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Kim J, Rajan L, Henry J, Mizher R, Johnson AH, Demetracopoulos C, Ellis S, Deland J. Incidence and predictors of valgus tibiotalar tilt after progressive collapsing foot deformity reconstruction using subtalar fusion with concomitant procedures. Arch Orthop Trauma Surg 2023; 143:6087-6096. [PMID: 37160446 DOI: 10.1007/s00402-023-04906-x] [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: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Development of valgus tibiotalar tilt is a significant complication after subtalar fusion for progressive collapsing foot deformity (PCFD) correction. However, its incidence and etiologic factors have not been extensively studied. The purpose of this study was to define the incidence of valgus tibiotalar tilt after subtalar fusion for PCFD reconstruction, and to determine predictors of this complication. METHODS This study included 59 patients who underwent PCFD reconstruction with subtalar fusion. Patients with tibiotalar tilt prior to surgery were excluded. On standard weightbearing radiographs, the talonavicular coverage angle, talo-1st metatarsal angle, calcaneal pitch, hindfoot moment arm (HMA), and medial distal tibial angle were measured. Weightbearing computed tomography (WBCT) was used to determine the presence of lateral bony impingement. A radiologist evaluated the superficial and deep deltoid ligaments using magnetic resonance imaging (MRI). Univariate regression analysis was used to identify the factors associated with development of postoperative valgus tibiotalar tilt, defined as tilt > 2 degrees. RESULTS Seventeen patients (28.8%) developed postoperative valgus tibiotalar tilt at a mean of 7.7 (range 2-31) months. Eight (47.1%) of these patients developed valgus tibiotalar tilt within 3 months. Univariate logistic regression demonstrated association between preoperative HMA and postoperative valgus tibiotalar tilt (odds ratio 1.06, P = 0.026), with a 6% increase in risk per millimeter of increased HMA. Deltoid ligament status and concomitant procedures on other joints did not correlate with postoperative valgus tilt. CONCLUSION Our findings indicate that surgeons should be cognizant of patients with a greater degree of preoperative hindfoot valgus and their propensity to develop a valgus ankle deformity. Additionally, our relatively high incidence of valgus tibiotalar tilt suggests that weightbearing ankle radiographs should be included in the initial and subsequent follow-up of PCFD patients with hindfoot valgus treated with subtalar fusion.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA.
| | - Lavan Rajan
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Jensen Henry
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Rami Mizher
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Anne Holly Johnson
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | | | - Scott Ellis
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
| | - Jonathan Deland
- Hospital for Special Surgery, 532 East 72Nd Street, 5Th Floor, New York, NY, 10021, USA
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Abstract
Weight-bearing computed tomography (WBCT) was introduced in 2012 for foot and ankle applications as a breakthrough technology that enables full weight-bearing, three-dimensional imaging unaffected by x-ray beam projections or foot orientation. The literature describing the use of WBCT in the treatment of foot and ankle disorders is growing, and this article provides an overview of what can be measured with WBCT.
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Affiliation(s)
- Jaeyoung Kim
- Foot and Ankle Service, Hospital for Special Surgery, 532 East 72nd Street, New York, NY, USA
| | - Scott Ellis
- Foot and Ankle Service, Hospital for Special Surgery, 532 East 72nd Street, New York, NY, USA
| | - John A Carrino
- Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
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3
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Knutson K, Peterson AC, Lisonbee RJ, Hintermann B, Krähenbühl N, Lenz AL. Joint coverage analysis in progressive collapsing foot deformity. J Orthop Res 2023; 41:1965-1973. [PMID: 36891918 PMCID: PMC10491741 DOI: 10.1002/jor.25543] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 01/26/2023] [Accepted: 03/01/2023] [Indexed: 03/10/2023]
Abstract
Progressive collapsing foot deformity (PCFD) is characterized by a progressive subluxation of the peritalar bones and respective joints. Two-dimensional conventional radiographs are limited in their ability to visualize the peritalar bones and joints with adequate detail to describe the complex three-dimensional deformity. An improved understanding of the relationship between joint coverage and deformity would allow clinicians to use coverage analysis to distinguish among the stages of PCFD. The aim of this study was to analyze the joint coverage of the six articular relationships within the talocrural, subtalar, and Chopart joints using weightbearing computed tomography (WBCT) scans. Ten individuals with a flexible hindfoot and ten individuals with a rigid hindfoot presentation of PCFD were compared to twenty-seven asymptomatic control individuals. The three most relevant findings are: (I) the anterior-medial facet of the subtalar joint contains the greatest reduction in coverage for patients with a rigid deformity, (II) an increase in talonavicular overlap (TNO) moderately correlated with a decreased coverage in the: tibiotalar, anterior-medial subtalar, talonavicular joints, and (III) the calcaneocuboid joint lacks radiographic values to adequately quantify alignment and coverage. To conclude, there were significant differences in coverage area of various articulating regions throughout the hind- and midfoot when comparing PCFD patients to asymptomatic control individuals. Relevant radiographic measures correlating to articular coverage areas of clinical interest were identified, possibly helping to better quantify PCFD in clinical practice.
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Affiliation(s)
- Kassidy Knutson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew C. Peterson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Rich J. Lisonbee
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Amy L. Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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4
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Chien BY, Greisberg JK, Arciero E. Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review. Foot Ankle Int 2023; 44:796-809. [PMID: 37341112 DOI: 10.1177/10711007231178538] [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: 06/22/2023]
Abstract
The spring ligament is one of the main stabilizers of the medial arch of the foot and the primary static supporter of the talonavicular joint. Attenuation or rupture of this ligament is thought to play a central role in the pathophysiology of progressive collapsing foot deformity. Traditional correction of flexible flatfoot consists of posterior tibial tendon augmentation along with various osteotomies or hindfoot fusions. Repair or reconstruction of the spring ligament has not been as widely pursued. In recent years, newer techniques have been explored and may improve outcomes of traditional procedures, or possibly entirely replace some osteotomies. Combined spring-deltoid ligament reconstruction is also gaining traction as a viable technique, particularly as the ankle begins to deform into valgus. This review summarizes the variety of nonanatomic and anatomic reconstruction techniques that have been described, including autologous tendon transfers, allografts, and synthetic augmentation. Although many have only been characterized in biomechanical cadaver studies, this article reviews preliminary clinical studies that have shown promising results. There is a need for more high-quality studies evaluating the clinical, radiographic, and patient-reported outcomes following spring ligament reconstruction.
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Affiliation(s)
- Bonnie Y Chien
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin K Greisberg
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily Arciero
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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5
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Kvarda P, Siegler L, Burssens A, Susdorf R, Ruiz R, Hintermann B. Effect of total ankle replacement on the 3-dimensional subtalar joint alignment in varus ankle osteoarthritis. Foot Ankle Surg 2023:S1268-7731(23)00103-0. [PMID: 37296030 DOI: 10.1016/j.fas.2023.05.009] [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: 01/06/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Varus ankle osteoarthritis (OA) is typically associated with peritalar instability, which may result in altered subtalar joint position. This study aimed to determine the extent to which total ankle replacement (TAR) in varus ankle OA can restore the subtalar alignment. METHODS Fourteen patients (15 ankles, mean age 61 ± 6 years) who underwent TAR for varus ankle OA were analyzed using semi-automated measurements based on weight-bearing computed tomography. Twenty healthy individuals served as a control group. RESULTS All angles improved between preoperative and a minimum of 1 year (mean 2.1 years) postoperative and were statistically significant in 6 out of 8 angles (P < 0.05). CONCLUSIONS Our findings indicate that talus repositioning after TAR restores the subtalar joint alignment which may improve hindfoot biomechanics. Future studies are required to implement these findings for TAR in presence of hindfoot deformity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland.
| | - Lena Siegler
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Arne Burssens
- Department of Orthopaedics, University of Gent, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
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Nozaki S, Watanabe K, Katayose M, Yamatsu K, Teramoto A, Ogihara N. Three-dimensional morphological variations in the calcaneus and talus in relation to the hallux valgus angle. Ann Anat 2023; 247:152053. [PMID: 36696928 DOI: 10.1016/j.aanat.2023.152053] [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: 08/31/2022] [Revised: 11/17/2022] [Accepted: 12/22/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND The present study aimed to clarify the morphological patterns of the calcaneus and talus that are associated with hallux valgus angle (HVA) by quantifying the differences in the hindfoot bone morphology between left and right sides in HV patients with clear bilateral difference of HVA. METHODS Three-dimensional (3D) computed tomography scans of 32 feet of 16 patients with HV who had right-to-left HVA differences of more than 5 degrees (68.8 ± 8.6 years) were enrolled, and 3D surface models of the calcaneus and talus were generated. A total of 556 and 430 landmarks were placed on the calcaneal and talar surfaces, respectively, to calculate the principal components (PCs) of shape variations. The PC scores were compared between the small and large HVA sides within an individual. RESULTS The calcaneus in patients with a larger HVA (mean, 43.2 degrees) possessed slender calcaneal tuberosity, more medially oriented posterior articular surface in the coronal plane, and narrower and more concave anterior-middle articular surfaces compared to those with a small HVA (mean, 33.7 degrees). The talus with a larger HVA exhibited more medially oriented talar head in the transverse plane and more anteriorly protruded lateral region of the talar head compared to the small HVA. CONCLUSIONS The morphological patterns of the calcaneus in patients with a larger HVA allows the hindfoot bones to easily rotate in the everting direction, while those of the talus could induce a larger internal rotation of the first metatarsal. These morphological patterns of the calcaneus and talus could be structural factors affecting the HV.
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Affiliation(s)
- Shuhei Nozaki
- Laboratory of Human Evolutionary Biomechanics, Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo 113-0033, Japan.
| | - Kota Watanabe
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan
| | - Masaki Katayose
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan
| | - Kenta Yamatsu
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan
| | - Naomichi Ogihara
- Laboratory of Human Evolutionary Biomechanics, Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo 113-0033, Japan.
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Dibbern K, Vivtcharenko V, Salomao Barbachan Mansur N, Lalevée M, Alencar Mendes de Carvalho K, Lintz F, Barg A, Goldberg AJ, de Cesar Netto C. Distance mapping and volumetric assessment of the ankle and syndesmotic joints in progressive collapsing foot deformity. Sci Rep 2023; 13:4801. [PMID: 36959355 PMCID: PMC10036322 DOI: 10.1038/s41598-023-31810-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023] Open
Abstract
The early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included. Three-dimensional DM and CM of the ankle and syndesmotic joints, as well volumetric assessment of the distal tibiofibular syndesmosis was performed as possible WBCT markers of early PCFD. Measurements were compared between PCFD and controls. Significant overall reductions in syndesmotic incisura distances were observed in PCFD patients when compared to controls, with no difference in the overall syndesmotic incisura volume at 1, 3, 5 and 10 cm proximally to the ankle joint. CMs showed significantly decreased articular coverage of the anterior regions of the tibiotalar joint as well as medial/lateral ankle joint gutters in PCFD patients. This study showed syndesmotic narrowing and decreased articular coverage of the anterior aspect of the ankle gutters and talar dome in stage I PCFD patients when compared to controls. These findings are consistent with early plantarflexion of the talus within the ankle Mortise, and absence of true syndesmotic overload in early PCFD, and support DM and CM as early 3D PCFD radiological markers.
