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Krüger L, Hedar A, Simon A, Spethmann T, Heinemann A, Viezens L, Lenz AL, Amling M, Beil FT, Hahn M, Rolvien T. Influence of the transverse tarsal arch on radiological components of progressive collapsing foot deformity. J Orthop Res 2024. [PMID: 39072848 DOI: 10.1002/jor.25946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/27/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
The importance of the transverse tarsal arch (TTA) has recently been extensively reevaluated and has even been considered to play a greater role in foot stability than the medial longitudinal arch (MLA). However, the relevance of this observation in the context of common clinical foot disorders, such as progressive collapsing foot deformity (PCFD), has not yet been fully clarified. In this biomechanical study, we examined ten pairs of human cadaveric feet by serial weight-bearing cone-beam computed tomography under controlled loading using a custom-designed testing machine. The MLA and TTA were transected separately, alternating the order in two study groups. A semiautomated three-dimensional evaluation of their influence on three components of PCFD, namely collapse of the longitudinal arch (sagittal Meary's angle), hindfoot alignment (sagittal talocalcaneal angle), and forefoot abduction (axial Meary's angle), was performed. Both arches had a relevant effect on collapse of the longitudinal arch, however the effect of transecting the MLA was stronger compared to the TTA (sagittal Meary's angle, 7.4° (95%CI 3.8° to 11.0°) vs. 3.2° (95%CI 0.5° to 5.9°); p = 0.021). Both arches had an equally pronounced effect on forefoot abduction (axial Meary's angle, 4.6° (95%CI 2.0° to 7.1°) vs. 3.0° (95%CI 0.6° to 5.3°); p = 0.239). Neither arch showed a consistent effect on hindfoot alignment. In conclusion, weakness of the TTA has a decisive influence on radiological components of PCFD, but not greater than that of the MLA. Our findings contribute to a deeper understanding and further development of treatment concepts for flatfoot disorders.
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Affiliation(s)
- Lara Krüger
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ali Hedar
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Simon
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Spethmann
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Viezens
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Michael Amling
- Institute of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hahn
- Institute of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Doan MK, Long JR, Verhey E, Wyse A, Patel K, Flug JA. Cone-Beam CT of the Extremities in Clinical Practice. Radiographics 2024; 44:e230143. [PMID: 38421913 DOI: 10.1148/rg.230143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Cone-beam CT (CBCT) is a promising tool with increasing applications in musculoskeletal imaging due to its ability to provide thin-section CT images of the appendicular skeleton and introduce weight bearing, which accounts for loading forces that typically interact with and affect this anatomy. CBCT devices include an x-ray source directly opposite a digital silicon detector panel that performs a single rotation around an object of interest, obtaining thin-section images. Currently, the majority of research has been focused on the utility of CBCT with foot and ankle pathologic abnormalities, due to the complex architectural arrangement of the tarsal bones and weight-bearing nature of the lower extremities. Associated software can provide a variety of options for image reconstruction, including metal artifact reduction, three-dimensional biometric measurements, and digitally reconstructed radiographs. Advancements in this technology have allowed imaging of the knee, hip, hand, and elbow. As more data are published, it is becoming evident that CBCT provides many additional benefits, including fast imaging time, low radiation dose, lower cost, and small equipment footprint. These benefits allow placement of CBCT units outside of the traditional radiology department, including the orthopedic clinic setting. These technologic developments have motivated clinicians to define the scope of CBCT for diagnostics, surgical planning, and longitudinal imaging. As efforts are made to create standardized protocol and measurements, the current understanding and surgical approach for various orthopedic pathologic conditions will continue to shift, with the hope of improving outcomes. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Matthew K Doan
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Jeremiah R Long
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Erik Verhey
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Aaron Wyse
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Karan Patel
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Jonathan A Flug
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
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Chien BY, Greisberg JK, Arciero E. Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review. Foot Ankle Int 2023; 44:796-809. [PMID: 37341112 DOI: 10.1177/10711007231178538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The spring ligament is one of the main stabilizers of the medial arch of the foot and the primary static supporter of the talonavicular joint. Attenuation or rupture of this ligament is thought to play a central role in the pathophysiology of progressive collapsing foot deformity. Traditional correction of flexible flatfoot consists of posterior tibial tendon augmentation along with various osteotomies or hindfoot fusions. Repair or reconstruction of the spring ligament has not been as widely pursued. In recent years, newer techniques have been explored and may improve outcomes of traditional procedures, or possibly entirely replace some osteotomies. Combined spring-deltoid ligament reconstruction is also gaining traction as a viable technique, particularly as the ankle begins to deform into valgus. This review summarizes the variety of nonanatomic and anatomic reconstruction techniques that have been described, including autologous tendon transfers, allografts, and synthetic augmentation. Although many have only been characterized in biomechanical cadaver studies, this article reviews preliminary clinical studies that have shown promising results. There is a need for more high-quality studies evaluating the clinical, radiographic, and patient-reported outcomes following spring ligament reconstruction.
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Affiliation(s)
- Bonnie Y Chien
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin K Greisberg
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily Arciero
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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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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