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Cai Y, Zhao Z, Huang J, Yu Z, Jiang M, Kang S, Yuan X, Liu Y, Wu X, Ouyang J, Li W, Qian L. Morphological changes in flatfoot: a 3D analysis using weight-bearing CT scans. BMC Med Imaging 2024; 24:219. [PMID: 39160476 PMCID: PMC11331803 DOI: 10.1186/s12880-024-01396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Flatfoot is a condition resulting from complex three-dimensional (3D) morphological changes. Most Previous studies have been constrained by using two-dimensional radiographs and non-weight-bearing conditions. The deformity in flatfoot is associated with the 3D morphology of the bone. These morphological changes affect the force line conduction of the hindfoot/midfoot/forefoot, leading to further morphological alterations. Given that a two-dimensional plane axis overlooks the 3D structural information, it is essential to measure the 3D model of the entire foot in conjunction with the definition under the standing position. This study aims to analyze the morphological changes in flatfoot using 3D measurements from weight-bearing CT (WBCT). METHOD In this retrospective comparative our CT database was searched between 4-2021 and 3-2022. Following inclusion criteria were used: Patients were required to exhibit clinical symptoms suggestive of flatfoot, including painful swelling of the medial plantar area or abnormal gait, corroborated by clinical examination and confirmatory radiological findings on CT or MRI. Healthy participants were required to be free of any foot diseases or conditions affecting lower limb movement. After applying the exclusion criteria (Flatfoot with other foot diseases), CT scans (mean age = 20.9375, SD = 16.1) confirmed eligible for further analysis. The distance, angle in sagittal/transverse/coronal planes, and volume of the two groups were compared on reconstructed 3D models using the t-test. Logistic regression was used to identify flatfoot risk factors, which were then analyzed using receiver operating characteristic curves and nomogram. RESULT The flatfoot group exhibited significantly lower values for calcaneofibular distance (p = 0.001), sagittal and transverse calcaneal inclination angle (p < 0.001), medial column height (p < 0.001), sagittal talonavicular coverage angle (p < 0.001), and sagittal (p < 0.001) and transverse (p = 0.015) Hibb angle. In contrast, the sagittal lateral talocalcaneal angle (p = 0.013), sagittal (p < 0.001) and transverse (p = 0.004) talocalcaneal angle, transverse talonavicular coverage angle (p < 0.001), coronal Hibb angle (p < 0.001), and sagittal (p < 0.001) and transverse (p = 0.001) Meary's angle were significantly higher in the flatfoot group. The sagittal Hibb angle (B = - 0.379, OR = 0.684) and medial column height (B = - 0.990, OR = 0.372) were identified as significant risk factors for acquiring a flatfoot. CONCLUSION The findings validate the 3D spatial position alterations in flatfoot. These include the abduction of the forefoot and prolapse of the first metatarsal proximal, the arch collapsed, subluxation of the talonavicular joint in the midfoot, adduction and valgus of the calcaneus, adduction and plantar ward movement of the talus in the hindfoot, along with the first metatarsal's abduction and dorsiflexion in the forefoot.
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Affiliation(s)
- Yuchun Cai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhe Zhao
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, 518035, People's Republic of China
| | - Jianzhang Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhendong Yu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Manqi Jiang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shengjie Kang
- School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Xinghong Yuan
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yingying Liu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiaoliu Wu
- Radiologic Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, 518035, People's Republic of China
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual and Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Experimental Education Demonstration Center for Basic Medical Sciences (Southern Medical University) and National Key Discipline of Human Anatomy, Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.
| | - Wencui Li
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, 518035, People's Republic of China.
| | - Lei Qian
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) and National Experimental Education Demonstration Center for Basic Medical Sciences (Southern Medical University) and National Key Discipline of Human Anatomy., School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.
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Xu Y, Zhu Y, Cao Y, Chen G, Xu X. Does the Sagittal Radiographic Morphology of Subtalar Joint Affect the Alignment of Foot? Orthop Surg 2024; 16:1269-1276. [PMID: 38618706 PMCID: PMC11144509 DOI: 10.1111/os.14054] [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: 12/28/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVES The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot. METHODS From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X-rays. The angles in different groups were compared via Mann-Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated. RESULTS The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = -0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary's angle (r = -0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = -0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent. CONCLUSION A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity.
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Affiliation(s)
- Yang Xu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yuan Zhu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yong‐xing Cao
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Gang Chen
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiang‐yang Xu
- Department of orthopedicsShanghai Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
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Raes L, Peiffer M, Leenders T, Kvarda P, Ahn J, Audenaert E, Burssens A. Medializing Calcaneal Osteotomy for progressive collapsing foot deformity alters the three-dimensional subtalar joint alignment. Foot Ankle Surg 2024; 30:79-84. [PMID: 37802663 DOI: 10.1016/j.fas.2023.09.009] [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: 06/27/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND A medializing calcaneal osteotomy (MCO) is considered as one of the key inframalleolar osteotomies to correct progressive collapsing foot deformity (PCFD). While many studies were able to determine the post-operative hind- and midfoot alignment, alternations of the subtalar joint alignment remained obscured by superposition on plain radiography. Therefore, we aimed to assess the hind-, midfoot- and subtalar joint alignment pre- compared to post-operatively using 3D weightbearing CT (WBCT) imaging. METHODS Seventeen patients with a mean age of 42 ± 17 years were retrospectively analyzed. Inclusion criteria consisted of PCFD deformity corrected by a medializing calcaneal osteotomy (MCO) as main procedure and imaged by WBCT before and after surgery. Exclusion criteria were patients who had concomitant calcaneal lengthening osteotomies, mid-/hindfoot fusions, hindfoot coalitions, and supramalleolar procedures. Image data were used to generate 3D models and compute the hindfoot (HA), midfoot (MA) - and subtalar joint (STJ) alignment in the coronal, sagittal and axial plane, as well as distance maps. RESULTS Pre-operative measurements of the HA and MA improved significantly relative to their post-operative equivalents p < 0.05). The post-operative STJ alignment showed significant inversion (2.8° ± 1.7), abduction (1.5° ± 1.8), and dorsiflexion (2.3° ± 1.7) of the talus relative to the calcaneus (p < 0.05) compared to the pre-operative alignment. The displacement between the talus and calcaneus relative to the sinus tarsi increased significantly (0.6 mm±0.5; p < 0.05). CONCLUSION This study detected significant changes in the sagittal, coronal, and axial plane alignment of the subtalar joint, which corresponded to a decompression of the sinus tarsi. These findings contribute to our clinical practice by demonstrating the magnitude of alteration in the subtalar joint alignment that can be expected after PCFD correction with MCO as main procedure.
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Affiliation(s)
- Loïc Raes
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium
| | - Matthias Peiffer
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium; Foot and Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA
| | - Tim Leenders
- Department of Orthopaedics, AZ Monica Hospital, Florent Pauwelslei 21, 2100 Deurne, Antwerp, Belgium
| | - Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Jiyong Ahn
- Foot and Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Emmanuel Audenaert
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium
| | - Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium.
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Smolinski MP, Amadio J, Prisk V, Conti SF, Miller MC. A Comparison of Imaging Outcomes From 2 Weightbearing CT Modalities. Foot Ankle Int 2023; 44:1174-1180. [PMID: 37772818 DOI: 10.1177/10711007231198230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND The use of weightbearing images to diagnose foot and ankle injuries continues to offer hope for improved insight into pathologies, but weightbearing CT imaging has been limited by availability. The ability to apply force to the lower limb in a horizontal bore CT system may offer an adaptation to currently available imaging systems that provides access to weightbearing images without the acquisition of additional expensive imaging space or equipment. METHODS In order to determine whether a horizontal CT system could produce the same results as a standing CT, 3 images of one foot from 10 subjects was obtained and standard measures were calculated. Each subject underwent a standing CT scan, a scan in a horizontal bore CT machine while the subject pressed against a pedal with spring resistance and a finally a scan with the foot placed on the pedal but without any pressure. RESULTS No statistically significant difference between the standing and pedal-based CTs resulted. Navicular height and Meary angle (axial) were statistically different from nonweightbearing for both standing and horizontal systems. The horizontal results were statistically different from nonweightbearing in IM angle, talocalcaneal angle, and talonavicular coverage. No differences from nonweightbearing were found for either system in talar tilt, talocrural angle, or the lateral Meary angle. CONCLUSION The results in this initial study of normal control subjects suggest that a pedal-based loading mechanism may adapt a horizontal-bore CT system for the acquisition of weightbearing images. CLINICAL RELEVANCE The ability to acquire a weightbearing CT from a horizontal bore CT machine can make these images more available.
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Affiliation(s)
| | | | - Victor Prisk
- Prisk Orthopaedics and Wellness, Pittsburgh, PA, USA
| | | | - Mark Carl Miller
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
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Buzzatti L, Keelson B, van der Voort JW, Segato L, Scheerlinck T, Héréus S, Van Gompel G, Vandemeulebroucke J, De Mey J, Buls N, Cattrysse E, Serrien B. Dynamic CT scanning of the knee: Combining weight bearing with real-time motion acquisition. Knee 2023; 44:130-141. [PMID: 37597475 DOI: 10.1016/j.knee.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Imaging the lower limb during weight-bearing conditions is essential to acquire advanced functional joint information. The horizontal bed position of CT systems however hinders this process. The purpose of this study was to validate and test a device to simulate realistic knee weight-bearing motion in a horizontal position during dynamic CT acquisition and process the acquired images. METHODS "Orthostatic squats" was compared to "Horizontal squats" on a device with loads between 35% and 55% of the body weight (%BW) in 20 healthy volunteers. Intraclass Correlation Coefficient (ICC), and standard error of measurement (SEM), were computed as measures of the reliability of curve kinematic and surface EMG (sEMG) data. Afterwards, the device was tested during dynamic CT acquisitions on three healthy volunteers and three patients with patellofemoral pain syndrome. The respective images were processed to extract Tibial-Tuberosity Trochlear-Groove distance, Bisect Offset and Lateral Patellar Tilt metrics. RESULTS For sEMG, the highest average ICCs (SEM) of 0.80 (6.9), was found for the load corresponding to 42%BW. Kinematic analysis showed ICCs were the highest for loads of 42%BW during the eccentric phase (0.79-0.87) and from maximum flexion back to 20° (0.76). The device proved to be safe and reliable during the acquisition of dynamic CT images and the three metrics were computed, showing preliminary differences between healthy and pathological participants. CONCLUSIONS This device could simulate orthostatic squats in a horizontal position with good reliability. It also successfully provided dynamic CT scan images and kinematic parameters of healthy and pathological knees during weight-bearing movement.