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Affiliation(s)
- Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Victoria Vivtcharenko
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Service d'orthopédie Traumatologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
| | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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8
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Wellenberg RHH, Schallig W, Steenbergen P, Tex PD, Dobbe JGG, Streekstra GJ, Witbreuk MMEH, Buizer AI, Maas M. Assessment of foot deformities in individuals with cerebral palsy using weight-bearing CT. Skeletal Radiol 2022; 52:1313-1320. [PMID: 36585514 DOI: 10.1007/s00256-022-04272-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aims of this study were to visualize and quantify relative bone positions in the feet of individuals with cerebral palsy (CP) with a foot deformity and compare bone positions with those of typically developed (TD) controls. MATERIALS AND METHODS Weight-bearing CT images of 14 individuals with CP scheduled for tendon transfer and/or bony surgery and of 20 TD controls were acquired on a Planmed Verity WBCT scanner. Centroids of the navicular and calcaneus with respect to the talus were used to quantify foot deformities. All taluses were aligned and the size and dimensions of the individuals' talus were scaled to correct for differences in bone sizes. In order to visualize and quantify variations in relative bone positions, 95% CI ellipsoids and standard deviations in its principle X-, Y-, and Z-directions were determined. RESULTS In individuals with CP (age 11-17), a large variation in centroid positions was observed compared to data of TD controls. Radiuses of the ellipsoids, representing the standard deviations of the 95% CI in the principle X-, Y-, and Z-directions, were larger in individuals with CP compared to TD controls for both the calcaneus (3.16 vs 1.86 mm, 4.26 vs 2.60 mm, 9.19 vs 3.60 mm) and navicular (4.63 vs 1.55 mm, 5.18 vs 2.10 mm, 16.07 vs 4.16 mm). CONCLUSION By determining centroids of the calcaneus and navicular with respect to the talus on WBCT images, normal and abnormal relative bone positions can be visualized and quantified in individuals with CP with various foot deformities.
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Affiliation(s)
- R H H Wellenberg
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. .,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - W Schallig
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1118, Amsterdam, The Netherlands.,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P Steenbergen
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P den Tex
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - J G G Dobbe
- Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - G J Streekstra
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - M M E H Witbreuk
- Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - A I Buizer
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1118, Amsterdam, The Netherlands.,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam UMC, Pediatric Rehabilitation, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - M Maas
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
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9
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Henry JK, Hoffman J, Kim J, Steineman B, Sturnick D, Demetracopoulos C, Deland J, Ellis S. The Foot and Ankle Kinematics of a Simulated Progressive Collapsing Foot Deformity During Stance Phase: A Cadaveric Study. Foot Ankle Int 2022; 43:1577-1586. [PMID: 36259688 DOI: 10.1177/10711007221126736] [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: 02/01/2023]
Abstract
BACKGROUND Progressive collapsing foot deformity (PCFD) is a complex pathology associated with tendon insufficiency, ligamentous failure, joint malalignment, and aberrant plantar force distribution. Existing knowledge of PCFD consists of static measurements, which provide information about structure but little about foot and ankle kinematics during gait. A model of PCFD was simulated in cadavers (sPCFD) to quantify the difference in joint kinematics and plantar pressure between the intact and sPCFD conditions during simulated stance phase of gait. METHODS In 12 cadaveric foot and ankle specimens, the sPCFD condition was created via sectioning of the spring ligament and the medial talonavicular joint capsule followed by cyclic axial compression. Specimens were then analyzed in intact and sPCFD conditions via a robotic gait simulator, using actuators to control the extrinsic tendons and a rotating force plate underneath the specimen to mimic the stance phase of walking. Force plate position and muscle forces were optimized using a fuzzy logic iterative process to converge and simulate in vivo ground reaction forces. An 8-camera motion capture system recorded the positions of markers fixed to bones, which were then used to calculate joint kinematics, and a plantar pressure mat collected pressure distribution data. Joint kinematics and plantar pressures were compared between intact and sPCFD conditions. RESULTS The sPCFD condition increased subtalar eversion in early, mid-, and late stance (P < .05), increased talonavicular abduction in mid- and late stance (P < .05), and increased ankle plantarflexion (P < .05), adduction (P < .05), and inversion (P < .05). The center of plantar pressure was significantly (P < .01) medialized in this model of sPCFD and simulated stance phase of gait. DISCUSSION Subtalar and talonavicular joint kinematics and plantar pressure distribution significantly changed with the sPCFD and in the directions expected from a PCFD foot. We also found that ankle joint kinematics changed with medial and plantar drift of the talar head, indicating abnormal talar rotation. Although comparison to an in vivo PCFD foot was not performed, this sPCFD model produced changes in foot kinematics and indicates that concomitant abnormal changes may occur at the ankle joint with PCFD. CLINICAL RELEVANCE This study describes the dynamic kinematic and plantar pressure changes in a cadaveric model of simulated progressive collapsing foot deformity during simulated stance phase.
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Affiliation(s)
- Jensen K Henry
- Foot & Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey Hoffman
- Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Jaeyoung Kim
- Foot & Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brett Steineman
- Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Sturnick
- Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | | | - Jonathan Deland
- Foot & Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott Ellis
- Foot & Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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10
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Lôbo CFT, Pires EA, Bordalo-Rodrigues M, de Cesar Netto C, Godoy-Santos AL. Imaging of progressive collapsing foot deformity with emphasis on the role of weightbearing cone beam CT. Skeletal Radiol 2022; 51:1127-1141. [PMID: 34693455 DOI: 10.1007/s00256-021-03942-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
The term progressive collapsing foot deformity (PCFD) is currently recommended as the replacement to adult-acquired flatfoot deformity and posterior tibial tendon dysfunction to better reflect its pathology, which consists of a complex three-dimensional deformity involving the foot and ankle. The new consensus has also provided a new classification that requires clinical and radiographic findings for patient stratification into each class. However, conventional radiographs are susceptible to errors resulting from the inadequate positioning of patients, incorrect angulation of the X-ray tube, and overlapping of bone structures. Weightbearing cone beam computed tomography (WBCBCT), which has greater diagnostic accuracy than conventional radiograph, is useful for evaluating progressive collapsing foot deformity to determine medial arch collapse, hindfoot alignment, peritalar subluxation, posterior subtalar joint valgus, intrinsic talus valgus, and lateral extra-articular bone impingement. The present review aimed to discuss the new recommendations for nomenclature, classification, and imaging evaluation of PCFD, with an illustrative and quantitative focus on the measurements used in conventional radiography and WBCBCT. The measurements presented here are important criteria for decision-making.
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Affiliation(s)
- Carlos Felipe Teixeira Lôbo
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.
| | - Eduardo Araújo Pires
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil
| | - Marcelo Bordalo-Rodrigues
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Alexandre Leme Godoy-Santos
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, SP, 05652-900, Brazil
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11
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Merian M, Kaim A. The Plantar Fascia Talar Head Correlation: A Radiographic Parameter With a Distinct Threshold to Validate Flatfoot Deformity and Its Corrective Surgery on Conventional Weightbearing Radiographs. Foot Ankle Int 2022; 43:414-425. [PMID: 34802299 DOI: 10.1177/10711007211052258] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Corrective surgery for flexible flatfoot deformity (FD) remains controversial, and one of the main reasons for this is the lack of standardized radiographic measurements to define an FD. Previously published radiographic parameters to differentiate between a foot with and without an FD do not have a commonly accepted and distinct threshold. METHODS The plantar fascia-talar head correlation (PTC) with its defined threshold was assessed by measuring the distance between the medial border of the plantar fascia and the center of the talar head (DPT) on conventional dorsoplantar and lateral weightbearing radiographs; the authors were blinded to the clinical diagnosis of the 189 patients' first visits. Feet were sorted into groups with and without an FD based on their clinical examination. The effect of operative corrections of FD on the PTC was retrospectively evaluated on an additional 38 patients. RESULTS The sensitivity of the PTC was 0.98 (95% CI: 0.9-1) and specificity 0.96 (95% CI: 0.92-0.98), respectively, to identify an FD, consistent with the clinical examination. Thirty-five of 38 surgeries sufficiently corrected the FD and the PTC comparable to that in subjects without an FD. Three corrections with a residual FD did not adequately correct the PTC. CONCLUSION The PTC is a reliable radiographic parameter with a distinct threshold that is sensitive and specific for the differentiation of feet with and without an FD including feet with and without residual FD after corrective surgery. The PTC is applicable to monitor the needed intraoperative amount of correction using simulated weightbearing fluoroscopy. LEVEL OF EVIDENCE Level III, diagnostic.
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Affiliation(s)
- Marc Merian
- Praxis für Fuss- und Sprunggelenkschirurgie, Klinik Birshof Hirslanden AG, Münchenstein, Switzerland
| | - Achim Kaim
- Department of Radiology, Klinik Birshof Hirslanden AG, Münchenstein, Switzerland
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12
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Kleipool RP, Stufkens SAS, Dahmen J, Vuurberg G, Streekstra GJ, Dobbe JGG, Blankevoort L, Knupp M. Difference in orientation of the talar articular facets between healthy ankle joints and ankle joints with chronic instability. J Orthop Res 2022; 40:695-702. [PMID: 33913551 PMCID: PMC9291144 DOI: 10.1002/jor.25068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Since both the talocrural and subtalar joints can be involved in chronic ankle instability, the present study assessed the talar morphology as this bone is the key player between both joint levels. The 3D orientation and curvature of the superior and the posteroinferior facet between subjects with chronic ankle instability and healthy controls were compared. Hereto, the talus was segmented in the computed tomography images of a control group and a chronic ankle instability group, after which they were reconstructed to 3D surface models. A cylinder was fitted to the subchondral articulating surfaces. The axis of a cylinder represented the facet orientation, which was expressed by an inclination and deviation angle in a coordinate system based on the cylinder of the superior talar facet and the geometric principal axes of the subject's talus. The curvature of the surface was expressed as the radius of the cylinder. The results demonstrated no significant differences in the radius or deviation angle. However, the inclination angle of the posteroinferior talar facet was significantly more plantarly orientated (by 3.5°) in the chronic instability group (14.7 ± 3.1°) compared to the control group (11.2 ± 4.9°) (p < 0.05). In the coronal plane this corresponds to a valgus orientation of the posteroinferior talar facet relative to the talar dome. In conclusion, a more plantarly and valgus orientated posteroinferior talar facet may be associated to chronic ankle instability.
