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Lee SW, Yon CJ, Kim JH, Lee JM, Lee JH, Heo YR. Comparison of the Usefulness of Computer-Assisted Three-Dimensional Analysis and Weight-Bearing Radiographs in Ankle Osteoarthritis. Clin Orthop Surg 2024; 16:141-148. [PMID: 38304214 PMCID: PMC10825248 DOI: 10.4055/cios23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024] Open
Abstract
Background To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the three-dimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computer-aided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced. Methods In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed. Results On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance. Conclusions We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.
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Affiliation(s)
- Si-Wook Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Jin Yon
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jae-Ho Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jung-Min Lee
- Industry-Academic Cooperation Foundation, Keimyung University, Daegu, Korea
| | - Jae-Ho Lee
- Department of Anatomy, Keimyung University College of Medicine, Daegu, Korea
| | - Yu-Ran Heo
- Department of Anatomy, Keimyung University College of Medicine, Daegu, Korea
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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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Alexander NB, Sarfani S, Strickland CD, Richardson DR, Murphy GA, Grear BJ, Bettin CC. Cost Analysis and Reimbursement of Weightbearing Computed Tomography. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231164143. [PMID: 37009418 PMCID: PMC10052493 DOI: 10.1177/24730114231164143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Weightbearing computed tomography (WBCT) is becoming a valuable tool in the evaluation of foot and ankle pathology. Currently, cost analyses of WBCT scanners in private practice are lacking in the literature. This study evaluated the costs of acquisition, utilization, and reimbursements for a WBCT at a tertiary referral center, information of particular interest to practices considering obtaining such equipment. Methods: All WBCT scans performed at a tertiary referral center over the 55-month period (August 2016 to February 2021) were retrospectively evaluated. Patient demographics, pathology location, etiology, subspecialty of the ordering provider, and whether the study was unilateral or bilateral were collected. Reimbursement was calculated based on payor source as a percentage of Medicare reimbursement for lower extremity CT. The number of total scans performed per month was evaluated to determine revenue generated per month. Results: Over the study period, 1903 scans were performed. An average of 34.6 scans were performed each month. Forty-one providers ordered WBCT scans over the study period. Foot and ankle fellowship-trained orthopaedic surgeons ordered 75.5% of all scans. The most common location of pathology was the ankle, and the most common etiology was trauma. The device was cost neutral at 44.2 months, assuming reimbursement for each study was commensurate with Medicare rates. The device became cost neutral at approximately 29.9 months when calculating reimbursement according to mixed-payor source. Conclusion: As WBCT scan becomes more widely used for evaluation of foot and ankle pathology, practices may be interested in understanding the financial implications of such an investment. To the authors’ knowledge, this study is the only cost-effectiveness analysis of WBCT based in the United States. We found that in a large, multispecialty orthopaedic group, WBCT can be a financially viable asset and a valuable diagnostic tool for a variety of pathologies. Level of Evidence: Level III, diagnostic.
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Affiliation(s)
- Nathaniel B. Alexander
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center—Campbell Clinic, Memphis, TN, USA
| | | | | | - David R. Richardson
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center—Campbell Clinic, Memphis, TN, USA
| | - G. Andrew Murphy
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center—Campbell Clinic, Memphis, TN, USA
| | - Benjamin J. Grear
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center—Campbell Clinic, Memphis, TN, USA
| | - Clayton C. Bettin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center—Campbell Clinic, Memphis, TN, USA
- Clayton C. Bettin, MD, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee, Campbell Foundation, 1211 Union Ave, Suite 510, Memphis, TN 38104, USA. Email.