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Affiliation(s)
- Luca Buzzatti
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium; School of Allied Health, Anglia Ruskin University (ARU), Young Street, CB1 1PT Cambridge, UK.
| | - Benyameen Keelson
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Joris Willem van der Voort
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Lorenzo Segato
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
| | - Thierry Scheerlinck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedic Surgery and Traumatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Savanah Héréus
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Gert Van Gompel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jef Vandemeulebroucke
- Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Johan De Mey
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Nico Buls
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erik Cattrysse
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ben Serrien
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
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Siegler S, Piarulli L, Stolle J. Definitions and Measurements of Hindfoot Alignment and Their Biomechanical and Clinical Implications. Foot Ankle Clin 2023; 28:115-128. [PMID: 36822681 DOI: 10.1016/j.fcl.2022.11.002] [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: 01/03/2023]
Abstract
This article presents a critical review of the past and the current state of the art in defining and measuring hindfoot, ankle, and subtalar alignment. It describes the transition occurring at present from two-dimensional to three-dimensional (3D) alignment measurements, which accompany the emergence of new, functional, high-resolution imaging modalities such as the weight-bearing cone-beam computerized tomography (CT) imaging. To ease and enhance the transition and acceptability of 3D alignment measurements, new acceptable standards for different clinical application are highly desirable.
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Affiliation(s)
- Sorin Siegler
- Department of Mechanical Engineering, Drexel University, 3141 Chestnut Street, Philadelphia, PA, USA.
| | - Luigi Piarulli
- Department of Mechanical Engineering, Drexel University, 3141 Chestnut Street, Philadelphia, PA, USA
| | - Jordan Stolle
- Department of Mechanical Engineering, Drexel University, 3141 Chestnut Street, Philadelphia, PA, USA
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Deng Z, Cai Z, Chen S, Liu Y, Chen F, Deng Z, Li Y, Xu J. Comparison of in vivo hindfoot joints motion changes during stance phase between non-flatfoot and stage II adult acquired flatfoot. J Foot Ankle Res 2022; 15:74. [PMID: 36229819 PMCID: PMC9559000 DOI: 10.1186/s13047-022-00577-w] [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: 02/26/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the kinematic characteristics of hindfoot joints in stage II adult acquired flatfoot deformity (AAFD) with those of non-flatfoot through the 3D-to-2D registration technology and single fluoroscopic imaging system. METHODS Eight volunteers with stage II AAFD and seven volunteers without stage II AAFD were recruited and CT scans were performed bilateral for both groups in neutral positions. Their lateral dynamic X-ray data during the stance phase, including 14 non-flatfeet and 10 flatfeet, was collected. A computer-aided simulated light source for 3D CT model was applied to obtain the virtual images, which were matched with the dynamic X-ray images to register in the "Fluo" software, so that the spatial changes during the stance phase could be calculated. RESULTS During the early-stance phase, the calcaneous was more dorsiflexed, everted, and externally-rotated relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). During the mid-stance phase, the calcaneous was more dorsiflexed and everted relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05); however, the rotation did not differ significantly between the two groups (p > 0.05). During the late-stance phase, the calcaneous was more plantarflexed, but less inverted and internally-rotated, relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). During the early- and mid-stance phase, the navicular was more dorsiflexed, everted, and externally-rotated relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). During the late-stance phase, the navicular was more plantarflexed, but less inverted and internally-rotated, relative to the talus in flatfoot compared with that in non-flatfoot (p < 0.05). There was no difference in the motion of cuboid between the two groups during the whole stance phase (p > 0.05). CONCLUSIONS During the early- and mid-stance phase, excessive motion was observed in the subtalar and talonavicular joints in stage II AAFD. During the late-stance phase, the motion of subtalar and talonavicular joints appeared to be in the dysfunction state. The current study helps better understanding the biomechanics of the hindfoot during non-flatfoot and flatfoot condition which is critical to the intervention to the AAFD using conservative treatment such as insole or surgical treatment for joint hypermotion.
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Affiliation(s)
- Zhenhan Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Zijun Cai
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siyu Chen
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yan Liu
- Department of Critical Care Medicine and Infection Prevention and Control, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Fanglin Chen
- Department of Orthopedics, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Liuzhou, 545000, Guangxi, China
| | - Zhiqin Deng
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Xu
- Department of Orthopedics, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker's Hospital, Liuzhou, 545000, Guangxi, China. .,Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
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Richter M, Duerr F, Schilke R, Zech S, Meissner SA, Naef I. Semi-automatic software-based 3D-angular measurement for Weight-Bearing CT (WBCT) in the foot provides different angles than measurement by hand. Foot Ankle Surg 2022; 28:919-927. [PMID: 35065853 DOI: 10.1016/j.fas.2022.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to compare semi-automatic software-based angular measurement (SAM) with previously validated measurement by hand (MBH) regarding angle values and time spent for the investigator for Weight-Bearing CT (WBCT). METHODS In this retrospective comparative study, five-hundred bilateral WBCT scans (PedCAT, Curvebeam, Warrington, PA, USA) were included in the study. Five angles (1st - 2nd intermetatarsal angle (IM), talo-metatarsal 1-angle (TMT) dorsoplantar and lateral projection, hindfoot angle, calcaneal pitch angle) were measured with MBH and SAM (Bonelogic Ortho Foot and Ankle, Version 1.0.0-R, Disior Ltd, Helsinki, Finland) on the right/left foot/ankle. The angles and time spent of MBH and SAM were compared (t-test, homoscesdatic). RESULTS The angles differed between MBH and SAM (mean values MBH/SAM; IM, 9.1/13.0; TMT dorsoplantar, -3.4/8.2; TMT lateral. -6.4/-1.1; hindfoot angle, 4.6/21.6; calcaneal pitch angle, 20.5/20.1; each p < 0.001 except the calcaneal pitch angle, p = 0.35). The time spent for MBH / SAM was 44.5 ± 12 s / 12 ± 0 s on average per angle (p < 0.001). CONCLUSIONS SAM provided different angles as MBH (except calcaneal pitch angle) and can currently not be considered as validated angle measurement method (except calcaneal pitch angle). The investigator time spent is 73% lower for SAM (12 s per angle) than for MBH (44.5 s per angle). SAM might be an important step forward for 3D-angle measurement of WBCT when valid angles are provided.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Fabian Duerr
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Regina Schilke
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | | | - Issam Naef
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
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Kimura T, Thorhauer ED, Kindig MW, Sangeorzan BJ, Ledoux WR. Evaluation of the Foot Arch in Partial Weightbearing Conditions. Foot Ankle Int 2022; 43:113-122. [PMID: 34404272 DOI: 10.1177/10711007211034804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Weightbearing plain radiography or computed tomography (CT) is used for diagnosis or treatment selection in foot disorders. This study compared foot alignment between full weightbearing (50% body weight [BW] per foot) plain radiography and nonweightbearing (0% BW) or partial weightbearing (10% BW per foot) CT scans. METHODS Subjects had both full (50% BW per foot) weightbearing plain radiographs and either a nonweightbearing (0% BW) or a partial weightbearing (20% BW or 10% BW per foot) CT scan. Feet (n = 89) had been previously classified as pes cavus (n = 14/17 [subjects/feet]), neutrally aligned (NA; 20/30), asymptomatic pes planus (APP; 18/24), and symptomatic pes planus (SPP; 15/18). Lateral talometatarsal angle (LTMA) and calcaneal pitch angle were compared between weightbearing radiography and maximum-intensity projection images generated from CT. RESULTS Significant differences in LTMA were found between nonweightbearing CT scans and full (50% BW per foot) weightbearing plain radiographs: the mean difference was 6.6 degrees in NA, 9.2 degrees in APP, and 11.3 degrees in SPP (P < .0001); no significant difference in LTMA was found for pes cavus. Although the interaction of foot type (P = .084) approached statistical significance, pairwise differences between 10% weightbearing and 50% weightbearing images by foot type were significant but small. The 50% weightbearing condition resulted in calcaneal pitch angles the same or slightly lower or higher than those of the 10% weightbearing and nonweightbearing images. LTMA and calcaneal pitch angle measurements made on full (50% BW per foot) weightbearing plain radiographs and non- (0%) or partial (10% BW per foot) weightbearing angles from CT scans were strongly correlated. CONCLUSION Different foot types have similar 2-dimensional sagittal plane morphologies with partial weightbearing (10% BW per foot) CT scans and, to a lesser degree, nonweightbearing (0%) neutral-position CT scans when compared to full weightbearing (50% BW per foot) plain radiographs. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Tadashi Kimura
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.,Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eric D Thorhauer
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Matthew W Kindig
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Bruce J Sangeorzan
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - William R Ledoux
- RR&D Center for Limb Loss and MoBility, (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.,Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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10
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Ferràs-Tarragó J, Grau-Llopis E, Navarrete-Faubel E, Sánchez-González M, Vicent-Carsí V. An Innovative Weightbearing Device for Weightbearing 3-Dimensional Imaging for Foot and Ankle Surgery Preoperative Planning. J Foot Ankle Surg 2021; 60:1124-1130. [PMID: 34024677 DOI: 10.1053/j.jfas.2020.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023]
Abstract
Three-dimensional preoperative planning has demonstrated multiple surgical advantages. Currently, we cannot carry out preoperative 3-dimensional planning of foot and ankle orthopedics in most hospitals due to the impossibility of performing weightbearing CT imaging. Our objective is to describe and evaluate an innovative accessible, simple, and effective device that simulates standing while in a supine position, to obtain 3-dimensional images supporting bodyweight load with a conventional CT machine. From a group of 30 volunteers, 10 patients were randomly selected and pressure and its distribution were analyzed while in a standing position in both feet. Differences between both feet were considered normal intrapersonal variability. Subsequently, the right footprint of the same 10 subjects was evaluated in the proposed loading device. Then, their pressures and distribution were compared with respect to standing and with respect to intrapersonal variability. The mean total standing pressure was 93 Kpa (standard deviation [SD] 14.32), which was reduced to 81.95 Kpa (SD 19.54) in the loading device. The load device reduced the pressure by a mean of16% (SD 22% (range -25% to -0.03%). At the hindfoot level, the loading device increased pressure by a mean of 20.59 Kpa, which expressed percentage implies an increase of 14% compared to standing. Due to its easy construction and effectiveness, this is the first device that opens the door of foot and ankle orthopedics in any hospital to 3D preoperative planning and the benefits derived from it.