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Affiliation(s)
- Roeland P. Kleipool
- Department of Medical Biology, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands
| | - Sjoerd A. S. Stufkens
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Jari Dahmen
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Gwendolyn Vuurberg
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands,Department of Radiology and Nuclear medicine, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Department of Radiology and Nuclear medicineRijnstate ZiekenhuisArnhemThe Netherlands
| | - Geert J. Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Johannes G. G. Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Leendert Blankevoort
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Markus Knupp
- Mein Fusszentrum, BaselUniversity of BaselSwitzerland
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13
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Hagen JE, Sands AK, Swords M, Rammelt S, Schmitz N, Richards G, Gueorguiev B, Souleiman F. Medial talar resection: how much remains stable? Eur J Trauma Emerg Surg 2022; 48:3961-3967. [PMID: 35199184 PMCID: PMC9532311 DOI: 10.1007/s00068-022-01915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
Purpose Pathologies of the medial talus (e.g., fractures, tarsal coalitions) can lead to symptomatic problems such as pain and nonunion. Bony resection may be a good solution for both. It is unclear how much of the medial talus can be taken before the subtalar joint becomes unstable. The aim of this study was to evaluate the effect a limited resection of the medial talar facet and the anteromedial portion of the posterior talar facet has on subtalar stability. Methods Eight fresh-frozen human cadaveric lower limbs were mounted in a frame for simulated weight-bearing. Computed tomography scans were obtained under 700 N single-legged stance loading, with the foot in neutral, 15° inversion, and 15° eversion positions. A sequential resection of 10, 20, and 30% of the medial facet and the anteromedial portion of the posterior talar facet to the calcaneus, based on the intact talus width, was performed. Measurements of subtalar vertical angulation, talar subluxation, coronal posterior facet angle and talocalcaneal (Kite) angle in the anteroposterior and lateral view were performed. Results Gross clinical instability was not observed in any of the specimens. No significant differences were detected in the measurements between the resected and intact states (P ≥ 0.10) as well as among the resected states (P ≥ 0.11). Conclusion In a biomechanical setting, resecting up to 30% of the medial facet and anteromedial portion of the posterior facet based on the intact talus width—does not result in any measurable instability of the subtalar joint in presence of intact ligamentous structures. Level of evidence V.
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Affiliation(s)
- Jennifer E Hagen
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopedics and Rehabilitation, Orthopedics University of Florida, Gainesville, FL, USA
| | - Andrew K Sands
- New York Presbyterian-Lower Manhattan Hospital, New York, NY, USA
| | | | - Stefan Rammelt
- Department of Foot and Ankle Surgery, University Hospital Dresden, Dresden, Germany
| | - Nina Schmitz
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | | | | | - Firas Souleiman
- AO Research Institute Davos, Davos, Switzerland. .,Department of Orthopedics, Trauma and Plastic Surgery, University Hospital of Leipzig, University of Leipzig, Leipzig, Germany.
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14
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Barbachan Mansur NS, Lalevee M, Maly C, Dibbern K, Lee HY, Godoy-Santos AL, Lintz F, de Cesar Netto C. Association Between Middle Facet Subluxation and Foot and Ankle Offset in Progressive Collapsing Foot Deformity. Foot Ankle Int 2022; 43:96-100. [PMID: 34581232 DOI: 10.1177/10711007211040820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subtalar middle facet (MF) subluxation was recognized as a reliable marker for progressive collapsing foot deformity (PCFD) diagnosis. Foot and Ankle Offset (FAO) is an established measurement, predictive of malalignment severity. The objective of this study was to assess the potential association between MF subluxation and FAO in PCFD patients. METHODS 56 individuals with flexible PCFD (74 feet) were assessed. Two blinded foot and ankle surgeons calculated MF uncoverage, MF incongruence, and FAO. Agreement was quantified using intraclass correlation coefficient (ICC). A multivariate regression analysis and partition prediction models were applied to assess relationship between values. RESULTS All ICCs were >0.80. MF subluxation and FAO were found to be correlated (rs = 0.56; P < .0001). Changes in the MF subluxation were noticeably explained by FAO and BMI (R2 = 0.33). MF incongruence was not correlated with the assessed variables (P = .10). In this cohort, an MF subluxation of 27.5% was a threshold for increased FAO (FAO of 3.4%±2.4% when below; FAO of 8.0% ±3.5% when above). CONCLUSION We found a correlation between MF subluxation and FAO. An MF subluxation of 27.5% was found to be a threshold for higher FAO, which corresponded to a greater malalignment. These data may help surgeons optimize treatment decisions in PCFD patients. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA.,Department of Orthopedics and Traumatology, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Connor Maly
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
| | - Hee Young Lee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
| | | | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
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15
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Krause F, Zderic I, Gueorguiev B, Vellasamy A, Schmid T. The Effect of the Mobile Subtalar Joint on Calcaneal and Supramalleolar Osteotomies. Foot Ankle Int 2021; 42:1606-1612. [PMID: 34378429 DOI: 10.1177/10711007211027295] [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 The mobile subtalar joint (STJ) may compensate for supra- and inframalleolar deformities and counteract the effect of realigning calcaneal or distal tibial osteotomies. The purpose of this study was to evaluate the compensatory effect of the mobile STJ after supramalleolar osteotomy (SMOT) and calcaneus osteotomy (COT) and whether the extent of the compensation correlates with STJ shape and orientation. METHODS In 10 human lower leg cadavers without evidence of deformity or prior trauma 700 Newton load were applied as a simulated standing pose. The center of force (COF) migration, maximum pressure (Pmax), and the area loaded were measured with high-resolution sensors in the ankle before and after 10-mm varus/valgus sliding COT and 10-degree varus / valgus SMOT. A computed tomographic evaluation of subtalar anatomy was conducted to correlate posterior facet curvature, its varus/valgus orientation in the coronal plane, and the effect on COF, Pmax, and area loaded. RESULTS The COF migration was significant for both varus and valgus SMOTs (varus SMOT: 1.78 mm, P = .0029; valgus SMOT: 1.85 mm, P = .0018) but not for COT (varus COT: 0.45 mm, P = .85; valgus COT: 1.15 mm, P = .11). Pmax and area loaded changed but not significantly. The radius of the posterior STJ surface showed a moderate correlation (varus SMOT: r = 0.61, P = .063; valgus SMOT: r = 0.28, P = .43, varus COT: r = -0.61, P = .063; valgus COT: r = 0.13, P = .38) and the axis a weak inverse correlation (varus SMOT: r = -0.51, P = .013; valgus SMOT: r = 0.58, P = .079; varus COT: r = -0.51, P = .14; valgus COT: r = 0.38, P = .28) with the COF migration after the osteotomies. CONCLUSION The compensatory capacity of a mobile STJ is relatively small but appears to limit the effect of COT more than SMOT. The COT is less effective in influencing ankle joint pressure for realignment purposes than SMOT in mobile STJ and clinically more consistent in stiff STJ. Correlations are moderate to weak, whereas the curvature more than orientation of posterior facet inversely correlates with osteotomy's effects. LEVEL OF EVIDENCE Level IV, biomechanical cadaver study.
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Affiliation(s)
- Fabian Krause
- Department of Orthopaedic Surgery, Inselspital, University of Berne, Berne, Switzerland
| | - Ivan Zderic
- AO Research Institute, Davos, Graubünden, Switzerland
| | | | | | - Timo Schmid
- Department of Orthopaedic Surgery, Hopital Sion, Sion, Switzerland
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16
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de Cesar Netto C, Saito GH, Roney A, Day J, Greditzer H, Sofka C, Ellis SJ, Richter M, Barg A, Lintz F, de Cesar Netto C, Burssens A, Ellis SJ, Deland J, Ellis SJ. Combined weightbearing CT and MRI assessment of flexible progressive collapsing foot deformity. Foot Ankle Surg 2021; 27:884-891. [PMID: 33358266 DOI: 10.1016/j.fas.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the correlation between Weightbearing CT (WBCT) markers of pronounced peritalar subluxation (PTS) and MRI findings of soft tissue insufficiency in patients with flexible Progressive Collapsing Foot Deformity (PCFD). We hypothesized that significant correlation would be found. METHODS Retrospective comparative study with 54 flexible PCFD patients. WBCT and MRI variables deformity severity were evaluated, including markers of pronounced PTS, as well as soft tissue degeneration. A multiple regression analysis and partition prediction models were used to evaluate the relationship between bone alignment and soft tissue injury. P-values of less than .05 were considered significant. RESULTS Degeneration of the posterior tibial tendon was significantly associated with sinus tarsi impingement (p = .04). Spring ligament degeneration correlated to subtalar joint subluxation (p = .04). Talocalcaneal interosseous ligament involvement was the only one to significantly correlate to the presence of subfibular impingement (p = .02). CONCLUSION Our results demonstrated that WBCT markers of pronounced deformity and PTS were significantly correlated to MRI involvement of the PTT and other important restraints such as the spring and talocalcaneal interosseus ligaments. LEVEL OF EVIDENCE Level III, Retrospective comparative study.
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Affiliation(s)
- Cesar de Cesar Netto
- The Hospital for Special Surgery, New York, NY, US; University of Iowa, Department of Orthopaedics and Rehabilitation, Iowa City, IA, US.
| | | | - Andrew Roney
- The Hospital for Special Surgery, New York, NY, US
| | - Jonathan Day
- The Hospital for Special Surgery, New York, NY, US
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- International Weight Bearing CT Society, Brussels, Belgium
| | | | - Alexej Barg
- The Hospital for Special Surgery, New York, NY, US
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17
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Zhang L, Peng X, He S, Zhou X, Yi G, Tang X, Li B, Wang G, Zhao W, Yang Y. Association between subtalar articular surface typing and flat foot deformity: which type is more likely to cause flat foot deformity. BMC Musculoskelet Disord 2021; 22:979. [PMID: 34814890 PMCID: PMC8611995 DOI: 10.1186/s12891-021-04872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have shown a wide range of anatomical classifications of the subtalar joint (STJ) in the population and this is related to the different force line structures of the foot. Different subtalar articular surface morphology may affect the occurrence and development of flat foot deformity, and there are fewer studies in this area. The main objective of our study was to determine the association of different subtalar articular surface with the occurrence and severity of flat foot deformity. Methods We analyzed the imaging data of 289 cases of STJ. The articular surface area, Gissane’s angle and Bohler’s angle of subtalar articular surface of different types were counted. The occurrence and severity of flat foot deformity in different subtalar articular surface were judged by measuring the Meary angle of foot. Results We classified 289 cases of subtalar articular surface into five types according to the morphology. According to Meary angle, the flat foot deformity of Type I and Type IV are significantly severer than Type II (P < 0.05). Type II (7.65 ± 1.38 cm2) was significantly smaller than Type I (8.40 ± 1.79 cm2) in the total joint facet area(P < 0.05). Type III (9.15 ± 1.92 cm2) was smaller than Type I (8.40 ± 1.79 cm2), II (7.65 ± 1.38 cm2) and IV (7.81 ± 1.74 cm2) (P < 0.05). Type II (28.81 ± 7.44∘) was significantly smaller than Type I (30.80 ± 4.61 degrees), and IV (32.25 ± 5.02 degrees) in the Bohler’s angle (P < 0.05). Type II (128.49 ± 6.74 degrees) was smaller than Type I (131.58 ± 7.32 degrees), and IV (131.94 ± 5.80 degrees) in the Gissane’s angle (P < 0.05). Conclusions After being compared and analyzed the measurement of morphological parameters, joint facet area and fusion of subtalar articular surface were closely related to the severity of flat foot deformity and Type I and IV were more likely to develop severer flat foot deformity. Level of evidence Level III, retrospective comparative study.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Xiaoyao Peng
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Siyuan He
- School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Gang Yi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Xiaogao Tang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Bingkun Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China. .,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China. .,Expert Workstation in Luzhou, Luzhou, 646000, China. .,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China.