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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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Stolle J, Lintz F, de Cesar Netto C, Bernasconi A, Rincon MR, Mathew R, Vispute D, Siegler S. Three-dimensional ankle, subtalar, and hindfoot alignment of the normal, weightbearing hindfoot, in bilateral posture. J Orthop Res 2022; 40:2430-2439. [PMID: 35067973 DOI: 10.1002/jor.25267] [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: 08/12/2021] [Revised: 11/17/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
The first goal of this study was to develop reliable three-dimensional definitions of alignment for the ankle, subtalar, and hindfoot joints. These alignments are based on three-dimensional morphological features derived from renderings of the bones obtained from weightbearing computer tomography. The second goal was to establish a database quantifying the alignment of the ankle, subtalar, and hindfoot joints in a healthy population during weightbearing bilateral standing. This level 1 study was performed on 95 normal subjects in which random subjects were recruited into a control group. Weightbearing computed tomography scans of the leg were collected in neutral, bilateral, standing posture. In 30 of the subjects, both the left and right leg was scanned. Six alignment parameters for each joint were calculated from morphological measurements conducted on three-dimensional renderings of the bones. Intra- and intertester reliability was assessed from repeated measurements by several testers. Analysis of variance statistics of the alignment parameters showed no statistical differences due to age, gender, or foot side. Intraclass correlation coefficient analysis showed excellent inter- and intratester reliability. It was concluded that the alignment process is comprehensive and reliable. Therefore, without classification by gender or age, it may be used as a foundation for quantifying abnormal alignment associated with various ankle deformities. Clinical significance: The alignment methodology and control database may be used to diagnose ankle, subtalar, and hindfoot misalignment. It can also serve as basis for surgical planning designed to restore normal alignment in various hindfoot pathologies, such as ankle realignment in total ankle replacement.
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Affiliation(s)
- Jordan Stolle
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Francois Lintz
- Department of Orthopedic Surgery, Ramsay GDS-Clinique de L'Union, Saint Jean, France
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Alessio Bernasconi
- Department of Orthopedic Surgery, University of Naples Federico II, Naples, Italy
| | - Maria R Rincon
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rena Mathew
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dhwanit Vispute
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
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Bernasconi A, De Cesar Netto C, Siegler S, Jepsen M, Lintz F. Weightbearing CT assessment of foot and ankle joints in Pes Planovalgus using distance mapping. Foot Ankle Surg 2022; 28:775-784. [PMID: 34656445 DOI: 10.1016/j.fas.2021.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/04/2021] [Accepted: 10/06/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The goal of this study was to describe the abnormal joint surface interaction at the ankle, hindfoot and midfoot joints in patients presenting with Pes Planovalgus (PPV) using three-dimensional (3D) distance mapping on weightbearing computed tomography (WBCT) images by comparing a series of PPVs to a series of normally-aligned feet. We hypothesized that in PPVs joint interactions would reveal significantly increased spaces in the medial side of the ankle, hindfoot and midfoot joints. METHODS In this case-control study, ten feet (10 patients) with asymptomatic PPV were compared to 10 matched-paired (by age, gender and body mass index) normally-aligned feet (10 patients). Three-dimensional models were produced from the images and distance maps representing joint surface configuration were generated for the ankle, hindfoot and midfoot joints. The distance maps for each joint were then compared between the two groups and between regions in the same group. RESULTS In PPV patients there was a significantly increased surface-to-surface distance anteromedially at the ankle joint (+46.3%, p < 0.001) along with an increased distance on the anterior halves of both the medial (+21.3%, p = 0.098) and lateral malleoli (+22.7%, p = 0.038). At the posterolateral corner of the posterior facet of the subtalar joint we found an increased surface-to-surface distance (by 57.1%, p < 0.001), while at the talonavicular joint there was a reduction of the distance at the superomedial corner (-20%, p = 0.097) along with a significant increase in the upper central (+20%, p = 0.039) and lateral (+30.7%, p = 0.015) zones. A reduction of the surface-to-surface distance was also observed in three of the four zones of the calcaneocuboid joint. Finally, a statistically significant increase in the mean distance was observed at the naviculocuneiform and tarsometatarsal joints in a range between 38% and 93.4% (p < 0.001 in all cases). CONCLUSION We found significant differences in surface-to-surface interaction at the foot and ankle joints between Pes Planovalgus and normally-aligned controls. Distance mapping on WBCT images could be used in clinical practice as a diagnostic support to gauge the morphological changes of articular spaces occurring in Pes Planovalgus. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Alessio Bernasconi
- Orthopaedic and Traumatology Unit, University "Federico II", Naples, Italy.
