured variables were not related to kinematic measures of rotation through the helical axis (3D) (p = 0.14; p = 0.19) CONCLUSIONS: The average range of motion of the STJ amounts to 31.5° ± 9.1° of rotation and 1.56 ± 0.8 mm of translation distance. We found no significant correlation between 2D and 3D measurements. In our opinion, the rotation angle and translation distance should be considered the most accurate measurements and should be calculated on every STJ instability for comparison with the asymptomatic population LEVEL OF EVIDENCE: Observational study. LEVEL OF EVIDENCE III
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Affiliation(s)
- Sergio Tejero
- Head of Foot and Ankle Unit, Orthopedic Surgery and Traumatology Deparment, Hospital Universitario Virgen del Rocío, Sevilla, Spain; University of Sevilla, Sevilla, Spain.
| | - Reyes Fernández-Marín
- Orthopedic Surgery and Traumatology Deparment, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - David González-Martín
- Orthopedic Surgery and Traumatology Deparment, Olympia, Quirón Salud, Madrid, Spain.
| | | | | | - Mario Herrera-Pérez
- School of Medicine (Health Sciences), Universidad de La Laguna, Spain; Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, Hospital Universitario de Canarias, Spain.
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Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations-a review of the literature. Skeletal Radiol 2022; 52:1073-1088. [PMID: 36350387 DOI: 10.1007/s00256-022-04223-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Weight bearing CT (WBCT) of the lower extremity is gaining momentum in evaluation of the foot/ankle and knee. A growing number of international studies use WBCT, which is promising for improving our understanding of anatomy and biomechanics during natural loading of the lower extremity. However, we believe there is risk of excessive enthusiasm for WBCT leading to premature application of the technique, before sufficiently robust protocols are in place e.g. standardised limb positioning and imaging planes, choice of anatomical landmarks and image slices used for individual measurements. Lack of standardisation could limit benefits from introducing WBCT in research and clinical practice because useful imaging information could become obscured. Measurements of bones and joints on WBCT are influenced by joint positioning and magnitude of loading, factors that need to be considered within a 3-D coordinate system. A proportion of WBCT studies examine inter- and intraobserver reproducibility for different radiological measurements in the knee or foot with reproducibility generally reported to be high. However, investigations of test-retest reproducibility are still lacking. Thus, the current ability to evaluate, e.g. the effects of surgery or structural disease progression, is questionable. This paper presents an overview of the relevant literature on WBCT in the lower extremity with an emphasis on factors that may affect measurement reproducibility in the foot/ankle and knee. We discuss the caveats of performing WBCT without consensus on imaging procedures and measurements.
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Kimura T, Thorhauer ED, Sangeorzan BJ, Ledoux WR. Foot radiographic angle variation as a function of weightbearing magnitude. J Orthop Res 2022; 40:2620-2625. [PMID: 35076121 DOI: 10.1002/jor.25283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Weightbearing radiographs are widely used to investigate foot disorders. However, it is unclear how imaging during partial weightbearing affects foot alignment measurements. This study aimed to determine a partial weightbearing threshold that yields consistent measurements of various radiographic angles. Eighteen normal fresh-frozen cadaveric foot specimens were dissected and prepared for mechanical testing using a custom-designed, computed tomography-compatible loading frame. Specimens were placed in a neutral ankle position and scanned in five axial loading conditions (0%, 12.5%, 25%, 37.5%, and 50% bodyweight) using weightbearing computed tomography. (Note 50% bodyweight per foot represents full bodyweight in quiet stance.) The lateral first talometatarsal and calcaneal pitch angles were measured on lateral radiographic projections, and the hallux valgus angle and first-second, fourth-fifth, and first-fifth intermetatarsal angles were measured on axial projection images. The lateral first talometatarsal angle decreased significantly with increased bodyweight loading (p < 0.01). Mean significant decreases in the lateral first talometatarsal angle compared to 0% were 6.6° for 12.5%, 7.6° for 25%, 8.8° for 37.5%, and 10.0° for 50% bodyweight loading; 12.5% to 50% was also significant. There was no significant differences between other loading condition pairings or with increased axial load at other angles. The medial longitudinal arch flattened with increasing axial load, resulting in a decreased lateral first talometatarsal angle. However, this radiographic parameter did not change between the 25% and 50% bodyweight conditions, indicating that partial weightbearing imaging (between 12.5% and 25% bodyweight) might be enough to reproduce the sagittal foot alignments observed under full weightbearing conditions in normal feet.