| | - Wanxue Zhao
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Yuening Yang
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
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18
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Crawford AW, Haleem AM. I am Afraid of Lateral Column Lengthening. Should I Be? Foot Ankle Clin 2021; 26:523-538. [PMID: 34332733 DOI: 10.1016/j.fcl.2021.06.003] [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: 02/02/2023]
Abstract
Lateral column lengthening has long been used in conjunction with other soft tissue and bony procedures to correct the midforefoot abduction seen in class B progressive collapsing foot deformity. The effectiveness of this osteotomy to restore the physiologic shape of the foot has been used by foot and ankle surgeons around the world to provide functional improvement for patients suffering from this disease. The overall low complication rates, low nonunion rates, and improved radiographic and functional outcomes provided by lateral column lengthening make this a valuable option for the treatment of class B progressive collapsing foot deformity.
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Affiliation(s)
- Alexander W Crawford
- Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, University of Oklahoma College of Medicine, 800 Stanton L Young Boulevard, Suite 3400, Oklahoma City, OK 73104, USA
| | - Amgad M Haleem
- Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, University of Oklahoma College of Medicine, 800 Stanton L Young Boulevard, Suite 3400, Oklahoma City, OK 73104, USA; Department of Orthopedic Surgery, Kasr Al-Ainy Hospitals, College of Medicine, Cairo University, Cairo, Egypt.
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19
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Abstract
Advanced imaging modalities have, in very recent years, enabled a considerable leap in understanding progressive collapsing foot deformity, evolving from a simple confirmation of clinical diagnostic using basic measurements to minute understanding of soft tissue and bone involvements. MRI and weight-bearing cone-beam computed tomography are enabling the development of new 3-dimensional measurement modalities. The identification of key articular and joint markers of advanced collapse will allow surgeons to better indicate treatments and assess chances of success with conservative therapies and less invasive surgical procedures, with the hope of improving patient outcomes.
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20
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Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools. Sci Rep 2021; 11:16139. [PMID: 34373546 PMCID: PMC8352889 DOI: 10.1038/s41598-021-95708-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Acquired adult flatfoot is a frequent deformity which implies multiple, complex and combined 3D modifications of the foot skeletal structure. The difficult thorough evaluation of the degree of severity pre-op and the corresponding assessment post-op can now be overcome by cone-beam (CBCT) technology, which can provide access to the 3D skeletal structure in weight-bearing. This study aims to report flatfoot deformities originally in 3D and in weight-bearing, with measurements taken using two different bone segmentation techniques. 21 such patients, with indication for surgical corrections, underwent CBCT (Carestream, US) while standing on one leg. From these scans, 3D models of each bone of the foot were reconstructed by using two different state-of-the-art segmentation tools: a semi-automatic (Mimics Innovation Suite, Materialise, Belgium), and an automatic (Bonelogic Ortho Foot and Ankle, Disior, Finland). From both reconstructed models, Principal Component Analysis was used to define anatomical reference frames, and original foot and ankle angles and other parameters were calculated mostly based on the longitudinal axis of the bones, in anatomical plane projections and in 3D. Both bone model reconstructions revealed a considerable valgus of the calcareous, plantarflexion and internal rotation of the talus, and typical Meary’s angles in the lateral and transverse plane projections. The mean difference from these angles between semi-automatic and automatic segmentations was larger than 3.5 degrees for only 3 of the 32 measurements, and a large number of these differences were not statistically significant. CBCT and the present techniques for bone shape reconstruction finally provide a novel and valuable 3D assessment of complex foot deformities in weight-bearing, eliminating previous limitations associated to unloaded feet and bidimensional measures. Corresponding measurements on the bone models from the two segmentation tools compared well. Other more representative measurements can be defined in the future using CBCT and these techniques.
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21
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Dibbern KN, Li S, Vivtcharenko V, Auch E, Lintz F, Ellis SJ, Femino JE, de Cesar Netto C. Three-Dimensional Distance and Coverage Maps in the Assessment of Peritalar Subluxation in Progressive Collapsing Foot Deformity. Foot Ankle Int 2021; 42:757-767. [PMID: 33504217 DOI: 10.1177/1071100720983227] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Progressive collapsing foot deformity (PCFD), formerly termed adult-acquired flatfoot deformity, is a complex 3-dimensional (3D) deformity of the foot characterized by peritalar subluxation (PTS). PTS is typically measured at the posterior facet, but recent studies have called this into question. The objective of this study was to use 3D distance mapping (DM) from weightbearing computed tomography (WBCT) to assess PTS in patients with PCFD and controls. We hypothesized that DMs would identify the middle facet as a superior marker for PTS. METHODS We analyzed WBCT data of 20 consecutive stage I patients with PCFD and 10 control patients with a novel DM technique to objectively characterize joint coverage across the entire peritalar surface, including both articular and nonarticular regions. Joint coverage was defined as the percentage of articular area with DMs <4 mm and impingement when distances were <0.5 mm. Comparisons were performed with independent t tests or Wilcoxon tests. P values <.05 were considered significant. RESULTS Overall, coverage was decreased in articular regions and impingement was increased in nonarticular regions of patients with PCFD with a significant increase in uncoverage in the middle (46.6%, P < .001) but not anterior or posterior facets. Significant increases in sinus tarsi coverage were identified (98.0%, P < .007) with impingement in 6 of 20 patients with PCFD. Impingement of the subfibular region was noted in only 1 of 20 cases but narrowing greater than 2 standard deviations was noted in 17 of 20 patients. CONCLUSION Objective DMs identified significant markers of PTS in the middle but not posterior or anterior facets. We confirmed prior 2-dimensional data that suggested uncoverage of the middle facet provided a more robust and consistent measure of PTS than measures in the posterior facet. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Kevin N Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Shuyuan Li
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Victoria Vivtcharenko
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Elijah Auch
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | | | - John E Femino
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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22
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Abstract
Undiagnosed medial ankle instability can be a prerequisite for pathogenic progression in the foot, particularly for adult acquired flatfoot deformity. With the complex anatomy in this region, and the limitations of each individual investigational method, accurately identifying peritalar instability remains a serious challenge to clinicians. Performing a thorough clinical examination aided by evaluation with advanced imaging can improve the threshold of detection for this condition and allow early proper treatment to prevent further manifestations of the instability.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Martinistr. 52, Hamburg 20246, Germany.
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23
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Abstract
The deltoid and spring ligaments are the primary restraints against pronation and valgus deformity of the foot, and in preserving the medial arch. The posterior tibial tendon has a secondary role in plantar arch maintenance, and its biomechanical stress increases considerably when other tissues fail. A thorough understanding of the anatomy and biomechanics of the deltoid-spring ligament is crucial for successful reconstruction of the tibiocalcanealnavicular ligament, hence, to restore ankle and medial peritalar stability. Although effective in correcting the deformity, tibionavicular tenodesis might be critical, as it blocks physiologic pronation of the hindfoot, which may result in dysfunction and pain.
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Affiliation(s)
- Beat Hintermann
- Center of Excellence for Foot and Ankle Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
| | - Roxa Ruiz
- Center of Excellence for Foot and Ankle Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
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24
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Bernasconi A, Cooper L, Lyle S, Patel S, Cullen N, Singh D, Welck M. Pes cavovarus in Charcot-Marie-Tooth compared to the idiopathic cavovarus foot: A preliminary weightbearing CT analysis. Foot Ankle Surg 2021; 27:186-195. [PMID: 32507338 DOI: 10.1016/j.fas.2020.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pes cavovarus is a foot deformity that can be idiopathic (I-PC) or acquired secondary to other pathology. Charcot-Marie-Tooth disease (CMT) is the most common adult cause for acquired pes cavovarus deformity (CMT-PC). The foot morphology of these distinct patient groups has not been previously investigated. The aim of this study was to assess if morphological differences exist between CMT-PC, I-PC and normal feet (controls) using weightbearing computed tomography (WBCT). METHODS A retrospective analysis of WBCT scans performed between May 2013 and June 2017 was undertaken. WBCT scans from 17 CMT-PC, 17 I-PC and 17 healthy normally-aligned control feet (age-, side-, sex- and body mass index-matched) identified from a prospectively collected database, were analysed. Eight 2-dimensional (2D) and three 3-dimensional (3D) measurements were undertaken for each foot and mean values in the three groups were compared using one-way ANOVA with the Bonferroni correction. RESULTS Significant differences were observed between CMT-PC or I-PC and controls (p<0.05). Two-dimensional measurements were similar in CMT-PC and I-PC, except for forefoot arch angle (p=0.04). 3D measurements (foot and ankle offset, calcaneal offset and hindfoot alignment angle) demonstrated that CMT-PC exhibited more severe hindfoot varus malalignment than I-PC (p=0.03, 0.04 and 0.02 respectively). CONCLUSIONS CMT-related cavovarus and idiopathic cavovarus feet are morphologically different from healthy feet, and CMT feet exhibit increased forefoot supination and hindfoot malalignment compared to idiopathic forms. The use of novel three-dimensional analysis may help highlight subtle structural differences in patients with similar foot morphology but aetiologically different pathology. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom; Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Lucy Cooper
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Shirley Lyle
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Nicholas Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Dishan Singh
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
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25
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Piraino JA, Theodoulou MH, Ortiz J, Peterson K, Lundquist A, Hollawell S, Scott RT, Joseph R, Mahan KT, Bresnahan PJ, Butto DN, Cain JD, Ford TC, Knight JM, Wobst GM. American College of Foot and Ankle Surgeons Clinical Consensus Statement: Appropriate Clinical Management of Adult-Acquired Flatfoot Deformity. J Foot Ankle Surg 2021; 59:347-355. [PMID: 32131002 DOI: 10.1053/j.jfas.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This clinical consensus statement of the American College of Foot and Ankle Surgeons focuses on the highly debated subject of the management of adult flatfoot (AAFD). In developing this statement, the AAFD consensus statement panel attempted to address the most relevant issues facing the foot and ankle surgeon today, using the best evidence-based literature available. The panel created and researched 16 statements and generated opinions on the appropriateness of the statements. The results of the research on this topic and the opinions of the panel are presented here.