| | - Cesar De Cesar Netto
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA
| | | | | | - François Lintz
- Ramsay Générale de Santé Clinique de l'Union, Foot and Ankle Department, Toulouse, Occitanie, France
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Lôbo CFT, Pires EA, Bordalo-Rodrigues M, de Cesar Netto C, Godoy-Santos AL. Imaging of progressive collapsing foot deformity with emphasis on the role of weightbearing cone beam CT. Skeletal Radiol 2022; 51:1127-1141. [PMID: 34693455 DOI: 10.1007/s00256-021-03942-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
The term progressive collapsing foot deformity (PCFD) is currently recommended as the replacement to adult-acquired flatfoot deformity and posterior tibial tendon dysfunction to better reflect its pathology, which consists of a complex three-dimensional deformity involving the foot and ankle. The new consensus has also provided a new classification that requires clinical and radiographic findings for patient stratification into each class. However, conventional radiographs are susceptible to errors resulting from the inadequate positioning of patients, incorrect angulation of the X-ray tube, and overlapping of bone structures. Weightbearing cone beam computed tomography (WBCBCT), which has greater diagnostic accuracy than conventional radiograph, is useful for evaluating progressive collapsing foot deformity to determine medial arch collapse, hindfoot alignment, peritalar subluxation, posterior subtalar joint valgus, intrinsic talus valgus, and lateral extra-articular bone impingement. The present review aimed to discuss the new recommendations for nomenclature, classification, and imaging evaluation of PCFD, with an illustrative and quantitative focus on the measurements used in conventional radiography and WBCBCT. The measurements presented here are important criteria for decision-making.
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Affiliation(s)
- Carlos Felipe Teixeira Lôbo
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.
| | - Eduardo Araújo Pires
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil
| | - Marcelo Bordalo-Rodrigues
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Alexandre Leme Godoy-Santos
- Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP, 05403-010, Brazil.,Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, SP, 05652-900, Brazil
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8
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Winn N, Kaur S, Cassar-Pullicino V, Ockendon M. A novel use of cone beam CT: flexion and extension weight-bearing imaging to assess spinal stability. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1667-1681. [PMID: 35585251 DOI: 10.1007/s00586-022-07233-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess spinal stability in different physiological positions whilst weight-bearing. METHODS A cone beam CT scanner (CBCT) was used to identify any abnormal motion in the spine in different physiological positions whilst weight-bearing. The lumbar spine was assessed in 6 different patients with a comfortable neutral standing position and standing flexion and extension images in selected patients. Seated, weight-bearing flexion and extension images of the cervical spine were obtained in a further patient. Clinical indications included stability assessment post-trauma, post-surgical fusion and back pain. The projection images were reconstructed using bone and soft tissue algorithms to give isotropic CT images which could be viewed as per conventional multi-detector CT images. The flexion and extension CBCT data were fused to give a representation of any spinal movement between the extremes of motion. RESULTS The flexion and extension weight-bearing images gave anatomical detail of the spine. Detail of the surgical constructs was possible. Dynamic structural information about spinal alignment, facet joints, exit foramina and paraspinal musculature was possible. The effective dose from the neutral position was equal to that of supine, multi-detector CT. CONCLUSION CBCT can be used to image the lumbar and cervical spine in physiological weight-bearing positions and at different extremes of spinal motion. This novel application of an existing technology can be used to aid surgical decision making to assess spinal stability and to investigate occult back and leg pain. Its use should be limited to specific clinical indications, given the relatively high radiation dose.
