Distance mapping of the foot and ankle joints using weightbearing CT: The cavovarus configuration

Category: Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The cavovarus configuration sets the grounds for various pathological conditions, often involving the arthritic degeneration of the medial column. The objective of this study was to analyze the joint surface interaction at the ankle, hindfoot and midfoot joints using distance mapping on WBCT images in a series of cavovarus feet and compare them to normally aligned feet. Methods: In this case-control study, a database containing WBCT datasets from 370 feet (189 patients) obtained in a specialized foot and ankle unit from July 2016 to October 2018 was used. Ten feet (10 patients) with asymptomatic cavovarus shape were extracted (cases group; N= 10) and compared to 10 matched-paired (by age, gender and body mass index) normally aligned feet (10 patients) (controls group; N=10). Colored distance maps were generated for the ankle, hindfoot and midfoot joints and divided in zones, therefore differences were assessed between the two groups. Results: In the cavovarus group there was a significant increase in surface-to-surface distance at the posterior tibiotalar joint and a reduced distance at the anterior part, together with a greater distance at the posterior half of the medial gutter. Also, a decrease in surface-to-surface distance on the anterior half of the anterior facet and an increased distance on the posterior quadrants of the posterior facet of the subtalar joint were found. At the sinus tarsi, the lateral aspect of the talonavicular joint, the naviculocuneiform and the tarsometatarsal joints there was a statistically significant increase in surface-to-surface distance in cavovarus patients as compared to controls. Conclusion: In this study, the use of distance mapping analysis on WBCT images enabled to identify significant differences in surface-to-surface interaction at the foot and ankle joints between cavovarus and normally-aligned feet.

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Foot and Ankle Joint Biomechanical Adaptations to an Unpredictable Coronally Uneven Surface

Journal of Biomechanical Engineering ◽

10.1115/1.4037563 ◽

2018 ◽

Vol 140 (3) ◽

Cited By ~ 4

Author(s):

Ava D. Segal ◽

Kyle H. Yeates ◽

Richard R. Neptune ◽

Glenn K. Klute

Keyword(s):

Foot And Ankle ◽

Uneven Surface ◽

Prosthetic Devices ◽

Uneven Terrain ◽

Increased Risk ◽

Heel Contact ◽

Ankle Joints ◽

Foot Model ◽

Ankle Complex ◽

Mobility Impaired

Coronally uneven terrain, a common yet challenging feature encountered in daily ambulation, exposes individuals to an increased risk of falling. The foot-ankle complex may adapt to improve balance on uneven terrains, a recovery strategy which may be more challenging in patients with foot-ankle pathologies. A multisegment foot model (MSFM) was used to study the biomechanical adaptations of the foot and ankle joints during a step on a visually obscured, coronally uneven surface. Kinematic, kinetic and in-shoe pressure data were collected as ten participants walked on an instrumented walkway with a surface randomly positioned ±15 deg or 0 deg in the coronal plane. Coronally uneven surfaces altered hindfoot–tibia loading, with more conformation to the surface in early than late stance. Distinct loading changes occurred for the forefoot–hindfoot joint in early and late stance, despite smaller surface conformations. Hindfoot–tibia power at opposite heel contact (@OHC) was generated and increased on both uneven surfaces, whereas forefoot–hindfoot power was absorbed and remained consistent across surfaces. Push-off work increased for the hindfoot–tibia joint on the everted surface and for the forefoot–hindfoot joint on the inverted surface. Net work across joints was generated for both uneven surfaces, while absorbed on flat terrain. The partial decoupling and joint-specific biomechanical adaptations on uneven surfaces suggest that multi-articulating interventions such as prosthetic devices and arthroplasty may improve ambulation for mobility-impaired individuals on coronally uneven terrain.