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Affiliation(s)
- Jason A Piraino
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL.
| | - Michael H Theodoulou
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Julio Ortiz
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Kyle Peterson
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Andrew Lundquist
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Shane Hollawell
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Ryan T Scott
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Robert Joseph
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Kieran T Mahan
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Philip J Bresnahan
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Danielle N Butto
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Jarrett D Cain
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Timothy C Ford
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Jessica Marie Knight
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
| | - Garrett M Wobst
- Adult-Acquired Flatfoot Deformity Clinical Consensus Statement Panel of the American College of Foot and Ankle Surgeons, Chicago, IL
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26
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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: 12] [Impact Index Per Article: 4.0] [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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27
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Tonogai I, Sairyo K. Arthrodesis for chronic lateral subtalar joint dislocation caused by posterior tibial tendon dysfunction: A case report. Int J Surg Case Rep 2020; 78:21-25. [PMID: 33310463 PMCID: PMC7736768 DOI: 10.1016/j.ijscr.2020.11.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022] Open
Abstract
Posterior tibial tendon dysfunction rarely leads to lateral subtalar dislocation. We successfully treated lateral subtalar joint dislocation with arthrodesis. Anterior calcaneal process acts as a pivot for anterolateral corner of the talus.
Introduction Adult acquired flatfoot deformity (AAFD) caused by posterior tibial tendon dysfunction (PTTD) can lead to the development of peritalar subluxation (PTS) and much more rarely to lateral subtalar dislocation. Presentation of case A 75-year-old woman was referred to our hospital with an approximately 15-year history of pain in her right foot without obvious trauma. The lateral shifting foot deformity had worsened in the previous 5 years. On presentation, she had tenderness over the talonavicular joint, and the skin overlying the talar head on the medial foot was taut. Imaging revealed lateral displacement of the calcaneus with simultaneous dislocation of the talonavicular and talocalcaneal joints. We diagnosed lateral subtalar dislocation including the talonavicular and talocalcaneal joints caused by PTTD, which we treated by reduction and fusion of the subtalar joint complex. The foot and ankle were immobilized with a cast for 6 weeks. Discussion At the 1-year follow-up visit, the patient reported no pain during daily activities, although flatfoot persisted. Conclusion We report a rare case of chronic lateral subtalar dislocation caused by PTTD that was treated by fusion of the talonavicular and talocalcaneal joints.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima, 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima, 770-8503, Japan.
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28
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Krahenbuhl N, Lenz AL, Lisonbee R, Peterson AC, Atkins PR, Hintermann B, Saltzman CL, Anderson AE, Barg A. Morphologic analysis of the subtalar joint using statistical shape modeling. J Orthop Res 2020; 38:2625-2633. [PMID: 32816337 PMCID: PMC8713294 DOI: 10.1002/jor.24831] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
Weightbearing computed tomography (WBCT) enables visualization of the foot and ankle as patients stand under load. Clinical measurements of WBCT images are generally limited to two-dimensions, which reduces the ability to quantify complex morphology of individual osseous structures as well as the alignment between two or more bones. The shape and orientation of the healthy/normal subtalar joint, in particular, is not well-understood, which makes it very difficult to diagnose subtalar pathoanatomy. Herein, we employed statistical shape modeling to evaluate three-dimensional (3D) shape variation, coverage, space, and congruency of the subtalar joint using WBCT data of 27 asymptomatic healthy individuals. The four most relevant findings were: (A) talar and calcaneal anatomical differences were found regarding the presence of (a) the talar posterior process, (b) calcaneal pitch, and (c) curvature of the calcaneal posterior facet; (B) the talar posterior facet articular surface area was significantly greater than the calcaneal posterior facet articular surface area; (C) the posterior facet varied in joint space distance, whereas the anteromedial facet was even; and (D) the posterior and anteromedial facet of the subtalar joint was consistently congruent. Despite considerable shape variation across the population, the posterior and anteromedial articular facets of the subtalar joint were consistently congruent. Results provide a detailed 3D analysis of the subtalar joint under a weightbearing condition in a healthy population which can be used for comparisons to pathological patient populations. The described SSM approach also shows promise for clinical evaluation of the subtalar joint from 3D surface reconstructions of WBCT images.
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Affiliation(s)
| | | | - Rich Lisonbee
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew C. Peterson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R. Atkins
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- 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
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29
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Sangeorzan BJ, Hintermann B, de Cesar Netto C, Day J, Deland JT, Ellis SJ, Johnson JE, Myerson MS, Schon LC, Thordarson DB. Progressive Collapsing Foot Deformity: Consensus on Goals for Operative Correction. Foot Ankle Int 2020; 41:1299-1302. [PMID: 32851848 DOI: 10.1177/1071100720950759] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
RECOMMENDATION In the treatment of progressive collapsing foot deformity (PCFD), the combination of bone shape, soft tissue failure, and host factors create a complex algorithm that may confound choices for operative treatment. Realignment and balancing are primary goals. There was consensus that preservation of joint motion is preferred when possible. This choice needs to be balanced with the need for performing joint-sacrificing procedures such as fusions to obtain and maintain correction. In addition, a patient's age and health status such as body mass index is important to consider. Although preservation of motion is important, it is secondary to a stable and properly aligned foot. LEVEL OF EVIDENCE Level V, consensus, expert opinion.
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Affiliation(s)
| | | | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | | | | | | | - Mark S Myerson
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lew C Schon
- Mercy Medical Center, Baltimore, MD, USA.,New York University Grossman School of Medicine, New York, NY, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,Georgetown School of Medicine, Washington, DC, USA
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30
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de Cesar Netto C, Myerson MS, Day J, Ellis SJ, Hintermann B, Johnson JE, Sangeorzan BJ, Schon LC, Thordarson DB, Deland JT. Consensus for the Use of Weightbearing CT in the Assessment of Progressive Collapsing Foot Deformity. Foot Ankle Int 2020; 41:1277-1282. [PMID: 32851880 DOI: 10.1177/1071100720950734] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
RECOMMENDATION There is evidence that the use of WEIGHTBEARING imaging aids in the assessment of progressive collapsing foot deformity (PCFD). The following WEIGHTBEARING conventional radiographs (CRs) are necessary in the assessment of PCFD patients: anteroposterior (AP) foot, AP or mortise ankle, and lateral foot. If available, a hindfoot alignment view is strongly recommended. If available, WEIGHTBEARING computed tomography (CT) is strongly recommended for surgical planning. When WEIGHTBEARING CT is obtained, important findings to be assessed are sinus tarsi impingement, subfibular impingement, increased valgus inclination of the posterior facet of the subtalar joint, and subluxation of the subtalar joint at the posterior and/or middle facet. LEVEL OF EVIDENCE Level V, consensus, expert opinion.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Mark S Myerson
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | | | | | - Lew C Schon
- Mercy Medical Center, Baltimore, MD, USA.,New York University Grossman School of Medicine, New York, NY, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,Georgetown School of Medicine, Washington, DC, USA
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31
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Hintermann B, Deland JT, de Cesar Netto C, Ellis SJ, Johnson JE, Myerson MS, Sangeorzan BJ, Thordarson DB, Schon LC. Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity. Foot Ankle Int 2020; 41:1295-1298. [PMID: 32851856 DOI: 10.1177/1071100720950738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
RECOMMENDATION Peritalar subluxation represents an important hindfoot component of progressive collapsing foot deformity, which can be associated with a breakdown of the medial longitudinal arch. It results in a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and pronation. Loss of peritalar stability allows the talus to rotate and translate on the calcaneal and navicular bone surfaces, typically moving medially and anteriorly, which may result in sinus tarsi and subfibular impingement. The onset of degenerative disease can manifest with stiffening of the subtalar (ST) joint and subsequent fixed and possibly arthritic deformity. While ST joint fusion may permit repositioning and stabilization of the talus on top of the calcaneus, it may not fully correct forefoot abduction and it does not correct forefoot varus. Such varus may be addressed by a talonavicular (TN) fusion or a plantar flexion osteotomy of the first ray, but, if too pronounced, it may be more effectively corrected with a naviculocuneiform (NC) fusion. The NC joint has a curvature in the sagittal plane. Thus, preserving the shape of the joint is the key to permitting plantarflexion correction by rotating the midfoot along the debrided surfaces and to fix it. Intraoperatively, care must be also taken to not overcorrect the talocalcaneal angle in the horizontal plane during the ST fusion (eg, to exceed the external rotation of the talus and inadvertently put the midfoot in a supinated position). Such overcorrection can lead to lateral column overload with persistent lateral midfoot pain and discomfort. A contraindication for an isolated ST fusion may be a rupture of posterior tibial tendon because of the resultant loss of the internal rotation force at the TN joint. In these cases, a flexor digitorum longus tendon transfer is added to the procedure. LEVEL OF EVIDENCE Level V, consensus, expert opinion.