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Affiliation(s)
- Naomi Winn
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK.
| | - Simranjeet Kaur
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK
| | - Victor Cassar-Pullicino
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK
| | - Matthew Ockendon
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK
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Arena CB, Sripanich Y, Leake R, Saltzman CL, Barg A. Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography. Foot Ankle Int 2021; 42:1482-1490. [PMID: 34109833 DOI: 10.1177/10711007211014171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hindfoot alignment view (HAV) radiographs are widely utilized for 2-dimensional (2D) radiographic assessment of hindfoot alignment; however, the development of weightbearing computed tomography (WBCT) may provide more accurate methods of quantifying 3-dimensional (3D) hindfoot alignment. The aim of this study was to compare the 2D calcaneal moment arm measurements on HAV radiographs with WBCT. METHODS This retrospective cohort study included 375 consecutive patients with both HAV radiographs and WBCT imaging. Measurement of the 2D hindfoot alignment moment arm was compared between both imaging modalities. The potential confounding influence of valgus/varus/neutral alignment, presence of hardware, and motion artifact were further analyzed. RESULTS The intraclass correlation coefficients (ICCs) of interobserver and intraobserver reliability for measurements with both imaging modalities were excellent. Both modalities were highly correlated (Spearman coefficient, 0.930; P < .001). HAV radiographs exhibited a mean calcaneal moment arm difference of 3.9 mm in the varus direction compared with WBCT (95% CI, -4.9 to 12.8). The difference of hindfoot alignment between both modalities was comparable in subgroups with neutral/valgus/varus alignment, presence of hardware, and motion artifact. CONCLUSION Both HAV radiographs and WBCT are highly reliable and highly correlated imaging methods for assessing hindfoot alignment. Measurements were not influenced by severe malalignment, the presence of hardware, or motion artifact on WBCT. On average, HAV radiographs overestimated 3.9 mm of varus alignment as compared with WBCT. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Christopher B Arena
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Orthopedic Sports Institute, Institute for Orthopedic Research & Innovation, Coeur d'Alene, ID, USA
| | - Yantarat Sripanich
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Tung Phayathai, Ratchathewi, Bangkok, Thailand
| | - Richard Leake
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
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Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools. Sci Rep 2021; 11:16139. [PMID: 34373546 PMCID: PMC8352889 DOI: 10.1038/s41598-021-95708-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Acquired adult flatfoot is a frequent deformity which implies multiple, complex and combined 3D modifications of the foot skeletal structure. The difficult thorough evaluation of the degree of severity pre-op and the corresponding assessment post-op can now be overcome by cone-beam (CBCT) technology, which can provide access to the 3D skeletal structure in weight-bearing. This study aims to report flatfoot deformities originally in 3D and in weight-bearing, with measurements taken using two different bone segmentation techniques. 21 such patients, with indication for surgical corrections, underwent CBCT (Carestream, US) while standing on one leg. From these scans, 3D models of each bone of the foot were reconstructed by using two different state-of-the-art segmentation tools: a semi-automatic (Mimics Innovation Suite, Materialise, Belgium), and an automatic (Bonelogic Ortho Foot and Ankle, Disior, Finland). From both reconstructed models, Principal Component Analysis was used to define anatomical reference frames, and original foot and ankle angles and other parameters were calculated mostly based on the longitudinal axis of the bones, in anatomical plane projections and in 3D. Both bone model reconstructions revealed a considerable valgus of the calcareous, plantarflexion and internal rotation of the talus, and typical Meary’s angles in the lateral and transverse plane projections. The mean difference from these angles between semi-automatic and automatic segmentations was larger than 3.5 degrees for only 3 of the 32 measurements, and a large number of these differences were not statistically significant. CBCT and the present techniques for bone shape reconstruction finally provide a novel and valuable 3D assessment of complex foot deformities in weight-bearing, eliminating previous limitations associated to unloaded feet and bidimensional measures. Corresponding measurements on the bone models from the two segmentation tools compared well. Other more representative measurements can be defined in the future using CBCT and these techniques.