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11
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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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12
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Zhang YJ, Long X, Du JY, Liu T, Lin XJ. Effect of soft inflatable orthosis on the medial longitudinal arch in patients with flexible flatfoot deformity. Clin Biomech (Bristol, Avon) 2021; 88:105418. [PMID: 34216988 DOI: 10.1016/j.clinbiomech.2021.105418] [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: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthoses can stabilize the foot and restore the medial longitudinal arch for symptomatic flexible flatfoot. However, the effectiveness of orthoses remains controversial. The purpose of this study was to evaluate effectiveness of a customized soft inflatable orthosis on the medial longitudinal arch of flexible flatfoot patients under load. METHODS We obtained CT scans of the feet of 14 healthy volunteers and 14 patients with flexible flatfoot under non- and simulated weight-bearing conditions. Then CT scans under the same conditions were taken for patients with flexible flatfoot equipped with soft inflatable orthosis. Three-dimensional models of the medial longitudinal arch and hindfoot were constructed from CT images. The three-dimensional mobility of the medial longitudinal arch joints under load was compared between patients with flexible flatfoot equipped with soft inflatable orthosis or not. FINDINGS From non- to simulated weight-bearing condition, the eversion and dorsiflexion of the talocalcaneal joint, the eversion of the talonavicular joint, the abduction and dorsiflexion of the cuneonavicular joint, and the dorsiflexion of the first tarsometatarsal joint were significantly larger in patients with flexible flatfoot than healthy volunteers. The customized soft inflatable orthosis could reduce the eversion of the talonavicular joint and the eversion and dorsiflexion of the talocalcaneal joint. INTERPRETATION The soft inflatable orthosis is effective to improve medial longitudinal arch height and reduce excessive mobility of joints for flexible flatfoot deformity. The results of this study could provide evidence for the optimal orthosis design to treat flexible flatfoot in the future.
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Affiliation(s)
- Yi-Jun Zhang
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China.
| | - Xiao Long
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
| | - Jing-Yu Du
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
| | - Tao Liu
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University School of Mechanical Engineering, Hangzhou 310027, PR China.
| | - Xiang-Jin Lin
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
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13
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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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14
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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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15
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KIM GEON, JUNG JIHEE, CHA YOUNGJOO, YOU JOSHUA(SUNGH. BIOMECHANICAL EFFECTS OF HYPERPRONATION ON MULTIDIRECTIONAL ANKLE ANGULAR DISPLACEMENT AND STIFFNESS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hyperpronation of the foot is believed to contribute to ankle hypermobility and associated stiffness reduction, but the underlying biomechanical mechanisms remain unknown. This study aimsed to investigate multidirectional ankle displacement and associated stiffness when a posterior–anterior impact force was applied to the posterior knee compartment. Forty healthy adults with and without foot hyperpronation were recruited. A three-dimensional motion capture system and force plates were used to acquire angular displacement and ankle joint moment data. The independent [Formula: see text]-test and Mann–Whitney [Formula: see text] test were used to compare the group differences in ankle angular displacement, moment, and stiffness. Spearman’s rho test was performed to determine the relationship between ankle angular displacement and stiffness. The hyperpronation group demonstrated significantly greater sagittal ([Formula: see text]) and frontal plane ([Formula: see text]) angular displacements and reduced sagittal plane ankle stiffness ([Formula: see text]) than the neutral group. The Spearman’s correlation analysis showed a close inverse relationship between the ankle angular displacement and stiffness, ranging from [Formula: see text] to [Formula: see text]. The biomechanical data in our study suggest that individuals with foot hyperpronation present with multidirectional hypermobility and a reduction in ankle stiffness. These factors contribute to an increased risk of ankle-foot injury in individuals with foot hyperpronation.
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Affiliation(s)
- GEON KIM
- Department of Physical Therapy, Yonsei University, Wonju City, Kangwon-do, Republic of South Korea
| | - JIHEE JUNG
- Department of Obstetrics and Gynecology, Seoul Samsung Hospital, Seoul City, Republic of South Korea
| | - YOUNGJOO CHA
- Department of Physical Therapy, Cheju Halla University, 38, Halladaehak-ro, Jeju-si, Jeju-do, Republic of South Korea
| | - JOSHUA (SUNG) H. YOU
- Sports Movement Artificial-Intelligence Robotics Technology (SMRAR) Institute, Department of Physical Therapy, Yonsei University, Wonju City, Republic of South Korea
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16
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Abstract
Weight-bearing CT (WBCT) scans of the foot and ankle have improved the understanding of deformities that are not easily identified on radiographs and are increasingly being used by orthopaedic surgeons for diagnostic and preoperative planning purposes. In contrast to standard CT scans, WBCT scans better demonstrate the true orientation of the bones and joints during loading. They have been especially useful in investigating the alignment of complex pathologies such as adult-acquired flatfoot deformity in which patients have been found to have a more valgus subtalar joint alignment than in a normal cohort and high rates of subfibular impingement. Studies using WBCT scans have also provided new insight into more common lower extremity conditions such as hallux valgus, ankle fractures, and lateral ankle instability. WBCT scans have allowed researchers to investigate pronation of the first metatarsal in patients with hallux valgus compared with normal feet, and patients with lateral ankle instability have been found to have more heel varus than healthy control subjects. Understanding the application of WBCT scans to clinical practice is becoming more important as surgeons strive for improved outcomes in the treatment of complicated foot and ankle disorders.
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Affiliation(s)
- Matthew S Conti
- From the Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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17
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Wang S, Yu J, Ma X, Zhao D, Geng X, Huang J, Wang X. Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw. J Orthop Surg Res 2020; 15:252. [PMID: 32650836 PMCID: PMC7350182 DOI: 10.1186/s13018-020-01767-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Arthroscopic ankle arthrodesis (AAA) is a standard surgical method for the treatment of advanced traumatic ankle arthritis and has become more popular due to its advantages. To fix the tibiotalar joint, the use of three percutaneous screws is considered to have better mechanical stability than the use of two screws. However, it is sometimes difficult to insert three screws because they might block each other due to the small area of the tibiotalar joint surface and the large diameter of the screws; few articles illustrate how to insert three screws without the screws disturbing each other. The purpose of this study is to explore possible screw configurations of tripod fixation in arthroscopic ankle arthrodesis that avoid the collision of screws and yield better biomechanical performance. Methods We used the finite element method to examine the impact of different screw positions and orientations on the biomechanical characteristics of a three-dimensional (3D) ankle model. Maximum and average micromotion, pressure on the articular surface, and von Mises stress values of the tibia and the talus were used to evaluate the initial stability of the ankle. Results Five kinds of three-screw configurations were identified, and finite element analysis results suggested that configurations with the posteromedial home-run screw presented lower micromotion (maximum, 17.96 ± 7.49 μm versus 22.52 ± 12.8 μm; mean, 4.88 ± 1.89 μm versus 5.19 ± 1.92 μm) (especially configuration 3) and better screw distributions on the articular surface than those with the posterolateral home-run screw. Conclusion Screw configurations with the posteromedial home-run screw avoid collision and are more biomechanically stable than those with the posterolateral home-run screw. Thus, inserting the home-run screw through the posteromedial approach is recommended for clinical practice.