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Affiliation(s)
| | | | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | | | - Mark S Myerson
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Lew C Schon
- Mercy Medical Center, Baltimore, MD, USA.,New York University Grossman School of Medicine, New York, NY, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,Georgetown School of Medicine, Washington, DC, USA
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32
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de Cesar Netto C, Silva T, Li S, Mansur NS, Auch E, Dibbern K, Femino JE, Baumfeld D. Assessment of Posterior and Middle Facet Subluxation of the Subtalar Joint in Progressive Flatfoot Deformity. Foot Ankle Int 2020; 41:1190-1197. [PMID: 32590925 DOI: 10.1177/1071100720936603] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adult acquired flatfoot deformity (AAFD) is a complex 3-dimensional pathology characterized by peritalar subluxation (PTS) of the hindfoot. For many years, PTS was measured at the posterior facet of the subtalar joint. More recently, subluxation of the middle facet has been proposed as a more accurate and reliable marker of symptomatic AAFD, enabling earlier detection. The objective of this study was to compare the amount of subluxation between the medial and posterior facets in patients with AAFD. METHODS In this institutional review board-approved retrospective comparative study, a total of 76 patients with AAFD (87 feet) who underwent standing weightbearing computed tomography (WBCT) as a standard baseline assessment of their foot deformity were analyzed. Two blinded fellowship-trained orthopedic foot and ankle surgeons with >10 years of experience measured subtalar joint subluxation (as a percentage of joint uncoverage) at the both posterior and middle facets. One of the readers also measured the foot and ankle offset (FAO). PTS measurements were performed at the sagittal midpoint of the articular facets using coronal plane WBCT images. Intra- and interobserver agreement was measured for PTS measurements using the intraclass correlation coefficient (ICC). The intermethod agreement between the posterior and middle facet subluxation was assessed using Spearman's correlation and bivariate analysis. Paired comparison of the measurements was performed using the Wilcoxon test. A multivariate analysis and a partition prediction model were used to assess influence of PTS measurements on FAO values. P values of <.05 were considered significant. RESULTS ICCs for intra- and interobserver reliabilities were 0.97 and 0.93, respectively, for posterior and 0.99 and 0.97, respectively, for middle facet subluxation. The intermethod Spearman's correlation between subluxation of the posterior and middle facets was measured at 0.61. In a bivariate analysis, both measurements were found to be significantly and linearly correlated (P < .0001; R2 = 0.42). Measurements of middle facet subluxation were found to be significantly higher than those for posterior facet subluxation, with a median difference (using the Hodges-Lehman factor) of 17.7% (P < .001; 95% CI, 10.9%-23.6%). We also found that for every 1% increase in posterior facet subluxation there was a corresponding 1.6-fold increase in middle facet subluxation. Only middle facet subluxation measurements were found to significantly influence FAO calculations (P = .003). The partition prediction model demonstrated that a middle facet subluxation value of 43.8% represented an important threshold for increased FAO. CONCLUSION This study is the first to compare WBCT measurements of subtalar joint subluxation at the posterior and middle facets as markers of PTS in patients with AAFD. We found a positive linear correlation between the measurements, with subluxation of the middle facet being significantly more pronounced than that of the posterior facet by an average of almost 18%. This suggests that middle facet subluxation may provide an earlier and more pronounced marker of progressive PTS in patients with AAFD. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Thiago Silva
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Hospital Madre Teresa, Orthopedics, Belo Horizonte, MG, Brazil
| | - Shuyuan Li
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Nacime Salomao Mansur
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Foot and Ankle Service, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Elijah Auch
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - John E Femino
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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33
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MacDonald A, Ciufo D, Vess E, Knapp E, Awad HA, Ketz JP, Flemister AS, Oh I. Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity. Foot Ankle Int 2020; 41:1149-1157. [PMID: 32495639 DOI: 10.1177/1071100720929004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adult acquired flatfoot deformity (AAFD) is a complex and progressive deformity involving the ligamentous structures of the medial peritalar joints. Recent anatomic studies demonstrated that the spring and deltoid ligaments form a greater medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial stability to the talonavicular, subtalar, and tibiotalar joints. The aim of this study was to assess the biomechanical effect of a spring ligament tear on the peritalar stability. The secondary aim was to assess the effect of TCNL reconstruction in restoration of peritalar stability in comparison with other medial stabilization procedures, anatomic spring or deltoid ligament reconstructions, in a cadaveric flatfoot model. METHODS Ten fresh-frozen cadaveric foot specimens were used. Reflective markers were mounted on the tibia, talus, navicular, calcaneus, and first metatarsal. Peritalar joint kinematics were captured by a multiple-camera motion capture system. Mild, moderate, and severe flatfoot models were created by sequential sectioning of medial capsuloligament complex followed by cyclic axial loading. Spring only, deltoid only, and combined deltoid-spring ligament (TCNL) reconstructions were performed. The relative kinematic changes were compared using 2-way analysis of variance (ANOVA). RESULTS Compared with the initial condition, we noted significantly increased valgus alignment of the subtalar joint of 5.1 ± 2.3 degrees (P = .031) and 5.8 ± 2.7 degrees (P < .01) with increased size of the spring ligament tear to create moderate to severe flatfoot, respectively. We noted an increased tibiotalar valgus angle of 5.1 ± 2.0 degrees (P = .03) in the severe model. Although all medial ligament reconstruction methods were able to correct forefoot abduction, the TCNL reconstruction was able to correct both the subtalar and tibiotalar valgus deformity (P = .04 and P = .02, respectively). CONCLUSION The TCNL complex provided stability to the talonavicular, subtalar, and tibiotalar joints. The combined deltoid-spring ligament (TCNL) reconstructions restored peritalar kinematics better than isolated spring or deltoid ligament reconstruction in the severe AAFD model. CLINICAL RELEVANCE The combined deltoid-spring ligament (TCNL) reconstruction maybe considered in advanced AAFD with medial peritalar instability: stage IIB with a large spring ligament tear or stage IV.
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Affiliation(s)
- Ashlee MacDonald
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - David Ciufo
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Vess
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Emma Knapp
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Hani A Awad
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - John P Ketz
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Adolph S Flemister
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Irvin Oh
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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Day J, Kim J, Conti MS, Williams N, Deland JT, Ellis SJ. Outcomes of Idiopathic Flexible Flatfoot Deformity Reconstruction in the Young Patient. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420937985. [PMID: 35097397 PMCID: PMC8697158 DOI: 10.1177/2473011420937985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Operative correction of flatfoot deformity has been well studied in the older population. There is a subset of younger patients without congenital foot deformity that also develop a collapsing flatfoot. However, assessment of outcomes across age groups is limited, especially in the young demographic. The purpose of our study was to compare operative outcomes of flatfoot reconstruction between these 2 age groups. Methods: Seventy-six feet (41 left, 35 right) in 71 patients who underwent flexible flatfoot reconstruction were divided into 2 groups based on age: ≤30 years (n = 22) and >30 years (n = 54). Exclusion criteria included congenital causes of flatfoot (tarsal coalition, vertical talus, overcorrected clubfoot). Average age was 20.8 years (range, 14-30) and 55.4 years (range, 35-74) in the younger and older cohorts, respectively. Preoperative and minimum 2-year postoperative Patient-Reported Outcomes Measurement Information Systems (PROMIS) scores were compared. Five radiographic parameters were assessed pre- and postoperatively: talonavicular coverage angle, lateral talo–first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, and hindfoot moment arm. Procedures performed and incidence of minor (removal of symptomatic hardware) and major (revision) reoperations were compared. Results: Younger patients were less likely to undergo flexor digitorum longus transfer, first tarsometatarsal fusion, spring ligament repair, and posterior tibial tendon repair (all P < .05). Both younger and older cohorts demonstrated significant improvement in multiple PROMIS domains at an average follow-up of 30.6 (range, 24-44) and 26.8 (range, 24-45) months, respectively ( P = .07). Younger patients demonstrated significantly higher pre- and postoperative Physical Function (mean difference postoperatively, 4.6; 95% confidence interval, 1.5-7.8; P = .03). There were no differences in radiographic parameters postoperatively. There were 8 (36.4%) reoperations (all minor) in the younger group, and 21 (38.9%) reoperations (6 major, 15 minor) in the older group ( P = .84). Conclusion: Our data suggest that age may play a role in clinical outcomes, procedures indicated, and subsequent corrective reoperations. Younger patients maintained greater physical function with comparable radiographic correction, with less frequent indication for tendon transfers, arthrodesis, and additional corrective surgeries. Level of Evidence: Level III, retrospective comparative study.
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de Cesar Netto C, Bang K, Mansur NS, Garfinkel JH, Bernasconi A, Lintz F, Deland JT, Ellis SJ. Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity. Foot Ankle Int 2020; 41:839-848. [PMID: 32441540 DOI: 10.1177/1071100720920274] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Semiautomatic 3-dimensional (3D) biometric weightbearing computed tomography (WBCT) tools have been shown to adequately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the foot and ankle offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD. METHODS In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20-86) years. 3D coordinates (x, y, and z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were assessed by 2 blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse planes were manually measured. RESULTS We found overall good to excellent intra- (range, 0.75-0.99) and interobserver (range, 0.73-0.99) reliability for manual AAFD measurements. FAO semiautomatic measurements demonstrated excellent intra- (0.99) and interobserver (0.99) reliabilities. Hindfoot moment arm (HMA) (P < .00001), subtalar horizontal angle (P < .00001), talonavicular coverage angle (P = .00004), and forefoot arch angle (P = .0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R2 value of 0.79. An HMA value of 19.8 mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8 mm and 14.6 when the HMA was equal to or higher than 19.8 mm. CONCLUSION We found that 3D WBCT semiautomatic measurements of FAO significantly correlated with some traditional markers of pronounced AAFD. Measurements of FAO were also found to be slightly more reliable than the manual measurements. The FAO offers a simple and more complete biomechanical and multiplanar assessment of the AAFD, representing in a single measurement the 3D components of the deformity. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Katrina Bang
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | | | | | - Francois Lintz
- Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| | - Jonathan T Deland
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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Intraobserver and interobserver reliability of cone beam weightbearing semi-automatic three-dimensional measurements in symptomatic pes cavovarus. Foot Ankle Surg 2020; 26:564-572. [PMID: 31378592 DOI: 10.1016/j.fas.2019.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/30/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Pes cavovarus is a three-dimensional (3D) foot deformity. New 3D semi-automatic measurements utilising weightbearing computerised topography (WBCT) images have recently been proposed to assess hindfoot alignment, but reliability in pes cavovarus has never been investigated. The aim of this study was to assess intraobserver and interobserver reliability of the foot ankle offset (FAO), calcaneal offset (CO) and hindfoot alignment angle (HAA) in pes cavovarus. METHODS Anonymised WBCT datasets from 51 feet (17 Charcot-Marie-Tooth related cavovarus, 17 idiopathic cavovarus and 17 controls) were retrospectively reviewed. Three observers (two senior foot and ankle fellows and one orthopaedic resident) independently measured FAO, CO and HAA using dedicated software, with measurements repeated two weeks apart. Subgroup analysis was performed to assess whether aetiology or severity of varus deformity and level of seniority affected reliability. RESULTS Mean values for intra and interobserver reliability for FAO (r=0.98; ICC: 0.99), CO (r=0.97; ICC: 0.98) and HAA measurements (r=0.97; ICC: 0.98) were excellent. Subgroup analyses showed that FAO, CO and HAA's intra (r/ρ range, 0.77-0.95) and interobserver (ICC range, 0.88-0.98) reliability remained excellent in patients with Charcot-Marie-Tooth related cavovarus, idiopathic pes cavovarus and normal feet, regardless of the severity of deformity. No difference was found in FAO, CO and HAA mean values from three observers (p>0.05 in all cases). DISCUSSION This study demonstrates that 3D semi-automatic measurements of WBCT images have excellent intra and interobserver reliability in the assessment of hindfoot alignment in pes cavovarus. Aetiology and severity of deformity, and level of seniority do not affect reliability of these measurements. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Kim H, Kipp K. Simulated anterior translation and medial rotation of the talus affect ankle joint contact forces during vertical hopping. Comput Methods Biomech Biomed Engin 2020; 23:484-490. [DOI: 10.1080/10255842.2020.1738405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hoon Kim
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Kristof Kipp
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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Tassone J, Violand M, Heigh EG, Hubbard C, Tien A, Shapiro J. Update on Investigation Methods for Lower Extremity Biomechanics. Clin Podiatr Med Surg 2020; 37:23-37. [PMID: 31735267 DOI: 10.1016/j.cpm.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Imaging with biomechanical analysis augments the clinical examination and improves outcomes by correlating imaging findings with the examination. Plain film radiographs are the gold standard to assess osseous alignment. The biomechanical examination provides information to formulate an accurate assessment. Weightbearing computed tomography scanning is a potentially valuable for functional information about joint biomechanics. True alignment of the lower extremity can be appreciated on weightbearing computed tomography scanning. Soft tissue structures can be assessed with diagnostic ultrasound examination. Acute and chronic injuries that compromise joint stability can be identified.
