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Hansen P, Brinch S, Radev DI, Nybing JU, Toftgaard S, Johannsen FE. Reliability and correlation of weight-bearing cone beam CT and Foot Posture Index (FPI) for measurements of foot posture: a test-retest study. Skeletal Radiol 2023; 52:2387-2397. [PMID: 37130960 PMCID: PMC10582147 DOI: 10.1007/s00256-023-04352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To assess test-retest reliability and correlation of weight-bearing (WB) and non-weight-bearing (NWB) cone beam CT (CBCT) foot measurements and Foot Posture Index (FPI) MATERIALS AND METHODS: Twenty healthy participants (age 43.11±11.36, 15 males, 5 females) were CBCT-scanned in February 2019 on two separate days on one foot in both WB and NWB positions. Three radiology observers measured the navicular bone position. Plantar (ΔNAVplantar) and medial navicular displacements (ΔNAVmedial) were calculated as a measure of foot posture changes under loading. FPI was assessed by two rheumatologists on the same two days. FPI is a clinical measurement of foot posture with 3 rearfoot and 3 midfoot/forefoot scores. Test-retest reproducibility was determined for all measurements. CBCT was correlated to FPI total and subscores. RESULTS Intra- and interobserver reliabilities for navicular position and FPI were excellent (intraclass correlation coefficient (ICC) .875-.997). In particular, intraobserver (ICC .0.967-1.000) and interobserver reliabilities (ICC .946-.997) were found for CBCT navicular height and medial position. Interobserver reliability of ΔNAVplantar was excellent (ICC .926 (.812; .971); MDC 2.22), whereas the ΔNAVmedial was fair-good (ICC .452 (.385; .783); MDC 2.42 mm). Using all observers' measurements, we could calculate mean ΔNAVplantar (4.25±2.08 mm) and ΔNAVmedial (1.55±0.83 mm). We demonstrated a small day-day difference in ΔNAVplantar (0.64 ±1.13mm; p<.05), but not for ΔNAVmedial (0.04 ±1.13mm; p=n.s.). Correlation of WBCT (WB navicular height - ΔNAVmedial) with total clinical FPI scores and FPI subscores, respectively, showed high correlation (ρ: -.706; ρ: -.721). CONCLUSION CBCT and FPI are reliable measurements of foot posture, with a high correlation between the two measurements.
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Affiliation(s)
- Philip Hansen
- Department of Radiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Signe Brinch
- Department of Radiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Janus Uhd Nybing
- Department of Radiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Finn Elkjær Johannsen
- Furesø-reumatologerne, Copenhagen, Farum Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
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Johannsen F, Konradsen L, Hansen P, Brinch S, Nybing JU, Krogsgaard MR. The Effect of Endoscopic Partial Plantar Fasciotomy on Morphologic and Functional Properties of the Foot. Foot Ankle Int 2023; 44:415-423. [PMID: 37002598 DOI: 10.1177/10711007231160741] [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: 05/16/2023]
Abstract
BACKGROUND The lifetime risk of plantar fasciitis is 10%, and operative treatment in the form of endoscopic partial plantar fascia release are often performed in cases refractory for nonsurgical treatment. The effect of the operation on the biomechanical properties of the foot has only been sparsely studied. METHODS This is a prospective, observational study of 25 patients with plantar fasciitis, for a minimum of 3 months, verified by ultrasonographic scanning, who had endoscopic partial fasciotomy. A bony spur was resected if present. At the calcaneal insertion, the medial half of the central band of the plantar fascia was excised in full thickness. The biomechanical properties of the foot were evaluated before surgery and 12 months postoperatively. RESULTS Foot length increased 0.17 cm (P = .03), the width of the central zone 0.35 cm (P = .019), the modified arch index 0.05 (P = .032), and the Foot Posture Index 1.0 (P = .0014). There were no significant changes in rearfoot eversion angle, ankle dorsiflexion and jump distance, or in magnetic resonance imaging-measured 3D navicular position from pre- to postoperation, with or without loading, and no changes in ultrasonographically measured heel pad thickness. A tantalum bead (0.7-mm-diameter) was inserted during operation into the most proximal part of the released medial plantar fascia. Radiographs obtained few days postoperatively and 1 year later revealed no changes in the tantalum-calcaneus distance in supine position, but an increase from 48.3 to 50.7 mm (P = .045) in one-leg standing, suggesting a higher flexibility of the remaining fascia. Patients with a body mass index above and below 27.0 demonstrated no significant differences in any of the assessments at 12 months. CONCLUSION There were minimal changes in the measured foot morphologic and functional properties at 1-year follow-up, after endoscopic partial plantar fascia release. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Finn Johannsen