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Affiliation(s)
- Sen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Jian Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Dahang Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiang Geng
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
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18
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Richter M, Lintz F, de Cesar Netto C, Barg A, Burssens A. Results of more than 11,000 scans with weightbearing CT - Impact on costs, radiation exposure, and procedure time. Foot Ankle Surg 2020; 26:518-522. [PMID: 31239196 DOI: 10.1016/j.fas.2019.05.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weightbearing CT (WBCT) has been proven to more precisely measure bone position than conventional weightbearing radiographic series (R) and conventional CT (CT). The purpose of this study was to assess the benefit of using WBCT instead of R and/or CT as the standard imaging modality, evaluating image acquisition time, radiation dose, and cost-effectiveness. METHODS All patients who obtained a WBCT as part of standard of care from July 1, 2013 until March 15, 2019 were included in the study. Image acquisition time (T), radiation dose (RD) per patient, and cost-effectiveness were analyzed and compared between the time period using WBCT (yearly average) and the parameters from 2012, i.e. before the availability of WBCT (RCT group). RESULTS 11,009 WBCT scans were obtained from 4987 patients (4,987 scans (45%) before treatment; 6,022 scans (55%) at follow-up). On a yearly average, 1,957 WBCTs (bilateral scans) and an additional 10.6 CTs (bilateral feet and ankles) were obtained (WBCT group). In 2012, 1,850 Rs (bilateral feet, dorsoplantar and lateral, metatarsal head skyline view) and 254 CTs were obtained from 885 patients (RCT group). The mean yearly RD was 4.3/4.8uSv for the WBCT/RCT groups (mean difference of .5uSv; a decrease of 10% for the WBCT group; p<.01). Yearly mean T was 114/493h in total (3.3/16.0min per patient) for WBCT/RCT groups (mean difference of 379h; a 77% decrease for the WBCT group; p<.01). Yearly cost-effectiveness was a mean profit of 43,959/-723 Euros for WBCT/RCT groups. CONCLUSIONS 11,009 WBCT scans from 4,987 patients over a period of 5.6 years at a foot and ankle department resulted in 10% decreased RD, 77% decreased T, and increased financial profit (51 Euros per patient) for the institution.
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Affiliation(s)
- Martinus Richter
- International Weight-Bearing CT Society, Gent, Belgium; Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Francois Lintz
- International Weight-Bearing CT Society, Gent, Belgium; Clinique de l'Union, Foot and Ankle Surgery Centre, Toulouse, France
| | - Cesar de Cesar Netto
- International Weight-Bearing CT Society, Gent, Belgium; Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Alexej Barg
- International Weight-Bearing CT Society, Gent, Belgium; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Arne Burssens
- International Weight-Bearing CT Society, Gent, Belgium; Department of Orthopaedics and Traumatology, University Hospital of Ghent, Gent, Belgium
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19
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Fadle AA, Campbell BC, Willett JF, Williams L, Conti SF, Miller MC. A simple foot pedal device in a horizontal bore imaging facility replicates weightbearing outcomes for Hallux Valgus patients. Foot Ankle Surg 2020; 26:320-324. [PMID: 31079958 DOI: 10.1016/j.fas.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weightbearing images are important to the diagnosis of foot pathologies as are the three dimensional views available from CT and MRI. Standard three-dimensional imaging hardware, however, does not have a simple tool to obtain weightbearing images. The current research aimed to design, build and test a simple device to apply load in a horizontal bore imaging facility. METHODS With the immediate need in hallux valgus studies, hallux valgus subjects were imaged using the new loading device, which could be easily transported and had no additional electronics. RESULTS Testing showed that the usual angular measures of the foot (intermetatarsal and hallux valgus) replicated the results from the standard of care standing plain film results. With application of load, HV angle changed from 29.9° non-weightbearing to 32.2° weightbearing, while IM angle changed from nonweightbearing 15.8° to weightbearing 16.5°. CONCLUSION The pedal-like device can provide weightbearing images in a horizontal bore MRI facility.
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Affiliation(s)
- Amr A Fadle
- Assiut University, Orthpaedic Department, Assiut, Egypt
| | - B C Campbell
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - J F Willett
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - L Williams
- Department of Radiology, Passavant Hospital, Pittsburgh PA, USA
| | - S F Conti
- Orthopedic Partners, Pittsburgh PA, USA
| | - M C Miller
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Orthopaedic Biomechanics Laboratory, Allegheny General Hospital, Pittsburgh, PA, USA.
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20
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Nozaki S, Watanabe K, Kamiya T, Katayose M, Ogihara N. Sex- and age-related morphological variations in the talar articular surfaces of the calcaneus. Ann Anat 2020; 229:151468. [PMID: 31972272 DOI: 10.1016/j.aanat.2020.151468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/23/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of foot pathologies, such as flatfoot deformity and hallux valgus, is higher in women and increases with age. It has been reported that these types of foot disorders may also be linked to excessive mobility of the subtalar joint to the eversion direction during weight bearing. Given that the mobility of the joint is determined by its articular morphology, sex- and age-related variations in the subtalar articular surface morphology are possible. The purpose of this study was to investigate the orientation and the curvature radii of the talar articular facets of the calcaneus in relation to age and sex using three-dimensional computer tomography. METHODS Fifty-six feet without subtalar injuries or disorders were included in this study. The orientations of the talar articular surfaces of the calcaneus were quantified in the sagittal and coronal planes. The curvature radii of the articular surfaces of the calcaneus were also assessed based on the approximations of the sphere surfaces. RESULTS The talar articular surface was oriented more anteriorly and medially in the females than in the males. The curvature radius of the calcaneal posterior facet in the females exhibited a positive correlation with age, indicative of increased articular surface flattening. CONCLUSIONS The morphological features of the female calcaneus could induce excessive eversion and could lead to a higher prevalence of foot disorders, including flatfoot and hallux valgus, in elderly females. This study contributes to an understanding of the sexual dimorphism of the articular surfaces of the calcaneus and provides insight into the mechanisms that underline various foot disorders.
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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, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan; Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda, Tokyo, 102-0083, Japan.
| | - Kota Watanabe
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, South-1, West-17, Chu-Ou-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Tomoaki Kamiya
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, South-1, West-16, Chu-Ou-Ku, Sapporo, Hokkaido, 060-8556, Japan; Center of Sports Medicine, Hokkaido Obihiro Kyokai Hospital, South-9, East-5, Obihiro, Hokkaido, 080-0805, Japan
| | - Masaki Katayose
- Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, South-1, West-17, Chu-Ou-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Naomichi Ogihara
- Laboratory of Human Evolutionary Biomechanics, Department of Biological Sciences, Graduate School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan
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21
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Bresnahan PJ, Juanto MA. Pediatric Flatfeet-A Disease Entity That Demands Greater Attention and Treatment. Front Pediatr 2020; 8:19. [PMID: 32117826 PMCID: PMC7026255 DOI: 10.3389/fped.2020.00019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/14/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Pediatric flatfoot is a common deformity. Unfortunately, the common opinion has been that most children with this faulty foot structure will simply out-grow it, despite no radiographic evidence to support this claim. Every step on a deformed foot leads to excessive tissue strain and further joint damage. Many forms of conservative and surgical treatments have been offered. This study was aimed at investigating the effectiveness of non-surgical and surgical treatment options. Main Text: faulty-foot structure is the leading cause of many secondary orthopedic deformities. A wide range of treatments for pediatric flatfeet have been recommended from the "do-nothing" approach, observation, to irreversible reconstructive surgery. Most forms of conservative care lack evidence of osseous realignment and stability. A conservative surgical option of extra-osseous talotarsal joint stabilization provides patients an effective form of treatment without the complications associated with other irreversible surgical procedures. Conclusion: Pediatric flatfeet should not be ignored or downplayed. The sooner effective treatment is prescribed, the less damage will occur to other parts of the body. When possible, a more conservative corrective procedure should be performed prior to irreversible, joint destructive options.
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22
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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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Zhang YJ, Du JY, Chen B, Jin RL, Hu JG, Lin XJ. Correlation between three-dimensional medial longitudinal arch joint complex mobility and medial arch angle in stage II posterior tibial tendon dysfunction. Foot Ankle Surg 2019; 25:721-726. [PMID: 30321919 DOI: 10.1016/j.fas.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/26/2018] [Accepted: 08/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate correlation between three-dimensional medial longitudinal arch joint complex mobility and medial arch angle in stage II posterior tibial tendon dysfunction flatfoot under loading. METHODS CT scans of 15 healthy feet and 15 feet with stage II posterior tibial tendon dysfunction flatfoot were taken both in non- and simulated weight-bearing condition. The CT images of the hindfoot and medial longitudinal arch bones were reconstructed into three-dimensional models with Mimics and Geomagic reverse engineering software. The three-dimensional complex mobility of each joint in the medial longitudinal arch and their correlation with the medial arch angle change were calculated. RESULTS From non- to simulated weight-bearing condition, the medial arch angle change and the medial longitudinal arch joints mobility were significant larger in stage II posterior tibial tendon dysfunction flatfoot (p<0.05). The eversion of the talocalcaneal joint, the proximal translation of the calcaneus relative to the talus, the dorsiflexion of the talonavicular joint, the dorsiflexion and abduction of the medial cuneonavicular joint, and the lateral translation of the medial cuneiform relative to the navicular, and the dorsiflexion of the first tarsometatarsal joint were all significantly correlated to the medial arch angle change in stage II posterior tibial tendon dysfunction flatfoot (all r>0.5, p<0.05). CONCLUSIONS There is increased mobility in the medial longitudinal arch joints in stage II posterior tibial tendon dysfunction flatfoot and the medial arch angle change under loading causes displacement not only at hindfoot joints but also involve midfoot and forefoot joint.