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Affiliation(s)
- John Tassone
- Arizona School of Podiatric Medicine, Glendale, AZ, USA; Private Practice, Summit Medical Group, Glendale, AZ, USA.
| | - Melanie Violand
- Arizona School of Podiatric Medicine, Midwestern University, Glendale, AZ, USA
| | - Evelyn G Heigh
- Arizona School of Podiatric Medicine, Glendale, AZ, USA; Private Practice, Summit Medical Group, 5620 West Thunderbird Road Suite G-2, Glendale, AZ 85306, USA
| | - Chandler Hubbard
- Podiatric Medicine and Surgery with Rearfoot Reconstruction and Ankle Certificate, Chino Valley Medical Center, 5451 Walnut Avenue, Chino, CA 91710, USA
| | - Audris Tien
- Podiatric Medicine and Surgery with Rearfoot Reconstruction and Ankle Certificate, Chino Valley Medical Center, 5451 Walnut Avenue, Chino, CA 91710, USA
| | - Jarrod Shapiro
- PMSR/RRA Podiatric Residency, Western University College of Podiatric Medicine, Chino Valley Medical Center, 309 East Second Street, Pomona, CA 91766, USA
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Conti MS, Garfinkel JH, Ellis SJ. Outcomes of Reconstruction of the Flexible Adult-acquired Flatfoot Deformity. Orthop Clin North Am 2020; 51:109-120. [PMID: 31739874 DOI: 10.1016/j.ocl.2019.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reconstruction of the flexible adult-acquired flatfoot deformity (AAFD) is controversial, and numerous procedures are frequently used in combination, including flexor digitorum longus transfer, medializing calcaneal osteotomy (MCO), heel cord lengthening/gastrocnemius recession, lateral column lengthening (LCL), Cotton osteotomy or first tarsometatarsal fusion, and spring ligament reconstruction. This article summarizes recent studies demonstrating that patients have significant improvements after operative treatment of flexible AAFD. It reviews current literature on clinical and radiographic outcomes of the MCO, LCL, and Cotton osteotomies. The authors describe how this information can be used in surgical decision making in order to tailor operative treatment to an individual patient's deformity.
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Affiliation(s)
- Matthew S Conti
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jonathan H Garfinkel
- Cedars-Sinai Medical Center, 444 S. San Vicente Boulevard, Suite 603, Los Angeles, CA 90048, USA
| | - Scott J Ellis
- Department of Orthopaedic Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Pilania K, Jankharia B, Monoot P. Role of the weight-bearing cone-beam CT in evaluation of flatfoot deformity. Indian J Radiol Imaging 2019; 29:364-371. [PMID: 31949337 PMCID: PMC6958891 DOI: 10.4103/ijri.ijri_288_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/12/2019] [Accepted: 10/08/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: Till date, weight-bearing radiographs have been the cornerstone for planning surgeries on flatfoot. The technique, however, has limitations due to the superimposition of the bones and the lack of reproducibility. Weight-bearing CT with its unique design overcomes these limitations and enables cross-sectional imaging of the foot to be done in the natural weight-bearing position. In this paper, we report our initial experience in weight-bearing cross-sectional imaging of the foot for assessment of flatfoot deformity. Materials and Methods: Around 19 known cases of flatfoot were scanned on the weight-bearing CT. Each foot was then assessed for the various angles and also for the presence/absence of extra-articular talocalcaneal impingement and subfibular impingement. Other associated abnormalities like secondary osteoarthritic changes, were also noted. Results: The Meary, as well as the calcaneal angles, were abnormal, in all but one separate foot. Forefoot abduction was seen in 7 of the 19 feet. The hind foot valgus angle was greater than 10° in all patients. Extra-articular talocalcaneal impingement was seen in 13 of 19 feet. Secondary osteoarthritic changes were seen in 14 feet. Conclusion: Weight-bearing CT scan is a very useful technique for evaluation of flatfoot and associated complications. It overcomes the limitations of the radiographs by providing multiplanar three-dimensional assessment of the foot in the natural weight-bearing position and at the same time being easily reproducible and consistent for the measurements around the foot. The definite advantage over the conventional cross-sectional scanners is the weight-bearing capability.
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Affiliation(s)
- Khushboo Pilania
- Department of Radiodiagnosis, Jankharia Imaging Centre, 383 S V P Road, Bhaveshwar Vihar, Mumbai, Maharashtra, India
| | - Bhavin Jankharia
- Department of Radiodiagnosis, Jankharia Imaging Centre, 383 S V P Road, Bhaveshwar Vihar, Mumbai, Maharashtra, India
| | - Pradeep Monoot
- Department of Orthopaedics, Breach Candy Hospital Trust, 60 A Bhulabhai Desai Road, Girgaon, Mumbai, Maharashtra, India.,Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Raja Rammohan Roy Rd, Prarthana Samaj, Khetwadi, Girgaon, Mumbai, Maharashtra, India
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de Cesar Netto C, Godoy-Santos AL, Saito GH, Lintz F, Siegler S, O'Malley MJ, Deland JT, Ellis SJ. Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity: A Case-Control Study. J Bone Joint Surg Am 2019; 101:1838-1844. [PMID: 31626008 DOI: 10.2106/jbjs.19.00073] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Progressive peritalar subluxation (PTS) is part of adult acquired flatfoot deformity (AAFD). We investigated the use of the middle facet as an indicator of PTS using standing, weight-bearing computed tomography (CT) images. We hypothesized that weight-bearing CT would be an accurate method of measuring increased subluxation ("uncoverage") and incongruence of the middle-facet among patients with AAFD. METHODS We included 30 patients with stage-II AAFD (20 female and 10 male; mean age, 57.4 years [range, 24 to 78 years]) and 30 matched controls (20 female and 10 male; mean age, 51.8 years [range, 19 to 81 years]) who underwent standing, weight-bearing CT. Two independent and blinded fellowship-trained foot and ankle surgeons measured the amount of subluxation (percentage of uncoverage) and the incongruence angle of the middle facet at the midpoint of its longitudinal length, using coronal-plane, weight-bearing, cone-beam CT images. Intraobserver and interobserver reliabilities were assessed using intraclass correlation coefficients (ICCs). Comparisons were performed using independent t tests or Wilcoxon tests. P values of <0.05 were considered significant. RESULTS Substantial to almost perfect intraobserver and interobserver reliability was observed for both measurements. We found that the middle facet demonstrated significantly increased PTS in patients with AAFD, with a mean value for joint uncoverage of 45.3% (95% confidence interval [CI], 38.5% to 52.1%) compared with 4.8% (95% CI, 3.2% to 6.4%) in controls (p < 0.0001). A significant difference was also found for the incongruence angle, with a mean value of 17.3° (95% CI, 14.7° to 19.9°) in the AAFD group and 0.3° (95% CI, 0.1° to 0.5°) in controls (p < 0.0001). A joint incongruence angle of >8.4° was found to be diagnostic for symptomatic stage-II AAFD. CONCLUSIONS We investigated the use of the middle facet of the subtalar joint as a marker for PTS in patients with AAFD. We confirmed that standing, weight-bearing CT images allowed accurate measurements and that significant differences were found in the percentage of joint uncoverage and the incongruence angle compared with controls. CLINICAL RELEVANCE The assessment of the amount of subluxation and incongruence of the middle facet of the subtalar joint represents an accurate diagnostic tool for symptomatic adult acquired flatfoot deformity.
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Affiliation(s)
- Cesar de Cesar Netto
- The Hospital for Special Surgery, New York, NY.,Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Alexandre Leme Godoy-Santos
- The Hospital for Special Surgery, New York, NY.,School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Lintz F, Bernasconi A, Baschet L, Fernando C, Mehdi N, de Cesar Netto C. Relationship Between Chronic Lateral Ankle Instability and Hindfoot Varus Using Weight-Bearing Cone Beam Computed Tomography. Foot Ankle Int 2019; 40:1175-1181. [PMID: 31253045 DOI: 10.1177/1071100719858309] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Varus hindfoot deformity may increase the risk of chronic lateral ankle instability (CLAI). Our aim was to analyze hindfoot alignment (HFA) in patients with CLAI using weight-bearing cone beam computed tomography (WBCT) to assess this risk. METHODS This retrospective, comparative analysis was carried out using an existing WBCT database (Talas, CurveBeam LLC), including data sets for 370 consecutive feet (189 patients) obtained between July 2016 and October 2018 at a single institution. The software provided semiautomated measurement of HFA, given as foot ankle offset (FAO). Univariate analysis was conducted to compare feet with and without CLAI against sex, age, body mass index, and FAO. Significant variables were included in a multivariable logistic model with random effects to take into account correlation between feet of the same patient. RESULTS Forty-three feet had CLAI (34 patients). FAO (P = .0009) was significant for CLAI by univariate analysis. Mean FAO was -2.2% ± 5.5% (varus) and + 2.6% ± 4.7% (valgus) with and without CLAI history, respectively. Multivariable logistic regression adjusted for sex and age demonstrated a 35% increased odds ratio (OR) of CLAI per 1% reduction in FAO value (varus) (adjusted OR=0.64, 95% confidence interval [CI]: 0.49-0.84; P = .001) and no significant effect of sex (adjusted OR=0.52; P = .617) or age (adjusted OR=0.94; P = .165) after adjustment for FAO. CONCLUSION A positive relationship was found between varus HFA and the risk to have CLAI. Systematic recording of FAO measurements from WBCT images along with clinical data regarding CLAI history proved successful at quantifying the risk of CLAI. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- François Lintz
- Ramsay Générale de Santé, Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.,Department of Public Health, Orthopaedic and Traumatology Unit, University of Napoli "Federico II," Napoli, Italy
| | - Louise Baschet
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Céline Fernando
- Ramsay Générale de Santé, Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| | - Nazim Mehdi
- Ramsay Générale de Santé, Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
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Influence of the ankle position and X-ray beam angulation on the projection of the posterior facet of the subtalar joint. Skeletal Radiol 2019; 48:1581-1589. [PMID: 31030252 DOI: 10.1007/s00256-019-03220-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Using digitally reconstructed radiographs (DRRs), we determined how changes in the projection angle influenced the assessment of the subtalar joint. MATERIALS AND METHODS Weightbearing computed tomography (CT) scans were acquired in 27 healthy individuals. CT scans were segmented and processed to create DRRs of the hindfoot. DRRs were obtained to represent 25 different perspectives to simulate internal rotation of the ankle with and without caudal angulation of the X-ray beam. Subtalar joint morphology was quantified by determining the joint space curvature, subtalar inclination angle (SIA), calcaneal slope (CS), and projection of the subtalar joint line on three-dimensional (3-D) reconstructions of the calcaneus. RESULTS The curvature of the projected joint space was altered substantially over the different DRR projections. Simulated caudal angulation of the X-ray beam with respect to the ankle decreased the SIA and CS significantly. Internal rotation also had a significant impact on the SIA and CS if the X-ray beam was in neutral or in 10° of caudal angulation. An antero-posterior (AP) view of the ankle showed the posterior area of the posterior facet, whereas a more anterior area was visible with internal rotation of the foot and caudal angulation of the X-ray beam. CONCLUSION Internal rotation of the foot of 20° is recommended to assess the posterior aspect of the posterior facet, whereas a combined 20° internal rotation of the foot and 40° caudal angulation of the X-ray beam is best to assess the anterior aspect of the posterior facet of the subtalar joint.
