1
|
Jo J, Park H. Fit of fire boots: exploring internal morphology using computed tomography. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:90-99. [PMID: 37596795 DOI: 10.1080/10803548.2023.2247765] [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] [Indexed: 08/20/2023]
Abstract
Fit of fire boots is a crucial factor in the safety and performance of firefighters on the hostile fireground. Firefighters have reported that ill-fitting fire boots restrict their lower body movement and sometimes cause very dangerous situations by falling off behind the wearer. By using computed tomography, this study demonstrates the potential to quantify and visualize the fit of fire boots, which previously relied on subjective feedback from the wearers. The high-resolution three-dimensional (3D) models of two fire boot products allowed a detailed observation and measurement of the internal space of the boots. Also, the boot's internal dimension was compared to the foot measurement of local firefighters, showing the significant differences between the two boots. Lastly, simulation wrapping the 3D scanned foot with the boot revealed large void spaces around the toe box and ankle, as well as the narrower ball width of the boot than the foot.
Collapse
Affiliation(s)
- Jeyeon Jo
- Department of Human Centered Design, Cornell University, USA
- Department of Textiles, Merchandising and Interiors, University of Georgia, USA
| | - Huiju Park
- Department of Human Centered Design, Cornell University, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Day J, de Cesar Netto C, Burssens A, Bernasconi A, Fernando C, Lintz F. A Case-Control Study of 3D vs 2D Weightbearing CT Measurements of the M1-M2 Intermetatarsal Angle in Hallux Valgus. Foot Ankle Int 2022; 43:1049-1052. [PMID: 35502522 DOI: 10.1177/10711007221091812] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Weightbearing computed tomography (WBCT) 3-dimensional measurements may be reliable in assessing hallux valgus (HV). The objective of this study was to compare 2D and 3D WBCT measurements of the M1-M2 intermetatarsal angle (IMA) in patients with HV and in healthy controls. We hypothesized that 2D and 3D IMA measurements would correlate and have similar reliability in both HV and controls. METHODS Retrospective multicenter comparative study included WBCT scans from 83 feet (41 HV, 42 controls). IMA was measured on digitally reconstructed radiographs (DRR-IMA). 3D angle (3D-IMA) and its projection on the weightbearing plane (2D-IMA) were calculated from 3D coordinates of the first and second metatarsals. Intraobserver reliability and intermethod correlations were calculated using intraclass correlation coefficients (ICCs). RESULTS Intraobserver reliability was very strong for DRR-IMA (0.95) and 3D-IMA (0.99). Intermethod correlation between the 3 modalities in HV patients ranged from moderate (DRR vs 2D, 0.48; DRR vs 3D, 0.48) to very strong (2D vs 3D, 0.91). Similarly, intermethod correlation in the control group ranged from moderate (DRR vs 2D, 0.56; DRR vs 3D, 0.60) to very strong (2D vs 3D, 0.92). CONCLUSION Measurements for IMA are similar using DRR, 3D and 2D projected angles, with very strong intraobserver reliability and moderate to very strong intermethod correlations. This is the first head-to-head comparison between these measurement modalities in HV. Further investigations are warranted before formulating guidelines for the clinical use of 3D angles. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
Affiliation(s)
- Jonathan Day
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Arne Burssens
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Alessio Bernasconi
- Frederico II University, Department of Orthopedic Surgery, Napoli, Italy
| | - Celine Fernando
- Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| | - François Lintz
- Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| |
Collapse
|
4
|
Pallamar M, Bock P, Kranzl A, Fruehwald-Pallamar J, Farr S, Ganger R. Does the way of weight-bearing matter? Single-leg and both-leg standing radiographic and pedobarographic differences in pediatric flatfoot. Gait Posture 2022; 93:135-141. [PMID: 35149243 DOI: 10.1016/j.gaitpost.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/22/2021] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND An exact definition is lacking for the term "weight-bearing" or different standing modalities when implementing foot radiographs for children and adults; moreover, only few studies have investigated the relationship between radiographic and pedobarographic measurements. RESEARCH QUESTION We hypothesized that the method of weight-bearing in single-leg and both-leg standing positions could influence the measurement results in radiographs and the distribution of foot pressure. METHODS This prospective study evaluated 33 children (66 feet) with flexible flatfoot deformities scheduled for subtalar screw arthroereisis surgery. Radiographs in the lateral and anteroposterior (AP) views were assessed independently in the single-leg and both-leg standing positions. Static pedobarography was performed as that for measuring weight-bearing. Standardized radiographic angles and pedobarographic data were analysed and correlated. RESULTS There were differences in radiographic measurements between the single-leg and both-leg standing positions, including the AP talocalcaneal angle (p = 0.032), AP talus-first metatarsal base angle (p = 0.003), AP talus-first metatarsal angle (p = 0.003), lateral calcaneal pitch angle (p = 0.001), talus-first metatarsal index (p = 0.004), and talocalcaneal index (p = 0.029). Moreover, differences between these two standing modalities were found in most of the static pedobarographic data, including the contact area (p = 0001), maximal force (p = 0.001), and peak pressure (p = 0.007). Overall, medial foot pressure increased more in both-leg standing than in the single-leg standing position, whereas radiographic measurements showed a more pronounced flatfoot deformity in the single-leg standing position. The AP talus-first metatarsal angle was the only angle or index with a significant association to some pedobarographic measurements in both standing modalities. SIGNIFICANCE As there are significant differences between single-leg standing and both-leg standing radiographic and static pedobarographic values, observers have to be precise in the definition of "weight-bearing" to gain reproducible and comparable study values in children and adults. We recommend acquiring both-leg standing foot radiographs because children with flexible flatfeet can stand more steadily in this position than in the single-leg standing position.