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Affiliation(s)
- Yi-Jun Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Jing-Yu Du
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Bin Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Ri-Long Jin
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Jin-Gen Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Xiang-Jin Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
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24
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Three-dimensional kinematic change of hindfoot during full weightbearing in standing: an analysis using upright computed tomography and 3D-3D surface registration. J Orthop Surg Res 2019; 14:355. [PMID: 31711523 PMCID: PMC6849314 DOI: 10.1186/s13018-019-1443-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background Weightbearing of the hindfoot affects positional changes of the ankle joint and subtalar joint (ankle-joint complex [AJC]). However, it is difficult to assess the kinematic changes in the hindfoot in a natural full weightbearing condition using conventional CT or cone beam computed tomography (CT) due to limitations of acquiring foot images under a physiological weightbearing condition using those imaging modalities. Analysis of AJC kinematics using fluoroscopy and 2D-3D registration technique requires data on the number of steps and amount of time to build and match the bones. This study aimed to analyze the effect of full weightbearing on hindfoot motion when standing using upright CT and 3D-3D surface registration. Methods Forty-eight AJCs of 24 asymptomatic volunteers (13 women, 11 men) were examined under no weightbearing, 50% weightbearing, and single leg full weightbearing conditions while standing. The CT images were acquired from the distal femur to the whole foot using a 320-row upright CT scanner. The condition of each weightbearing stance was measured using a pressure mat. Bone-to-bone rotations of the talus relative to the tibia and calcaneus relative to the talus were evaluated using the surface registration technique. Image quality of the CT and intra- and interobserver reliabilities of the rotation angle were also evaluated. Results All CT images were excellent or good quality and the intra- and interobserver correlation coefficients for the angle were 0.996 and 0.995, respectively. The motion of the ankle joint and subtalar joint under 50% and 100% weightbearing were as follows (in degrees); the talus plantarflexed (5.1 ± 4.5 and 6.8 ± 4.8), inverted (1.3 ± 1.4 and 2.0 ± 1.6), and internally rotated (2.4 ± 4.2 and 4.3 ± 4.6) relative to the tibia, and the calcaneus dorsiflexed (2.8 ± 1.4 and 3.8 ± 1.7), everted (5.3 ± 2.6 and 8.0 ± 3.6), and externally rotated (3.0 ± 2.0 and 4.1 ± 2.4) relative to the talus, respectively. Conclusions The effect of weightbearing was clearly identified using an upright CT and the 3D-3D registration technique. Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes.
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Talar Dome Investigation and Talocrural Joint Axis Analysis Based on Three-Dimensional (3D) Models: Implications for Prosthetic Design. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8634159. [PMID: 31828138 PMCID: PMC6885182 DOI: 10.1155/2019/8634159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/03/2019] [Accepted: 09/05/2019] [Indexed: 01/14/2023]
Abstract
Ankle joint kinematics is mainly stabilized by the morphology of the talar dome and the articular surface of tibiofibular mortise as well as the medial and lateral ligament complexes. Because of this the bicondylar geometry of talus dome is believed to be crucial for ankle implant design. However, little data exist describing the precise anatomy of the talar dome and the talocrural joint axis. The aim of this study is to document the anatomy of the talar dome and the axis of the talocrural joint using three-dimensional (3D) computed tomographic (CT) modeling. Seventy-one participants enrolled for CT scanning and 3D talar model reconstruction. All the ankles were held in a neutral position during the CT scanning. Six points on the lateral and medial crest of the talar dome were defined. The coordinate of the six points; radii of lateral-anterior (R-LA), lateral-posterior (R-LP), medial-anterior (R-MA), and medial-posterior (R-MP) sections; and inclination angle of the talar dome were measured, and the inclination and deviation angles of the talocrural joint axis were determined. The mean values of R-LA, R-LP, R-MA, and R-MP were 19.23 ± 2.47 mm, 18.76 ± 2.90 mm, 17.02 ± 3.49 mm, and 22.75 ± 3.04 mm. The mean inclination angle of the talar dome was 9.86 ± 3.30 degrees. Gender variation was found in this parameter. The mean inclination and deviation angles were 8.60 ± 0.07 and 0.76 ± 0.69 degrees for the dorsiflexion axis and −7.34 ± 0.07 and 0.09 ± 0.18 degrees for the plantarflexion axis. Bilateral asymmetries between the medial and lateral crest of the talar dome were found, which resulted in different dorsiflexion and plantarflexion axes of the talocrural joint. Currently, no ankle implants replicate this talar anatomy, and these findings should be considered in future implant designs.
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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: 54] [Impact Index Per Article: 10.8] [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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Saito Y, Chikenji TS, Takata Y, Kamiya T, Uchiyama E. Can an insole for obese individuals maintain the arch of the foot against repeated hyper loading? BMC Musculoskelet Disord 2019; 20:442. [PMID: 31604431 PMCID: PMC6790017 DOI: 10.1186/s12891-019-2819-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Insoles are often applied as preventive therapy of flatfoot deformity, but the therapeutic effects on obese individuals are still controversial. We aimed to investigate the effect of insole use on time-dependent changes in the foot arch during a repeated-loading simulation designed to represent 20,000 contiguous steps in individuals with a BMI value in the range of 30-40 kg/m2. METHODS Eighteen cadaveric feet were randomly divided into the following three groups: normal, obese, and insole. Ten thousand cyclic loadings of 500 N (normal group) or 1000 N (obese and insole groups) were applied to the feet. We measured time-dependent change in arch height and calculated the bony arch index (BAI), arch flexibility, and energy absorption. RESULTS The normal group maintained more than 0.21 BAI, which is the diagnostic criterion for a normal arch, throughout the 10,000 cycles; however, BAI was less than 0.21 at 1000 cycles in the obese group (mean, 0.203; 95% confidence interval [CI] 0.196-0.209) and at 6000 cycles in the insole group (mean, 0.200; 95% CI, 0.191-0.209). Although there was a significant time-dependent decrease in flexibility and energy absorption in both the obese and insole groups (P < 0.001), the difference between 1 and 10,000 cycles were significantly smaller in the insole group than in the obese group (P = 0.024). CONCLUSIONS Use of insoles for obese individuals may help to slow time-dependent foot structural changes. However, the effect was not enough to maintain the foot structure against repeated hyper loadings.
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Affiliation(s)
- Yuki Saito
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
| | - Takako S. Chikenji
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuichi Takata
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Eiichi Uchiyama
- Graduate School of Health Sciences, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, 0608556 Japan
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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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The hind- and midfoot alignment computed after a medializing calcaneal osteotomy using a 3D weightbearing CT. Int J Comput Assist Radiol Surg 2019; 14:1439-1447. [DOI: 10.1007/s11548-019-01949-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/13/2019] [Indexed: 11/26/2022]
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30
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Wang C, Wang H, Cao S, Wang S, Ma X, Wang X, Huang J, Zhang C, Chen L, Geng X, Wang K. Pathological kinematic patterns of the tarsal complex in stage II adult-acquired flatfoot deformity. J Orthop Res 2019; 37:477-482. [PMID: 29194779 DOI: 10.1002/jor.23821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/27/2017] [Indexed: 02/04/2023]
Abstract
The in vivo kinematic characteristics of the tarsal joints during gait stance phase were still unclear in adult-acquired foot deformity (AAFD). This study included seven healthy subjects (14 feet) and 12 stage II AAFD patients (14 feet). The 3D models of tarsal bones were reconstructed based on CT scan. Each subject took standard gait on the single fluoroscopy system. Continuous lateral fluoroscopic images were collected. The key postures during the stance phase were selected. The 2D-3D registration technique was applied to explore the spatial motions of the tarsal joints in 6 degrees of freedom (DOF). During the whole stance phase, the AAFD talo-navicular joint (TNJ) exhibited ROM of 13 ± 6° in the sagittal plane while the normal subjects showed ROM of 7 ± 3° (p = 0.004). In AAFD, the subtalar joint (STJ) demonstrated 19 ± 8° and 7 ± 3° of motion in coronal and horizontal plane, respectively, while the normal subjects showed 14 ± 4°(p = 0.031) and 11 ± 3° (p = 0.014) of motion, respectively. Additionally STJ of AAFD patients showed significantly less dorsiflexion during the weight acceptance and showed significantly less external rotation both during the weight acceptance and single limb support of stance phase. In conclusion, for stage II AAFD patients, the talonavicular joint and the subtalar joint showed hypermobility in dorsi/planterflexion and inversion/eversion, respectively, during the gait stance phase while the internal/external rotation of the subtalar joint was reduced. The current study improves our understanding of the pathological kinematics of the tarsal complex in AAFD patients. Notice should be taken about these tarsal joints mobility in AAFD during clinical practice. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:477-482, 2019.
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Affiliation(s)
- Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Heng Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Shaobai Wang
- Harvard Medical School, Boston, Massachusetts.,Key Laboratory of Exercise and Health Science.Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Li Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xiang Geng
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Kan Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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Kleipool RP, Dahmen J, Vuurberg G, Oostra RJ, Blankevoort L, Knupp M, Stufkens SAS. Study on the three-dimensional orientation of the posterior facet of the subtalar joint using simulated weight-bearing CT. J Orthop Res 2019; 37:197-204. [PMID: 30345548 DOI: 10.1002/jor.24163] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/11/2018] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to describe the normal 3D orientation and shape of the subtalar calcaneal posterior facet. This is not adequately described in current literature. In a supine position both feet of 20 healthy subjects were imaged in a simulated weight-bearing CT. A cylinder and plane were fitted to the posterior facet of the surface model. The orientation of both shapes was expressed by two angles in (1) the CT-based coordinate system with the axis of the foot aligned with the sagittal axis and (2) a coordinate system based on the geometric principal axes of the subject's calcaneus. The subtalar vertical angle was determined in the intersection in three different coronal planes of the cylinder. The cylinder's axis oriented from supero-postero-laterally to infero-antero-medially. The plane's normal directed supero-antero-medially in the CT-based coordinate system, and supero-antero-laterally in the other coordinate system. The subtalar vertical angle was significantly different (p < 0.001) between the three defined coronal planes and increased from anterior to posterior. The mean diameter of the fitted cylinder was 42.0 ± 7.7 mm and the root mean square error was 0.5 ± 0.1 mm. The posterior facet can be modelled as a segment of a cylinder with a supero-postero-lateral to infero-antero-medial orientation. The morphometry of the posterior facet in a healthy population serves as a reference in identifying abnormal subtalar joint morphology. More generally this study shows the need to include the full 3D morphology in assessing the orientation of the subtalar posterior facet. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-8, 2018.