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AAFD: Conventional Radiographs are not Enough! I Need the Third Dimension. TECHNIQUES IN FOOT AND ANKLE SURGERY 2019. [DOI: 10.1097/btf.0000000000000234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Erard MAJUE, Sheean MAJAJ, Sangeorzan BJ. Triple Arthrodesis for Adult-Acquired Flatfoot Deformity. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419849609. [PMID: 35097328 PMCID: PMC8500395 DOI: 10.1177/2473011419849609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Originally described as a means to address fixed deformities or uncontrolled movement of the hindfoot observed in paralytic foot deformities, triple arthrodesis has evolved into a powerful procedure for the correction of a variety of foot deformities. Over the past decade, multiple advances have been made with respect to diagnostic imaging, fixation options, bone graft substitutes, and postoperative regimens. While this operation requires experience and skill to execute, when properly performed, it allows for correction of deformity and a plantigrade and ideally pain-free foot for ambulation. The purpose of this review is to highlight advances in the procedure and its application to the rigid planovalgus foot. Level of Evidence: Level V, review.
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Affiliation(s)
- MAJ Uma E. Erard
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - MAJ Andrew J. Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
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de Cesar Netto C, Shakoor D, Dein EJ, Zhang H, Thawait GK, Richter M, Ficke JR, Schon LC, Demehri S. Influence of investigator experience on reliability of adult acquired flatfoot deformity measurements using weightbearing computed tomography. Foot Ankle Surg 2019; 25:495-502. [PMID: 30321961 DOI: 10.1016/j.fas.2018.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/23/2018] [Accepted: 03/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our purpose was to assess the reliability of measurements of adult-acquired flatfoot deformity (AAFD) taken by investigators of different levels of clinical experience using weightbearing computed tomography (WBCT). METHODS Nineteen AAFD patients underwent WBCT. Three investigators with different levels of clinical experience made AAFD measurements in axial, coronal, and sagittal planes. Intra- and interobserver reliability were assessed. Mean values for each measurement were compared between investigators. RESULTS After a training protocol, substantial to perfect intra- and interobserver reliability was observed for most measures, regardless of the investigator's experience level. Significant differences between investigators were observed in 2 of 21 measured parameters: medial cuneiform-first metatarsal angle (P=0.003) and navicular-medial cuneiform angle (P=0.001). CONCLUSIONS AAFD radiographic measurements can be performed reliably by investigators with different levels of clinical experience using WBCT. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA; Department of Foot and Ankle Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA; Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Delaram Shakoor
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric J Dein
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanci Zhang
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Gaurav K Thawait
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martinus Richter
- Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Schwarzenbruck, Germany
| | - James R Ficke
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lew C Schon
- Department of Foot and Ankle Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Shadpour Demehri
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Brodell JD, MacDonald A, Perkins JA, Deland JT, Oh I. Deltoid-Spring Ligament Reconstruction in Adult Acquired Flatfoot Deformity With Medial Peritalar Instability. Foot Ankle Int 2019; 40:753-761. [PMID: 30902021 DOI: 10.1177/1071100719839176] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A spring ligament tear is commonly present in advanced stages of adult acquired flatfoot deformity (AAFD). Previous anatomic studies have demonstrated that the superficial deltoid ligament blends with the superomedial spring ligament, forming the tibiocalcaneonavicular ligament (TCNL). Adding allograft TCNL reconstruction to osseous correction has been suggested to augment medial peritalar stability in advanced AAFD with large spring ligament tears. We aimed to investigate the clinical and radiographic outcomes of TCNL reconstruction for flexible AAFD with medial peritalar instability. METHODS Fourteen feet in 12 patients who underwent osseous and TCNL reconstructions for advanced AAFD (stage IIB with large spring ligament tears or stage IV) were recruited for the study. The mean postoperative follow-up was 24 (range, 12-33) months. Pre- and postoperative clinical outcomes were assessed by the Foot and Ankle Ability Measure (FAAM), SF-36, and Patient-Reported Outcomes Measurement Information System (PROMIS). Correction of forefoot abduction and the sagittal arch were measured from pre- and postoperative weightbearing radiographs. RESULTS The FAAM Activities of Daily Living improved from 69.3 to 90.1 (P = .001). The SF-36 Physical Function (PF) and Pain subscales both improved significantly (39.4 to 87.8 and 44.6 to 93.1, respectively, P < .001 for each). The PROMIS PF improved from 38.2 to 46.8 (P = .002) and the PROMIS Pain Interference (PI) from 62.6 to 50.1 (P = .003). Radiographic measures showed an improved anterior-posterior (AP) talo-first metatarsal angle of 24.7 to 11.8 degrees (P < .001) and talonavicular coverage angle of 47.4 to 23.1 degrees (P < .01). An improved Meary's angle of 29.7 to 12.5 degrees (P < .001) and a calcaneal pitch angle of 11.7 to 16.9 degrees (P = .14) were noted in the lateral view. CONCLUSION Considering the anatomic characteristics of the deltoid-spring ligament complex, TCNL reconstruction may play a significant role in maintaining peritalar stability when performed with osseous correction. Deltoid-spring ligament (TCNL) reconstruction is a viable surgical option for those with advanced stage AAFD with medial peritalar instability that leads to improved functional and radiographic outcomes. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- James D Brodell
- 1 Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Ashlee MacDonald
- 1 Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
| | - James A Perkins
- 2 College of Health Sciences & Technology, Rochester Institute of Technology, Rochester, NY, USA
| | - Jonathan T Deland
- 3 Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Irvin Oh
- 1 Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA
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Classification and Morphological Parameters of the Calcaneal Talar Facet: Which Type Is More Likely to Cause Osteoarthritis in Chinese Population? BIOMED RESEARCH INTERNATIONAL 2019; 2019:6095315. [PMID: 31080826 PMCID: PMC6475557 DOI: 10.1155/2019/6095315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/13/2019] [Indexed: 12/02/2022]
Abstract
Due to the calcaneal osteoarthritis, patients had a lower quality of life. This research was to study which type of calcaneus was more likely to cause osteoarthritis and then to guide the clinical prevention and treatment in Chinese population. All 505 intact Chinese calcaneus facets were reconstructed by CT-3D reconstruction scanner and classified into five types based on the calcaneal talar facet (CTF) configuration. CTF's morphology parameters (osteophyte, cortical thickness of calcaneus, GIssane's and Bohler's angle, and long and short axis) were measured and recorded by PACS CT system. Researchers used the length of long and short axis to calculate the CTF area. By comparing the morphology parameters of five types of calcaneus, the differences among different types of calcaneus in Chinese people were statistically different. The study showed that Type II and Type IV had the highest percentage of osteophytes. After being compared and analyzed, the CTF pressure and the subtalar joint stability were closely related to the occurrence of osteoarthritis. Based on the measurement and comparison of morphological parameters in this study, Types II and IV were the most likely to develop osteoarthritis in Chinese population.
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Krähenbühl N, Siegler L, Deforth M, Zwicky L, Hintermann B, Knupp M. Subtalar joint alignment in ankle osteoarthritis. Foot Ankle Surg 2019; 25:143-149. [PMID: 29409290 DOI: 10.1016/j.fas.2017.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although it has been proposed that in mid-stage ankle osteoarthritis, the subtalar joint can compensate for deformities above the ankle joint, the evidence is weak. We thus investigated subtalar joint alignment in different stages of ankle osteoarthritis using weightbearing computed tomography (CT) scans. METHODS The subtalar joint of 88 patients with osteoarthritis of the ankle joint and a control group of 27 healthy volunteers were assessed. Subgroups were performed according to the ankle deformity (varus and valgus) and stage of ankle joint osteoarthritis. Subtalar joint alignment was assessed on weightbearing CT scans. RESULTS A more valgus subtalar joint alignment was found in patients with varus ankle osteoarthritis. No significant difference of the subtalar joint alignment was evident when comparing different stages of ankle osteoarthritis. CONCLUSIONS Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation does not correlate with the stage of ankle osteoarthritis.
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Affiliation(s)
- Nicola Krähenbühl
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland.
| | - Lena Siegler
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Manja Deforth
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lukas Zwicky
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Markus Knupp
- Mein Fuss Zentrum AG, Eichenstrasse 41, 4054 Basel, Switzerland
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50
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Kang DH, Kang C, Hwang DS, Song JH, Song SH. 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 2019; 25:215-220. [PMID: 29409280 DOI: 10.1016/j.fas.2017.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Full weightbearing (WB) three dimensional computed tomography (3D CT) is an excellent imaging tool. However, due to its high cost, it is only used in a few hospitals. We evaluated the usefulness and cost-effectiveness of axial loading (AL) 3D CT by comparing bony alignments with standing radiographs, and assessed reproducibility according to the degree of AL. METHODS Eighty patients (156 feet), who underwent standing radiographs and 3D CT with an AL device from January 2016 to May 2017, were investigated. According to the degree of AL (AL force×100/body weight), the patients were randomly assigned to three groups: Group A (30-50%; n=21, 40 feet), Group B (50-70%; n=32, 63 feet), and Group C (70-100%; n=27, 53 feet). The following angles were measured three times by two orthopedists: hallux valgus (HVA), 1st-2nd intermetatarsal (IMA1-2), and talo-navicular coverage (TNCA), calcaneal pitch (CPA), talo-1st metatarsal (T1MA), and talo-calcaneal angle (TCA). Agreements between the two imaging methods were analyzed and compared according to the degree of axial loading in each group. RESULTS Intra- and interobserver reliability was excellent (>0.75). In Group A (30-50% AL), all of the angles except HVA and IMA1-2 differed (p<.05). In Group B (50-70%), TNCA (p=.023), T1MA (p=.017), and TCA (p=.035) differed. In Group C (70-100%), none of the angles differed between the two imaging methods (p>.05). Higher agreement between the two imaging methods was realized when 70% or more(>70%) AL was applied. CONCLUSIONS AL 3D CT with >70% axial load has full WB effects and can be substituted for expensive full WB 3D CT.
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Affiliation(s)
- Dong Hun Kang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
| | - Deuk Soo Hwang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jae Hwang Song
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Seok Hwan Song
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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