Collapse
Affiliation(s)
- Matthias Pallamar
- From the Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria.
| | - Peter Bock
- From the Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
| | - Andreas Kranzl
- The Laboratory for Gait and Human Movements, Orthopaedic Hospital Speising, Vienna, Austria
| | | | - Sebastian Farr
- From the Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
| | - Rudolf Ganger
- From the Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
| |
Collapse
|
5
|
Abstract
The standard for diagnostic radiographic imaging in foot and ankle surgery was until 2012 radiographs with full weight-bearing without any useful alternative. Weight-bearing cone-beam computed tomography (WBCT) was introduced 2012 for foot and ankle use as a new technology that allows 3D imaging with full weight-bearing which should be not influenced by projection and/or foot orientation. The assessment of ankle osteoarthritis with WBCT including the description of healthy status, effect of alignment and7or (in)stability is extensively illustrated in this review article.
Collapse
|
6
|
Day J, de Cesar Netto C, Richter M, Mansur NS, Fernando C, Deland JT, Ellis SJ, Lintz F. Evaluation of a Weightbearing CT Artificial Intelligence-Based Automatic Measurement for the M1-M2 Intermetatarsal Angle in Hallux Valgus. Foot Ankle Int 2021; 42:1502-1509. [PMID: 34088236 DOI: 10.1177/10711007211015177] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Weightbearing cone beam computed tomography (WBCT) has been gaining traction as a useful imaging modality in the diagnosis and follow-up of foot and ankle musculoskeletal pathologies due to the ability to perform quick, low-dose, 3-dimensional (3D) scans. However, the resulting wealth of 3D data renders daily clinical use time-consuming. The aim of this study was to evaluate a new artificial intelligence (AI)-based automatic measurement for the M1-M2 intermetatarsal angle (IMA) in hallux valgus (HV). We hypothesized that automatic and manual measurements would have a strong correlation, and that the AI software would yield better reproducibility and would be faster compared with manual measurements. METHODS This was a multicenter retrospective comparative case-control study in which a total of 128 feet were included from 93 patients who underwent WBCT scans as part of their routine follow-up: 59 feet with symptomatic HV and 69 controls. The IMA was measured automatically using the AI software and manually on digitally reconstructed radiographs (DRRs). The AI software produced both an automatic 2D (auto 2D) and 3D (auto 3D) measurement. RESULTS There were strong intermethod correlations between the DRR IMA and the auto 2D (HV, r = 0.61; control, r = 0.60; all P < .0001) and auto 3D (HV, r = 0.63; control, r = 0.52; all P < .0001) measurements, respectively. The intrasoftware reproducibility was very close to 100%. Measurements took 23.6 ± 2.31 seconds and 14.5 ± 1.18 seconds, respectively, when taken manually on DRRs and automatically. Controls demonstrated a mean DRR IMA of 8.6 (95% CI, 8.1-9.1), mean auto 2D of 11.2 (95% CI, 10.7-11.7), and mean auto 3D IMA of 11.0 (95% CI, 10.5-11.5). The HV group demonstrated significantly increased IMA compared with controls (P < .0001), with a mean DRR IMA of 15.4 (95% CI, 14.8-16.1), mean auto 2D of 17.8 (95% CI, 17.2-18.4), and mean auto 3D IMA of 16.8 (95% CI, 16.8-17.4). CONCLUSION Measurements generated by the WBCT AI-based automatic measurement system for IMA demonstrated strong correlations with manual measurements, with near-perfect reproducibility. Further developments are warranted in order to make this tool more usable in daily practice, particularly with respect to its use in the presence of hardware in the foot. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Jonathan Day
- Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Martinus Richter
- Department for Foot and Ankle Surgery, Nuremberg and Rummelsberg, Schwarzenbruck, Germany
| | - Nacime Salomao Mansur
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Celine Fernando
- Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| | | | | | - François Lintz
- Foot and Ankle Surgery Center, Clinique de l'Union, Saint-Jean, France
| |
Collapse
|
7
|