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Affiliation(s)
- Roeland P Kleipool
- Department of Medical Biology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Jari Dahmen
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC, IOC Research Center, Amsterdam, The Netherlands
| | - Gwen Vuurberg
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC, IOC Research Center, Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Department of Medical Biology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC, IOC Research Center, Amsterdam, The Netherlands
| | - Markus Knupp
- Mein Fusszentrum, Basel, University of Basel, Switzerland
| | - Sjoerd A S Stufkens
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC, IOC Research Center, Amsterdam, The Netherlands
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Lintz F, de Cesar Netto C, Burssens A, Barg A, Richter M. The value of axial loading three dimensional (3D) CT as a substitute for full weightbearing (standing) 3D CT: Comparison of reproducibility according to degree of load. Foot Ankle Surg 2018; 24:553-554. [PMID: 30321918 DOI: 10.1016/j.fas.2018.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Francois Lintz
- Ankle and Foot Surgery Center, Clinique de l'Union, 31240, Saint Jean Toulouse, France.
| | | | - Arne Burssens
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Martinus Richter
- Department of Orthopedic Surgery, Rummelsberg Hospital, Rummelsberg, Germany.
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Xu J, Lu W, Li X. Letter to the Editor on "The value of axial loading three dimensional (3D) CT as a substitute for full weightbearing (standing) 3D CT: Comparison of reproducibility according to degree of load". Foot Ankle Surg 2018; 24:551. [PMID: 30321937 DOI: 10.1016/j.fas.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Jian Xu
- Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen University, Shenzhen 510378, Guangdong Province, China
| | - Wei Lu
- Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen University, Shenzhen 510378, Guangdong Province, China.
| | - Xuchun Li
- Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen University, Shenzhen 510378, Guangdong Province, China
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Burssens A, Van Herzele E, Leenders T, Clockaerts S, Buedts K, Vandeputte G, Victor J. Weightbearing CT in normal hindfoot alignment - Presence of a constitutional valgus? Foot Ankle Surg 2018; 24:213-218. [PMID: 29409213 DOI: 10.1016/j.fas.2017.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/18/2017] [Accepted: 02/03/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The normal hindfoot angle is estimated between 2° and 6° of valgus in the general population. These results are solely based on clinical findings and plain radiographs. The purpose of this study is to assess the hindfoot alignment using weightbear CT. METHODS Forty-eight patients, mean age of 39.6±13.2 years, with clinical and radiological absence of hindfoot pathology were included. A weightbear CT was obtained and allowed to measure the anatomical tibia axis (TAx) and the hindfoot alignment (HA). The HA was firstly determined using the inferior point of the calcaneus (HAIC). A density measurement of this area was subsequently performed to analyze if this point concurred with an increased ossification, indicating a higher load exposure. Secondly the HA was determined by dividing the calcaneus in the long axial view (HALA) and compared to the (HAIC) to point out any possible differences attributed to the measurement method. Reliability was assessed using an intra class correlation coefficient (ICC). RESULTS The mean HAIC equaled 0.79° of valgus±3.2 (ICCHA IC=0.73) with a mean TAx of 2.7° varus±2.1 (ICCTA=0.76). The HALA equaled 9.1° of valgus±4.8 (ICCHA LA=0.71) and differed significantly by a P<0.001 from the HAIC, which showed a more neutral alignment. Correlation between both was shown to be good by a Spearman's correlation coefficient of 0.74. The mean density of the inferior calcaneal area equaled 271.3±84.1 and was significantly higher than the regional calcaneal area (P<0.001). CONCLUSIONS These results show a more neutral alignment of the hindfoot in this group of non-symptomatic feet as opposed to the generally accepted constitutional valgus. This could have repercussion on hindfoot position during fusion or in quantifying the correction of a malalignment. The inferior calcaneus point in this can be used during pre-operative planning of a hindfoot correction as an anatomical landmark due to its shown influence on load transfer.
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Affiliation(s)
- A Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
| | - E Van Herzele
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - T Leenders
- AZ Monica, Florent Pauwelslei 21, 2100 Deurne, Belgium
| | - S Clockaerts
- AZ Groeninge, Burgemeester Vercruysselaan 5, 8500 Kortrijk, Belgium
| | - K Buedts
- ZNA Middelheim, Lindendreef 1, 2020 Antwerpen, Belgium
| | - G Vandeputte
- Department of Orthopaedic Surgery, H.-Hartziekenhuis, Mechelstraat 24, 2500 Lier, Belgium
| | - J Victor
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
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GODOY-SANTOS ALEXANDRELEME, CESAR NETTO CESARDE. WEIGHT-BEARING COMPUTED TOMOGRAPHY OF THE FOOT AND ANKLE: AN UPDATE AND FUTURE DIRECTIONS. ACTA ORTOPEDICA BRASILEIRA 2018; 26:135-139. [PMID: 29983632 PMCID: PMC6032618 DOI: 10.1590/1413-785220182602188482] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Spatial understanding of osteoarticular deformities of the foot and ankle is vital to correct diagnosis and therapeutic decision making. Poor reproducibility in conventional standing radiography in three orthogonal views has driven the development of weight-bearing computed tomography (WBCT) technology over the last decade. We analyzed the available literature on WBCT imaging in patients with foot and ankle disorders by performing a literature review of relevant clinical studies in multiple databases including PubMed, MedLine, and Scopus from January 1999 to October 2017. WBCT imaging allows correct evaluation of foot and ankle anatomy with the patient in a standing position, providing images with high spatial resolution, short image acquisition time, low dose of radiation, and costs which are similar to other available imaging technologies. This diagnostic tool can be used for decision making in the treatment of deformities of the ankle, hindfoot, midfoot, and forefoot. Level of Evidence III; Systematic review of level III studies.
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Barg A, Bailey T, Richter M, de Cesar Netto C, Lintz F, Burssens A, Phisitkul P, Hanrahan CJ, Saltzman CL. Weightbearing Computed Tomography of the Foot and Ankle: Emerging Technology Topical Review. Foot Ankle Int 2018; 39:376-386. [PMID: 29171283 DOI: 10.1177/1071100717740330] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED In the last decade, cone-beam computed tomography technology with improved designs allowing flexible gantry movements has allowed both supine and standing weight-bearing imaging of the lower extremity. There is an increasing amount of literature describing the use of weightbearing computed tomography in patients with foot and ankle disorders. To date, there is no review article summarizing this imaging modality in the foot and ankle. Therefore, we performed a systematic literature review of relevant clinical studies targeting the use of weightbearing computed tomography in diagnosis of patients with foot and ankle disorders. Furthermore, this review aims to offer insight to those with interest in considering possible future research opportunities with use of this technology. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Alexej Barg
- 1 Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Travis Bailey
- 1 Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Martinus Richter
- 2 Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Schwarzenbruck, Germany
| | - Cesar de Cesar Netto
- 3 Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - François Lintz
- 4 Foot and Ankle Surgery Department, Clinique de l'Union, Saint-Jean, Toulouse, France
| | - Arne Burssens
- 5 Department of Orthopaedic Surgery, Ghent University Hospital, Gent, Belgium
| | - Phinit Phisitkul
- 6 Department of Orthopaedic and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Christopher J Hanrahan
- 7 Department of Radiology and Imaging Sciences, Musculoskeletal Imaging, University of Utah, Salt Lake City, UT, USA
| | - Charles L Saltzman
- 1 Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Wong DWC, Wang Y, Leung AKL, Yang M, Zhang M. Finite element simulation on posterior tibial tendinopathy: Load transfer alteration and implications to the onset of pes planus. Clin Biomech (Bristol, Avon) 2018; 51:10-16. [PMID: 29144991 DOI: 10.1016/j.clinbiomech.2017.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior tibial tendinopathy is a challenging foot condition resulting in pes planus, which is difficult to diagnose in the early stage. Prior to the deformity, abnormal internal load transfer and soft tissue attenuation are anticipated. The objective of this study was to investigate the internal load transfer and strain of the ligaments with posterior tibial tendinopathy, and the implications to pes planus and other deformities. METHODS A three-dimensional finite element model of the foot and ankle was reconstructed from magnetic resonance images of a 28-year-old normal female. Thirty bones, plantar fascia, ligaments and tendons were reconstructed. With the gait analysis data of the model subject, walking stance was simulated. The onset of posterior tibial tendinopathy was resembled by unloading the tibialis posterior and compared to the normal condition. FINDINGS The load transfer of the joints at the proximal medial column was weaken by posterior tibial tendinopathy, which was compromised by the increase along the lateral column and the intercuneiforms during late stance. Besides, the plantar tarsometatarsal and cuboideonavicular ligaments were consistently over-stretched during stance. Particularly, the maximum tensile strain of the plantar tarsometatarsal ligament was about 3-fold higher than normal at initial push-off. INTERPRETATION Posterior tibial tendinopathy altered load transfer of the medial column and unbalanced the load between the proximal and distal side of the medial longitudinal arch. Posterior tibial tendinopathy also stretched the midfoot plantar ligaments that jeopardized midfoot stability, and attenuated the transverse arch. All these factors potentially contributed to the progress of pes planus and other foot deformities.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Ming Yang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Department of Pediatric Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
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Cheung ZB, Myerson MS, Tracey J, Vulcano E. Weightbearing CT Scan Assessment of Foot Alignment in Patients With Hallux Rigidus. Foot Ankle Int 2018; 39:67-74. [PMID: 28971698 DOI: 10.1177/1071100717732549] [Citation(s) in RCA: 27] [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 An association between hallux rigidus and metatarsus primus elevatus (MPE) has been suggested, although there remains no general consensus about the nature of this relationship. Past studies were limited due to inaccuracies of assessing MPE on 2-dimensional radiographs. The aims of this study were to (1) assess and compare foot alignment in patients with and without hallux rigidus using 3-dimensional (3D) reconstructions from weightbearing computed tomography (CT) and (2) assess intraobserver and interobserver reliability of these measurements. METHODS A prospective study was performed in 50 consecutive patients with symptomatic hallux rigidus and 50 control patients who underwent a weightbearing CT. Two investigators measured first and second metatarsal declination angles, first and second metatarsal lengths, first to second intermetatarsal angle (IMA), hallux valgus angle (HVA), and foot width on 3D CT reconstructions. Measurements were repeated after 1 month. Student t tests were performed to compare hallux rigidus and control groups. Intraclass and interclass correlation coefficients were calculated to evaluate reliability. RESULTS The first to second metatarsal declination ratio was less in patients with hallux rigidus (mean, 0.81) than controls (mean, 0.92; P < .001). Patients with Coughlin and Shurnas grade 3 and 4 hallux rigidus had greater first metatarsal declination than patients with grade 1 and 2 hallux rigidus. Last, IMA was higher (mean, 13 degrees) but HVA was lower (mean, 11 degrees) in patients with hallux rigidus than controls (IMA mean, 12 degrees; HVA mean, 15 degrees; P = .04). Intraobserver (ICC1,1 ≥ 0.93) and interobserver (ICC3,1 ≥ 0.85) reliability were good to excellent for all measured parameters. CONCLUSIONS Patients with hallux rigidus had MPE. Patients with grade 3 and 4 hallux rigidus had more MPE than patients with grade 1 and 2 hallux rigidus. There was no clear correlation between hallux rigidus and bunions. Finally, weightbearing CT proved to be a reliable method of assessing all measured parameters. LEVEL OF EVIDENCE II, prospective comparative series.