- Department of Orthopedic Surgery, Institute of Sports Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Furesø-Reumatologerne, Private Rheumatology Clinic, Farum, Denmark
| | - Lars Konradsen
- Section for sports Traumatology, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Philip Hansen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Signe Brinch
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Janus Uhd Nybing
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for sports Traumatology, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations-a review of the literature. Skeletal Radiol 2022; 52:1073-1088. [PMID: 36350387 DOI: 10.1007/s00256-022-04223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Weight bearing CT (WBCT) of the lower extremity is gaining momentum in evaluation of the foot/ankle and knee. A growing number of international studies use WBCT, which is promising for improving our understanding of anatomy and biomechanics during natural loading of the lower extremity. However, we believe there is risk of excessive enthusiasm for WBCT leading to premature application of the technique, before sufficiently robust protocols are in place e.g. standardised limb positioning and imaging planes, choice of anatomical landmarks and image slices used for individual measurements. Lack of standardisation could limit benefits from introducing WBCT in research and clinical practice because useful imaging information could become obscured. Measurements of bones and joints on WBCT are influenced by joint positioning and magnitude of loading, factors that need to be considered within a 3-D coordinate system. A proportion of WBCT studies examine inter- and intraobserver reproducibility for different radiological measurements in the knee or foot with reproducibility generally reported to be high. However, investigations of test-retest reproducibility are still lacking. Thus, the current ability to evaluate, e.g. the effects of surgery or structural disease progression, is questionable. This paper presents an overview of the relevant literature on WBCT in the lower extremity with an emphasis on factors that may affect measurement reproducibility in the foot/ankle and knee. We discuss the caveats of performing WBCT without consensus on imaging procedures and measurements.
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Maruyama M, Yozu A, Okamoto Y, Shiraki H. The Effects of a Medial Heel Wedge on the Weight-Bearing Response of Hindfoot Valgus and the Total Weight-Bearing Responses of the Navicular and Talus Bones. THE ASIAN JOURNAL OF KINESIOLOGY 2021. [DOI: 10.15758/ajk.2021.23.3.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Medial heel wedges are commonly prescribed to manage the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones. Previous studies have reported that a medial heel wedge is effective in the management of musculoskeletal injuries. However, it remains unclear the effect of a medial heel wedge on the weight-bearing responses of footarch bones in vivo. To clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones is necessary to understand how best to treat musculoskeletal injuries clinically. The purpose of our study was to clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones.METHODS Twenty-five healthy males were analyzed. We obtained MRI scanning of the right foot under non-loading (NL) and full weight-bearing (FW) conditions. Participants wore two insole types, a flat insole and a medial heel wedge. To evaluate the weight-bearing response in hindfoot valgus, the hindfoot alignment view (HAV) was measured. We also measured navicular and talus bone positions and calculated the total positional changes of the navicular and talus bones (ΔTPCN, ΔTPCT) from the vertical and medial displacements using the Pythagorean theorem.RESULTS Significant interactions were observed with the HAV. Under both NL and FW conditions, the HAV was smaller on the medial heel wedge than on the flat insole. In addition, the ΔTPCN was significantly smaller on the medial heel wedge than on the flat insole. However, no significant differences were observed for ΔTPCT.CONCLUSIONS Our results suggest that use of a medial heel wedge decreases hindfoot valgus values under both NL and FW conditions and stabilizes the total weight-bearing response of the navicular bone.