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Affiliation(s)
- Tadashi Kimura
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA.,Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eric D Thorhauer
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Bruce J Sangeorzan
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - William R Ledoux
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA.,Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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Clarke AJ, Conti SF, Conti M, Fadle AA, Ellis SJ, Miller MC. The Association of Crista Volume With Sesamoid Position as Measured From 3D Reconstructions of Weightbearing CT Scans. Foot Ankle Int 2022; 43:658-664. [PMID: 34918579 DOI: 10.1177/10711007211061363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malposition of the sesamoids relative to the first metatarsal head may relate to intersesamoid crista underdevelopment or erosion. Using 3-dimensional models created from weightbearing CT (WBCT) scans, the current work examined crista volume and its relationship to first metatarsal pronation and sesamoid station. METHODS Thirty-eight hallux valgus (HV) patients and 10 normal subjects underwent weightbearing or simulated WBCT imaging. The crista was outlined by the inferior articular surface, and a line was drawn to connect the lowest point of each sulcus on either side of the intersesamoidal crista throughout the length of the crista. The volume was calculated. Sesamoid station and first metatarsal pronation were calculated from the 3D reconstructions. The mean crista volumes between HV and normal patients were statistically compared, as were the crista volume and pronation angle between sesamoid stations. RESULTS The mean crista volume in HV patients was 80.10 ± 35 mm3 and in normal subjects was 150.64 ± 24 mm3, which differed significantly between the 2 groups (P < .001). Mean crista volumes were found to be statistically significantly different between the sesamoid stations (P < .001) with decreasing crista volumes significantly and strongly correlated with increasing sesamoid station (r = -0.80, P < .001). There was no difference in the mean pronation angle between the 4 sesamoid stations (P = .37). The pronation angle was not associated with crista volume (P = .52). CONCLUSION HV patients have lower mean crista volume than normal patients. Crista volume is correlated with sesamoid station. Pronation of the first metatarsal was not associated with crista volume. CLINICAL RELEVANCE Crista volume may offer an additional determinant for the severity of hallux valgus.
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Affiliation(s)
| | - Stephen F Conti
- Orthopaedic Partners, UPMC Passavant Hospital, Pittsburgh, PA, USA
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Kimura T, Thorhauer ED, Kindig MW, Sangeorzan BJ, Ledoux WR. Evaluation of the Foot Arch in Partial Weightbearing Conditions. Foot Ankle Int 2022; 43:113-122. [PMID: 34404272 DOI: 10.1177/10711007211034804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Weightbearing plain radiography or computed tomography (CT) is used for diagnosis or treatment selection in foot disorders. This study compared foot alignment between full weightbearing (50% body weight [BW] per foot) plain radiography and nonweightbearing (0% BW) or partial weightbearing (10% BW per foot) CT scans. METHODS Subjects had both full (50% BW per foot) weightbearing plain radiographs and either a nonweightbearing (0% BW) or a partial weightbearing (20% BW or 10% BW per foot) CT scan. Feet (n = 89) had been previously classified as pes cavus (n = 14/17 [subjects/feet]), neutrally aligned (NA; 20/30), asymptomatic pes planus (APP; 18/24), and symptomatic pes planus (SPP; 15/18). Lateral talometatarsal angle (LTMA) and calcaneal pitch angle were compared between weightbearing radiography and maximum-intensity projection images generated from CT. RESULTS Significant differences in LTMA were found between nonweightbearing CT scans and full (50% BW per foot) weightbearing plain radiographs: the mean difference was 6.6 degrees in NA, 9.2 degrees in APP, and 11.3 degrees in SPP (P < .0001); no significant difference in LTMA was found for pes cavus. Although the interaction of foot type (P = .084) approached statistical significance, pairwise differences between 10% weightbearing and 50% weightbearing images by foot type were significant but small. The 50% weightbearing condition resulted in calcaneal pitch angles the same or slightly lower or higher than those of the 10% weightbearing and nonweightbearing images. LTMA and calcaneal pitch angle measurements made on full (50% BW per foot) weightbearing plain radiographs and non- (0%) or partial (10% BW per foot) weightbearing angles from CT scans were strongly correlated. CONCLUSION Different foot types have similar 2-dimensional sagittal plane morphologies with partial weightbearing (10% BW per foot) CT scans and, to a lesser degree, nonweightbearing (0%) neutral-position CT scans when compared to full weightbearing (50% BW per foot) plain radiographs. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Tadashi Kimura
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.,Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eric D Thorhauer
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Matthew W Kindig
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Bruce J Sangeorzan
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - William R Ledoux
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.,Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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Hall ME, Black MS, Gold GE, Levenston ME. Validation of watershed-based segmentation of the cartilage surface from sequential CT arthrography scans. Quant Imaging Med Surg 2022; 12:1-14. [PMID: 34993056 PMCID: PMC8666781 DOI: 10.21037/qims-20-1062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study investigated the utility of a 2-dimensional watershed algorithm for identifying the cartilage surface in computed tomography (CT) arthrograms of the knee up to 33 minutes after an intra-articular iohexol injection as boundary blurring increased. METHODS A 2D watershed algorithm was applied to CT arthrograms of 3 bovine stifle joints taken 3, 8, 18, and 33 minutes after iohexol injection and used to segment tibial cartilage. Thickness measurements were compared to a reference standard thickness measurement and the 3-minute time point scan. RESULTS 77.2% of cartilage thickness measurements were within 0.2 mm (1 voxel) of the thickness calculated in the reference scan at the 3-minute time point. 42% fewer voxels could be segmented from the 33-minute scan than the 3-minute scan due to diffusion of the contrast agent out of the joint space and into the cartilage, leading to blurring of the cartilage boundary. The traced watershed lines were closer to the location of the cartilage surface in areas where tissues were in direct contact with each other (cartilage-cartilage or cartilage-meniscus contact). CONCLUSIONS The use of watershed dam lines to guide cartilage segmentation shows promise for identifying cartilage boundaries from CT arthrograms in areas where soft tissues are in direct contact with each other.