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Affiliation(s)
- Zoe B Cheung
- 1 Department of Orthopaedic Surgery, Mount Sinai West, New York, NY, USA
| | - Mark S Myerson
- 2 The Institute for Foot & Ankle Reconstruction at Mercy, Baltimore, MD, USA
| | - Joseph Tracey
- 3 The Medical University of South Carolina, Charleston, SC, USA
| | - Ettore Vulcano
- 4 Department of Orthopaedic Surgery, Mount Sinai West, New York, NY, USA
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Influence of tibialis posterior muscle activation on foot anatomy under axial loading: A biomechanical CT human cadaveric study. Foot Ankle Surg 2017; 23:250-254. [PMID: 29202983 DOI: 10.1016/j.fas.2016.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/19/2016] [Accepted: 07/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Collapse of the medial longitudinal arch and subluxation of the subtalar joint are common occurrences in adult flatfoot deformity. Controversy exists about the role of the tibialis posterior (TP) tendon as first and/or essential lesion. Subtle changes in the foot configuration can occur under weight bearing. PURPOSE This human cadaveric study is designed to investigate the effect that isolated actuation of the TP tendon has on the medial longitudinal arch and the hindfoot configuration under simulated weight bearing. METHODS A radiolucent frame was developed to apply axial loading on cadaveric lower legs during computer tomography (CT) examinations. Eight pairs of fresh-frozen specimens were imaged in neutral position under foot-flat loading (75N) and under single-leg stance weight bearing (700N) without and with addition of 150N pulling force on the TP tendon. Measurements of subtalar joint subluxation, forefoot arch angle and talo-first metatarsal angle were conducted on each set of CT scans. RESULTS Subtalar subluxation, talo-first metatarsal angle and talo-navicular coverage angle significantly increased under single-leg stance weight bearing, whereas forefoot arch angle significantly decreased. Actuation of the TP tendon under weight bearing did not restore the forefoot arch angle or correct subtalar subluxation and talo-metatarsal angle. CONCLUSION Significant effect that weight bearing has on the medial longitudinal arch and the subtalar joint configuration is demonstrated in an ex-vivo model. In absence of other medial column derangement, actuation of the TP tendon alone does not seem to reconstitute the integrity of the medial longitudinal arch or correct the hindfoot subluxation under weight bearing. CLINICAL RELEVANCE The findings of this study together with the developed model for ex-vivo investigation provide a further insight in foot anatomy.
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Abstract
Subtalar joint anatomy is complex and can vary significantly between individuals. Movement is affected by several adjacent joints, ligaments and periarticular tendons. The subtalar joint has gained interest from foot and ankle surgeons in recent years, but its importance in hindfoot disorders is still under debate. The purpose of this article is to give a general overview of the anatomy, biomechanics and radiographic assessment of the subtalar joint. The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is additionally discussed.
Cite this article: EFORT Open Rev 2017;2:309-316. DOI: 10.1302/2058-5241.2.160050
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Affiliation(s)
- Nicola Krähenbühl
- Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Tamara Horn-Lang
- Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Beat Hintermann
- Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Markus Knupp
- Mein Fusszentrum, Eichenstrasse 31, 4054 Basel, Switzerland
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Van de Velde M, Matricali GA, Wuite S, Roels C, Staes F, Deschamps K. Foot segmental motion and coupling in stage II and III tibialis posterior tendon dysfunction. Clin Biomech (Bristol, Avon) 2017; 45:38-42. [PMID: 28460254 DOI: 10.1016/j.clinbiomech.2017.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/11/2017] [Accepted: 04/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Classification systems developed in the field of posterior tibialis tendon dysfunction omit to include dynamic measurements. Since this may negatively affect the selection of the most appropriate treatment modality, studies on foot kinematics are highly recommended. Previous research characterised the foot kinematics in patients with posterior tibialis tendon dysfunction. However, none of the studies analysed foot segmental motion synchrony during stance phase, nor compared the kinematic behaviour of the foot in presence of different posterior tibialis tendon dysfunction stages. Therefore, we aimed at comparing foot segmental motion and coupling in patients with posterior tibialis tendon dysfunction grade 2 and 3 to those of asymptomatic subjects. METHODS Foot segmental motion of 11 patients suffering from posterior tibialis tendon dysfunction stage 2, 4 patients with posterior tibialis tendon dysfunction stage 3 and 15 asymptomatic subjects was objectively quantified with the Rizzoli foot model using an instrumented walkway and a 3D passive motion capture system. Dependent variables were the range of motion occurring at the different inter-segment angles during subphases of stance and swing phase as well as the cross-correlation coefficient between a number of segments. RESULTS Significant differences in range of motion were predominantly found during the forefoot push off phase and swing phase. In general, both patient cohorts demonstrated a reduced range of motion compared to the control group. This hypomobility occurred predominantly in the rearfoot and midfoot (p<0.01). Significant differences between both posterior tibialis tendon dysfunction patient cohorts were not revealed. Cross-correlation coefficients highlighted a loss of joint coupling between rearfoot and tibia as well as between rearfoot and forefoot in both posterior tibialis tendon dysfunction groups. INTERPRETATION The current evidence reveals considerable mechanical alterations in the foot which should be considered in the decision making process since it may help explaining the success and failure of certain conservative and surgical interventions.
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Affiliation(s)
- Maarten Van de Velde
- KULeuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Belgium
| | - Giovanni Arnoldo Matricali
- KULeuven, Department of Development & Regeneration, Belgium; KULeuven, Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, Belgium
| | - Sander Wuite
- KULeuven, Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, Belgium
| | - Charlotte Roels
- KULeuven, Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, Belgium
| | - Filip Staes
- KULeuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Belgium
| | - Kevin Deschamps
- KULeuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Belgium; KULeuven, Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, Belgium; Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Belgium; Artevelde University College, Department of Podiatry, Ghent, Belgium.
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Watanabe K, Ikeda Y, Suzuki D, Teramoto A, Kobayashi T, Suzuki T, Yamashita T. Three-dimensional analysis of tarsal bone response to axial loading in patients with hallux valgus and normal feet. Clin Biomech (Bristol, Avon) 2017; 42:65-69. [PMID: 28110242 DOI: 10.1016/j.clinbiomech.2017.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with hallux valgus present a variety of symptoms that may be related to the type of deformity. Weightbearing affects the deformities, and the evaluation of the load response of tarsal bones has been mainly performed using two-dimensional plane radiography. The purpose of this study was to investigate and compare structural changes in the medial foot arch between patients with hallux valgus and normal controls using a computer image analysis technique and weightbearing computed tomography data. METHODS Eleven patients with hallux valgus and eleven normal controls were included. Computed tomograms were obtained with and without simulated weightbearing using a compression device. Computed tomography data were transferred into a personal computer, and a three-dimensional bone model was created using image analysis software. The load responses of each tarsal bone in the medial foot arch were measured three-dimensionally and statistically compared between the two groups. FINDINGS Displacement of each tarsal bone under two weightbearing conditions was visually observed by creating three-dimensional bone models. At the first metatarsophalangeal joint, the proximal phalanges of the hallux valgus group showed significantly different displacements in multiple directions. Moreover, opposite responses to axial loading were also observed in both translation and rotation between the two groups. INTERPRETATION Weightbearing caused deterioration of the hallux valgus deformity three-dimensionally at the first metatarsophalangeal joint. Information from the computer image analysis was useful for understanding details of the pathology of foot disorders related to the deformities or instability and may contribute to the development of effective conservative and surgical treatments.