Day J, de Cesar Netto C, Nishikawa DRC, Garfinkel J, Roney A, J O'Malley M, T Deland J, J Ellis S. Three-Dimensional Biometric Weightbearing CT Evaluation of the Operative Treatment of Adult-Acquired Flatfoot Deformity. Foot Ankle Int 2020; 41:930-936. [PMID: 32506953 DOI: 10.1177/1071100720925423] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Assessment of operative correction of adult-acquired flatfoot deformity (AAFD) has been traditionally performed by clinical evaluation and conventional radiographic imaging. Previously, a 3-dimensional biometric weightbearing computed tomography (WBCT) tool, the foot ankle offset (FAO), has been developed and validated in assessing hindfoot alignment. The purpose of this study was to investigate the role of FAO in evaluating operative deformity correction in AAFD. METHODS In this prospective comparative study, 19 adult patients (20 feet) with stage II (flexible) flatfoot deformity underwent preoperative and postoperative standing WBCT examination at mean 19 months (range, 6-24) after surgery. Three-dimensional coordinates of the foot tripod and center of the ankle joint were acquired by 2 independent and blinded observers. These coordinates were used to calculate the FAO using dedicated software, and subsequently compared pre- and postoperatively. The FAO is a previously validated biometric measurement that represents centering of the foot tripod as well as hindfoot alignment, with a normal mean FAO of 2.3% ± 2.9%. In addition, Patient Reported Outcomes Measurement Information System (PROMIS) clinical outcomes scores were compared pre- and postoperatively with a mean follow-up of 22.6 months (range, 14-37). RESULTS There was significant correction of flatfoot deformity from a mean preoperative FAO of 9.8% to a mean postoperative value of 1.3% (P < .001). Additionally, there was statistically significant improvement in all PROMIS domains (P < .05), except depression, at an average follow-up of 22.6 months. Spring ligament reconstruction was the only procedure associated with a significant correction in FAO (P = .0064). CONCLUSION The FAO was a reliable and sensitive tool that was used to evaluate preoperative deformity as well as postoperative correction, with patients demonstrating both significant improvement in FAO as well as patient-reported outcomes. These findings demonstrate the role for biometric 3-dimensional WBCT imaging in assessing operative correction after flatfoot reconstruction, as well as the potential role for operative planning to address preoperative deformity. LEVEL OF EVIDENCE Level II, prospective comparative study.
Collapse
Affiliation(s)
| | - Cesar de Cesar Netto
- Department of Orthopedic Foot and Ankle Surgery, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Danilo R C Nishikawa
- Department of Orthopaedics, Hospital do Servidor Publico Municipal de Sao Paulo (HSPM), Foot and Ankle Surgery, Sao Paolo, SP, Brazil
| | | | | | | | | | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
|
10
|
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: 178] [Impact Index Per Article: 29.7] [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.
Collapse
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
| |
Collapse
|
11
|
Barg A, Ruiz R, Hintermann B. [Triple arthrodesis for correction of cavovarus deformity]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:461-472. [PMID: 29052742 DOI: 10.1007/s00064-017-0519-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/01/2017] [Accepted: 07/12/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim is to correct the underlying cavovarus deformity and to achieve a pain-free and stable hindfoot. INDICATIONS Rigid neurologic, posttraumatic, congenital, and idiopathic cavovarus deformities. CONTRAINDICATIONS General surgical or anesthesiological risks, infections, critical soft tissue conditions, neurovascular impairment of the lower extremity, noncompliance, patients with severely reduced bone quality, insulin-dependent diabetes mellitus, smoking. SURGICAL TECHNIQUE The talonavicular and subtalar joints are exposed using a single medial approach. Joint cartilage is carefully debrided. Hindfoot reposition with complete correction of cavovarus deformity in all three planes. Joints are stabilized using cannulated screws, followed by wound closure. POSTOPERATIVE MANAGEMENT A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts on postoperative day 1 using a stabilizing walking boot or cast for 6 weeks with 15 kg partial weight bearing. Clinical and radiographic follow-up 6 weeks postoperatively to assess osseous consolidation at the arthrodesis site. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is gradually initiated. RESULTS Between January 2012 and July 2014, triple arthrodesis was performed in 11 patients with a mean age of 62 ± 14 years due to cavovarus deformity. The mean follow-up was 34 ± 8 months (range 24-48 months). In all patients, the cavovarus deformity was substantially corrected. Significant pain relief from 7.1 ± 2.2 (range 5-10) to 1.8 ± 1.5 (range 0-4) on the visual analogue scale was observed.
Collapse
Affiliation(s)
- A Barg
- Orthopädische Klinik, Universität Utah, 590 Wakara Way, 84108, Salt Lake City, UT, USA.
- Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA.
| | - R Ruiz
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland, Liestal, Schweiz
| | - B Hintermann
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland, Liestal, Schweiz
| |
Collapse
|