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Affiliation(s)
- Mary E. Hall
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Marianne S. Black
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Marc E. Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
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Godoy-Santos AL, Bernasconi A, Bordalo-Rodrigues M, Lintz F, Lôbo CFT, de Cesar Netto C. Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update. Radiol Bras 2021; 54:177-184. [PMID: 34108765 PMCID: PMC8177673 DOI: 10.1590/0100-3984.2020.0048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022] Open
Abstract
Cone-beam computed tomography (CBCT) has been applied in dentistry and medicine for nearly two decades. Its application in the foot and ankle specialty has grown exponentially in recent years. Weight-bearing CBCT allows clinicians to obtain weight-bearing images that can be viewed in all three planes and to construct three-dimensional models, similar to those constructed from traditional CT scans, as well as exposing patients to less radiation than do traditional CT scans. This technology has revolutionized diagnoses, improving the understanding of various lesions and surgical planning in the foot and ankle specialty. Ongoing studies of the use of weight-bearing CBCT in foot and ankle surgery are focused on fully automated and semi-automated three-dimensional measurements, as well as bone segmentation, mapping of the distances/orientation of the joints, and the production of customized implants. The aims of this review article are to show the evolution of this emerging tool in the foot and ankle specialty, to update those in related specialties on its use in current clinical practice, and to indicate where the research community is heading.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil., Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Correspondence: Dr. Alexandre Leme Godoy-Santos. Laboratório Professor Manlio Mario Marco Napoli - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 333, Cerqueira César. São Paulo, SP, Brazil, 05403-010.
| | | | - Marcelo Bordalo-Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | | | - Carlos Felipe Teixeira Lôbo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
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Abstract
Weight-bearing CT (WBCT) scans of the foot and ankle have improved the understanding of deformities that are not easily identified on radiographs and are increasingly being used by orthopaedic surgeons for diagnostic and preoperative planning purposes. In contrast to standard CT scans, WBCT scans better demonstrate the true orientation of the bones and joints during loading. They have been especially useful in investigating the alignment of complex pathologies such as adult-acquired flatfoot deformity in which patients have been found to have a more valgus subtalar joint alignment than in a normal cohort and high rates of subfibular impingement. Studies using WBCT scans have also provided new insight into more common lower extremity conditions such as hallux valgus, ankle fractures, and lateral ankle instability. WBCT scans have allowed researchers to investigate pronation of the first metatarsal in patients with hallux valgus compared with normal feet, and patients with lateral ankle instability have been found to have more heel varus than healthy control subjects. Understanding the application of WBCT scans to clinical practice is becoming more important as surgeons strive for improved outcomes in the treatment of complicated foot and ankle disorders.
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Affiliation(s)
- Matthew S Conti
- From the Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Carrara C, Caravaggi P, Belvedere C, Leardini A. Radiographic angular measurements of the foot and ankle in weight-bearing: A literature review. Foot Ankle Surg 2020; 26:509-517. [PMID: 31402285 DOI: 10.1016/j.fas.2019.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/17/2019] [Accepted: 07/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND For the diagnosis and treatment of the foot and ankle, bone alignments have long been evaluated using planar radiographs in weight-bearing conditions and a large number of measurements have been reported. The present survey reviews the major radiographic angles that are currently present in the literature for a possible better comprehension and classification of them. METHODS PubMed and Google Scholar were used to retrieve technical and clinical papers related to these angles, and were classified based on five typologies and the three projection planes. These angles were grouped into one definition if they described similar concepts, regardless of their anatomical references and names. A corresponding original definition and diagrammatic representation are offered. RESULTS Thirty-one conceptual radiographic angles were identified across all descriptions from the literature: 18 in the sagittal plane, 9 in the transverse, and 4 in the coronal. Most angular measures represent relative bone orientations; absolute orientations, bone morphology and joint lines are less frequently used or reported. CONCLUSIONS The present survey reveals a confused scenario of angular measures, particularly in terms of anatomical references and names. It is therefore recommended to establish common relevant techniques and terminology.
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Affiliation(s)
- Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy.
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
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Lintz F, de Cesar Netto C, Burssens A, Barg A, Richter M. The value of axial loading three dimensional (3D) CT as a substitute for full weightbearing (standing) 3D CT: Comparison of reproducibility according to degree of load. Foot Ankle Surg 2018; 24:553-554. [PMID: 30321918 DOI: 10.1016/j.fas.2018.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Francois Lintz
- Ankle and Foot Surgery Center, Clinique de l'Union, 31240, Saint Jean Toulouse, France.
| | | | - Arne Burssens
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Martinus Richter
- Department of Orthopedic Surgery, Rummelsberg Hospital, Rummelsberg, Germany.
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