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Affiliation(s)
- Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Japan.
| | - Yasutoshi Ikeda
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Takuma Kobayashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
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Natsakis T, Burg J, Dereymaeker G, Jonkers I, Vander Sloten J. Foot-ankle simulators: A tool to advance biomechanical understanding of a complex anatomical structure. Proc Inst Mech Eng H 2016; 230:440-9. [PMID: 27160562 DOI: 10.1177/0954411915617983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/26/2015] [Indexed: 11/15/2022]
Abstract
In vitro gait simulations have been available to researchers for more than two decades and have become an invaluable tool for understanding fundamental foot-ankle biomechanics. This has been realised through several incremental technological and methodological developments, such as the actuation of muscle tendons, the increase in controlled degrees of freedom and the use of advanced control schemes. Furthermore, in vitro experimentation enabled performing highly repeatable and controllable simulations of gait during simultaneous measurement of several biomechanical signals (e.g. bone kinematics, intra-articular pressure distribution, bone strain). Such signals cannot always be captured in detail using in vivo techniques, and the importance of in vitro experimentation is therefore highlighted. The information provided by in vitro gait simulations enabled researchers to answer numerous clinical questions related to pathology, injury and surgery. In this article, first an overview of the developments in design and methodology of the various foot-ankle simulators is presented. Furthermore, an overview of the conducted studies is outlined and an example of a study aiming at understanding the differences in kinematics of the hindfoot, ankle and subtalar joints after total ankle arthroplasty is presented. Finally, the limitations and future perspectives of in vitro experimentation and in particular of foot-ankle gait simulators are discussed. It is expected that the biofidelic nature of the controllers will be improved in order to make them more subject-specific and to link foot motion to the simulated behaviour of the entire missing body, providing additional information for understanding the complex anatomical structure of the foot.
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Affiliation(s)
- Tassos Natsakis
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Josefien Burg
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium Department of Kinesiology and Rehabilitation Science, KU Leuven, Leuven, Belgium
| | - Greta Dereymaeker
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Kinesiology and Rehabilitation Science, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
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Krähenbühl N, Tschuck M, Bolliger L, Hintermann B, Knupp M. Orientation of the Subtalar Joint: Measurement and Reliability Using Weightbearing CT Scans. Foot Ankle Int 2016; 37:109-14. [PMID: 26293157 DOI: 10.1177/1071100715600823] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Up to 60% of patients with an osteoarthritic ankle joint develop talar tilt with progression of the osteoarthritic process. The configuration of the subtalar joint, in particular the posterior facet, may contribute to the development of this wear pattern. Recently, the subtalar vertical angle (SVA) was used to describe the posterior facet of the subtalar joint in the frontal plane. The aim of this work was to analyze if the orientation of the subtalar joint may influence the type of asymmetric ankle osteoarthritis. METHODS In total, 60 ankles were retrospectively analyzed including 40 osteoarthritic patients and 20 healthy controls. The osteoarthritic ankles were divided into 4 groups: varus ankle joints with (incongruent) or without (congruent) a tilted talus and valgus ankle joints with (incongruent) or without (congruent) a tilted talus. The orientation of the subtalar joint was described using the SVA. The SVA was determined for every patient using weightbearing CT scans. Additionally, the inter- and intraobserver reliability was assessed using intraclass correlation coefficients (ICCs). RESULTS The inter- and intraobserver reliability was excellent (ICC > 0.989 and >0.975, respectively). The varus groups (incongruent and congruent) had significantly lower SVA values, that is, more varus orientation of the subtalar joint than the valgus groups (P < .05). The SVA of the control group was between the values of the varus and valgus ankles. CONCLUSION The SVA provided a reliable and consistent method to assess the varus/valgus configuration of the posterior facet of the subtalar joint. In our cohort, varus osteoarthritis of the ankle joint occurred with varus orientation of the subtalar joint whereas in patients with valgus osteoarthritis, valgus orientation of the subtalar joint was found. Our data suggest that the subtalar joint orientation may be a risk factor for the development of ankle joint osteoarthritis. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Nicola Krähenbühl
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Switzerland
| | - Michael Tschuck
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Switzerland
| | - Lilianna Bolliger
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Switzerland
| | - Beat Hintermann
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Switzerland
| | - Markus Knupp
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Switzerland
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Simpson AHRW. Orthopaedic journals, impact factors, research impact and research quality. Bone Joint Res 2015; 4:117-9. [PMID: 26184104 PMCID: PMC4678364 DOI: 10.1302/2046-3758.47.2000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- A H R W Simpson
- The Bone and Joint Journal, 22 Buckingham Street, London, WC2N 6ET, UK
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Probasco W, Haleem AM, Yu J, Sangeorzan BJ, Deland JT, Ellis SJ. Assessment of coronal plane subtalar joint alignment in peritalar subluxation via weight-bearing multiplanar imaging. Foot Ankle Int 2015; 36:302-9. [PMID: 25380775 DOI: 10.1177/1071100714557861] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with adult-acquired flatfoot deformity (AAFD) develop peritalar subluxation, which may stem from valgus inclination of the inferior surface of the talus. We hypothesized that patients with AAFD would have an increased valgus tilt of the subtalar joint in the coronal plane compared to controls when assessed with a novel multiplanar weight-bearing imaging (MP-WB). METHODS Eighteen normal and 36 stage II AAFD patients scheduled to undergo operative reconstruction were evaluated by MP-WB through measuring 3 novel angles of the subtalar joint in the coronal view: (1) angle between inferior facet of the talus and the horizontal/floor (inftal-hor), (2) angle between inferior and superior facets of the talus (inftal-suptal), and (3) angle between inferior facet of the talus and superior facet of the calcaneus (inftal-supcal). Intra- and interobserver reliability were evaluated via intraclass correlation coefficients (ICCs). Differences in angles between AAFD patients and controls were evaluated using Wilcoxon rank-sum test. RESULTS Intra- and interobserver reliability were excellent for inftal-hor (ICC .942 and .991, respectively) and inftal-suptal (ICC .948 and .989, respectively), and moderate-good for inftal-supcal (ICC .604 and .742, respectively). Inftal-hor and inftal-suptal angles were found to be significantly greater in AAFD patients (P < 0.001) at all 3 locations along the posterior subtalar joint, while inftal-supcal did not demonstrate a significant difference (P = .741). While controls exhibited varus orientation at the anterior aspect of the joint, AAFD patients maintained a valgus orientation throughout. CONCLUSION Inftal-hor and inftal-suptal angles provided a reliable means of evaluating the orientation of the subtalar joint axis in AAFD via MP-WB, and showed that the subtalar joint had increased valgus orientation in AAFD compared to controls. This may allow for identification of patients at risk for developing AAFD, and could potentially be used in guiding operative reconstruction.
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Affiliation(s)
- William Probasco
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY
| | - Amgad M Haleem
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY
| | - Jeanne Yu
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY
| | - Bruce J Sangeorzan
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA
| | - Jonathan T Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY
| | - Scott J Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY
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Zhang YJ, Xu J, Wang Y, Lin XJ, Ma X. Correlation between hindfoot joint three-dimensional kinematics and the changes of the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot. Clin Biomech (Bristol, Avon) 2015; 30:153-8. [PMID: 25553652 DOI: 10.1016/j.clinbiomech.2014.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to explore the correlation between the kinematics of the hindfoot joint and the medial arch angle change in stage II posterior tibial tendon dysfunction flatfoot three-dimensionally under loading. METHODS Computed tomography (CT) scans of 12 healthy feet and 12 feet with stage II posterior tibial tendon dysfunction flatfoot were taken both in non- and full-body-weight-bearing condition. The CT images of the hindfoot bones were reconstructed into three-dimensional models with Mimics and Geomagic reverse engineering software. The three-dimensional changes of the hindfoot joint were calculated to determine their correlation to the medial longitudinal arch angle. FINDINGS The medial arch angle change was larger in stage II posterior tibial tendon dysfunction flatfoot compared to that in healthy foot under loading. The rotation and translation of the talocalcaneal joint, the talonavicular joint and the calcanocuboid joint had little influence on the change of the medial arch angle in healthy foot. However, the eversion of the talocalcaneal joint, the proximal translation of the calcaneus relative to the talus and the dorsiflexion of talonavicular joint could increase the medial arch angle in stage II posterior tibial tendon dysfunction flatfoot under loading. INTERPRETATION Joint instability occurred in patients with stage II posterior tibial tendon dysfunction flatfoot under loading. Limitation of over movement of the talocalcaneal joint and the talonavicular joint may help correct the medial longitudinal arch in stage II posterior tibial tendon dysfunction flatfoot.
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Affiliation(s)
- Yi-Jun Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China.
| | - Jian Xu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, PR China.
| | - Yue Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China.
| | - Xiang-Jin Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China.
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, PR China.
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Colin F, Horn Lang T, Zwicky L, Hintermann B, Knupp M. Subtalar joint configuration on weightbearing CT scan. Foot Ankle Int 2014; 35:1057-62. [PMID: 25015393 DOI: 10.1177/1071100714540890] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Standard values that describe the morphology of the subtalar (ST) joint have previously been obtained from cadaveric studies or by using conventional unloaded radiographs. It is known that these parameters differ significantly from those measured in vivo and in loaded images, limiting the diagnostic value of the previously published morphological parameters in the literature. However, the morphology of the ST joint clearly affects its function. The objective of this study was to determine the morphology of the posterior facet of the ST joint using loaded computed tomography (CT) images and to describe the different configurations found in asymptomatic patients. METHODS A weightbearing CT scan was performed on 59 patients without any history of hindfoot and ankle pathology. The shape of the posterior facet and the subtalar vertical angle (SVA) were measured in 3 different coronal planes of the ST joint. RESULTS The posterior facet was concave in 88% and flat in 12%. The posterior facet was oriented in valgus in 90% and varus in 10% when measured in the middle coronal plane. However, the SVA changed depending on which coronal plane it was measured in. CONCLUSION We believe it is important to get a better insight into the morphological parameters of the ST joint. CLINICAL RELEVANCE Knowledge of subtalar joint morphology could help clarify why certain failures have occurred in reconstructive hindfoot surgery and thus might help plan the surgical procedure to reduce these failures in the future.
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Affiliation(s)
- Fabrice Colin
- Clinic of Orthopaedic & Traumatology Surgery, Nantes, France
| | | | - Lukas Zwicky
- Clinic of Orthopaedic Surgery, Liestal, Switzerland
| | | | - Markus Knupp
- Clinic of Orthopaedic Surgery, Liestal, Switzerland
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