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Maruyama M, Yozu A, Okamoto Y, Shiraki H. Relationship between total weight-bearing response of the navicular and talus bones and weight-bearing response of hindfoot valgus in normal foot arch. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2021. [DOI: 10.7600/jpfsm.10.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Masafumi Maruyama
- Graduate School of Comprehensive Human Science, University of Tsukuba
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences
| | - Arito Yozu
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences
| | - Yoshikazu Okamoto
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba
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Osteoarthritis year in review 2016: imaging. Osteoarthritis Cartilage 2017; 25:216-226. [PMID: 27965137 DOI: 10.1016/j.joca.2016.12.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The current narrative review covers original research related to imaging in osteoarthritis (OA) in humans published in English between April 1st 2015 and March 31st 2016, in peer reviewed journals available in Medline via PubMed (http://www.ncbi.nlm.nih.gov/pubmed/). METHODS Relevant studies in humans, subjectively decided by the authors, contributing significantly to the OA imaging field, were selected from an extensive Medline search using the terms "Osteoarthritis" in combination with "MRI", "Imaging", "Radiography", "X-rays", "Ultrasound", "Computed tomography", "Nuclear medicine", "PET-CT", "PET-MRI", "Scintigraphy", "SPECT". Publications were sorted according to relevance for the OA imaging research community with an emphasis on high impact special interest journals using the software for systematic reviews www.covidence.org. RESULTS An overview of newly published studies compared to studies reported previous years is presented, followed by a review of selected imaging studies of primarily knee, hip and hand OA focussing on (1) results for detection of OA and OA-related pathology (2) studies dealing with treatments and (3) studies focussing on prognosis of disease progression or joint replacement. A record high number of 1420 articles were published, among others, of new technologies and tools for improved morphological and pathophysiological understanding of OA-related changes in joints. Also, imaging data were presented of monitoring treatment effect and prognosis of OA progression, primarily using established radiographic, magnetic resonance imaging (MRI), and ultrasound (US) methods. CONCLUSION Imaging continues to play an important role in OA research, where several exciting new technologies and computer aided analysis methods are emerging to complement the conventional imaging approaches.
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Johannsen F, Hansen P, Stallknecht S, Rathleff MS, Hangaard S, Nybing JD, Boesen M. Can positional MRI predict dynamic changes in the medial plantar arch? An exploratory pilot study. J Foot Ankle Res 2016; 9:35. [PMID: 27588043 DOI: 10.1186/s13047-016-0168-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Positional MRI (pMRI) allows for three-dimensional visual assessment of navicular position. In this exploratory pilot study pMRI was validated against a stretch sensor device, which measures movement of the medial plantar arch. We hypothesized that a combined pMRI measure incorporating both vertical and medial displacement of the navicular bone induced by loading would be correlated with corresponding stretch sensor measurements. METHODS 10 voluntary participants were included in the study. Both pMRI and subsequent stretch sensor measurements were performed in a) supine, b) standing and c) standing position with addition of 10 % body weight during static loading of the foot. Stretch sensor measurements were also performed during barefoot walking. RESULTS The total change in navicular position measured by pMRI was 10.3 mm (CI: 7.0 to 13.5 mm). No further displacement occurred when adding 10 % bodyweight (mean difference: 0.7 mm (CI: -0.7 to 2.0 mm), P = 0.29). The total navicular displacement correlated with stretch sensor measurement under static loading conditions (Spearman's rho = 0.66, P = 0.04) but not with measurements during walking (Spearman's rho = 0.58, P = 0.08). CONCLUSIONS Total navicular bone displacements determined by pMRI showed concurrent validity with stretch sensor measurements but only so under static loading conditions. Although assessment of total navicular displacement by combining concomitant vertical and medial navicular bone movements would appear advantageous compared to monoplanar measurement the combined measure did not seem to predict dynamic changes of the medial foot arch during walking, which are among several possible factors depending on different walking patterns.
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Affiliation(s)
- Finn Johannsen
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Building 8, 1., Bispebjerg Bakke 23, Copenhagen, DK-2400, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital Bispebjerg & Frederiksberg, Nordre Fasanvej 57, vej 4, opg. 5, Frederiksberg, DK-2000 Denmark
| | - Sandra Stallknecht
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Building 8, 1., Bispebjerg Bakke 23, Copenhagen, DK-2400, Denmark
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark ; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Stine Hangaard
- Department of Radiology, Copenhagen University Hospital Bispebjerg & Frederiksberg, Nordre Fasanvej 57, vej 4, opg. 5, Frederiksberg, DK-2000 Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg & Frederiksberg, Nordre Fasanvej 57, vej 4, opg. 5, Frederiksberg, DK-2000 Denmark
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg & Frederiksberg, Nordre Fasanvej 57, vej 4, opg. 5, Frederiksberg, DK-2000 Denmark ; The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg & Frederiksberg, Copenhagen, Denmark
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