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11
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The awareness of hindfoot malalignment on non-weight-bearing ankle MRI. Skeletal Radiol 2021; 50:1317-1323. [PMID: 33230727 DOI: 10.1007/s00256-020-03674-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hindfoot malalignment is a relatively common clinical finding and several studies have suggested that hindfoot valgus can be identified on non-weight-bearing ankle MRI. The aim of this study was to determine the awareness of hindfoot malalignment on ankle MRI amongst consultant musculoskeletal radiologists. MATERIALS AND METHODS All MRI studies referred by Foot and Ankle Unit Consultants reported by one of 14 consultant musculoskeletal radiologists between March 2016 and August 2019 were retrieved from the Hospital Radiology Information System. These were reviewed independently by a radiology fellow and a consultant radiologist. Tibiocalcaneal angle (TCA) was measured, and extra-articular talocalcaneal (EA-TCI) and calcaneofibular impingement (EA-CFI) were recorded. Radiology reports were then analysed for mention of hindfoot malalignment and the presence of EA-TCI and EA-CFI. RESULTS The study group comprised 129 patients, 46 males and 83 females with a mean age of 46.8 years (range 8-84 years). Based on review, hindfoot valgus was present in 78-80 cases (60.5-62%), EA-TCI in 30-36 cases (23.2-27.9%) and EA-CFI in 18-21 cases (14-16.3%). By comparison, MRI reports mentioned hindfoot valgus in 18 cases (2 incorrectly), EA-TCI in 8 cases (1 incorrectly) and EA-CFI in 10 cases (1 incorrectly). CONCLUSION Hindfoot valgus, EA-TCI and EA-CFI were present relatively commonly on review of ankle MRI studies in patients referred from a specialist Foot and Ankle Unit but were commonly under-reported highlighting a relative lack of awareness of hindfoot malalignment on ankle MRI amongst musculoskeletal radiologists, which could impact negatively on patient management.
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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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13
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Toyooka S, Shimazaki N, Yasui Y, Ando S, Saho Y, Nakagawa T, Kawano H, Miyamoto W. Validity of a simple footprint assessment board for diagnosing the severity of flatfoot: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:285. [PMID: 33736625 PMCID: PMC7977274 DOI: 10.1186/s12891-021-04154-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A simple, non-quantitative, and cost-effective diagnostic tool would enable the diagnosis of flatfoot without need for specialized training. A simple footprint assessment board that investigates which toe the cord passes through from the centre point of the heel to the most lateral point of the medial contour of the footprint has been developed to assess flatfoot. The purpose of this study was to verify the validity of a simple footprint assessment board for flatfoot. METHODS Thirty-five consecutive patients with foot pain, foot injury, or any associated symptoms who underwent computed tomography (CT) were analysed prospectively. At the time of the CT scan, a footprint analysis using a simple footprint assessment board was performed. The navicular index, tibiocalcaneal angle, and calcaneal inclination angle were evaluated by CT to assess flat feet. These three criteria were compared to those evaluated with the simple footprint assessment board by regression analysis. In addition, the same analysis was conducted separately for young, middle-aged, and older patients in order to investigate each age group. RESULTS The navicular index and tibiocalcaneal angle generally decreased as the score of the simple footprint assessment board increased. Calcaneal inclination angle generally increased as the score of the simple footprint assessment board increased. As the scores of the simple footprint assessment board decreased by approaching the great toe, the navicular index and tibiocalcaneal angle were higher and calcaneal inclination angle was lower, which is indicative of a higher likelihood of flatfoot. The scores derived from the simple footprint assessment board was correlated with these three criteria measured by CT, not only when the result of simple footprint assessment board was set as a non-continuous variable but also when the result was set as a continuous variable. The results of the age-stratified survey were similar for all groups. CONCLUSIONS The findings of this study suggest that a simple footprint assessment board can be potentially useful to detect flatfoot. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoya Shimazaki
- Department of Orthopaedic Surgery, Shimazaki Hospital, Ibaraki, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ando
- Department of Information Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yasuaki Saho
- Faculty of Medical Technology, Teikyo University Institute of Sports Science and Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
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