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Comparison of a new versus standard removable offloading device in patients with neuropathic diabetic foot ulcers: a French national, multicentre, open-label randomized, controlled trial

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000954 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000954

Author(s):

Louis Potier ◽

Maud François ◽

Dured Dardari ◽

Marilyne Feron ◽

Narimene Belhatem ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Adverse Events ◽

Diabetic Foot ◽

Primary Outcome ◽

Controlled Trial ◽

Control Group ◽

Foot And Ankle ◽

End Points ◽

Randomized Controlled ◽

Ankle Joints

IntroductionThe offloading is crucial to heal neuropathic diabetic foot ulcer (DFU). Removable offloading are the most used devices. Orthèse diabète is a new customized removable knee-high offloading device immobilizing foot and ankle joints, with some specific and innovative features that may improve offloading. We aimed to evaluate the efficiency of this device in DFU healing.Research, design and methodsThe evaluation of Offloading using a new removable ORTHOsis in DIABetic foot study is a French multicenter (13 centers) randomized controlled trial with blinded end points evaluation. Adults with neuropathic DFU were randomly assigned to either Orthèse Diabète (experimental device), or any type of conventional (usually used in France) removable offloading devices (control group). The primary outcome was the 3-month proportion of patients with fully healed DFU.ResultsAmong 112 randomized patients (men 78%, age 62±10 years), the primary outcome occurred in 19 (33%) participants using conventional device vs 19 (35%) Orthèse Diabète users (p=0.79). Study groups were also comparable in terms of prespecified secondary end points including occurrence of new DFU (25% vs 27% in conventional and experimental groups), ipsilateral lower-limb amputation (4% vs 10%) or infectious complications (14% vs 13%) (p>0.05 for all). Adverse events were comparable between groups, including 4 deaths unrelated to study allocation (1 sudden death, 2 ventricular arrhythmias and 1 pancreatic cancer). Adverse events believed to be related to the device were higher in the Orthèse Diabète group than in the control group (15% vs 4%). Orthèse Diabète was less frequently worn than conventional devices (46% vs 66%, p=0.04).ConclusionsOrthèse Diabète, a new removable offloading orthosis immobilizing foot and ankle joints did not show superiority compared with conventional removable devices in neuropathic DFU healing and cannot be recommended to heal DFU.Trial registration numberNCT01956162.

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The Effects of Kinesio Taping Applying to Foot and Ankle Joints on Foot Pressure and Gait in Patients with Chronic Stroke

10.17817/2019.05.28.111397 ◽

2019 ◽

Author(s):

Lee Bo

Keyword(s):

Chronic Stroke ◽

Foot And Ankle ◽

Foot Pressure ◽

Kinesio Taping ◽

Ankle Joints

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Combination of PedCAT Weightbearing CT With Pedography Assessment of the Relationship Between Anatomy-Based Foot Center and Force/Pressure-Based Center of Gravity

Foot & Ankle International ◽

10.1177/1071100717744206 ◽

2017 ◽

Vol 39 (3) ◽

pp. 361-368 ◽

Cited By ~ 22

Author(s):

Martinus Richter ◽

Francois Lintz ◽

Stefan Zech ◽

Stefan Andreas Meissner

Keyword(s):

Relative Position ◽

Standing Position ◽

Center Of Gravity ◽

Foot And Ankle ◽

Ankle Surgery ◽

Definition Of ◽

The Relationship ◽

Weightbearing Ct ◽

Force Pressure

Background: A customized pedography sensor (Pliance; Novel, Munich, Germany) was inserted into a pedCAT (Curvebeam, Warrington, PA). The aim of this study was to analyze the relative position of the anatomical foot center (FC) and the pedographic center of gravity (COG). The hypothesis was that FC should be a good predictor of mediolateral position of COG but not longitudinal since hindfoot anatomy allows free anteroposterior movement but limited mediolateral movement. Methods: In 90 patients (180 feet), a pedCAT scan with simultaneous pedography with full weightbearing in a standing position was performed. The morphology-based definition of the FC was performed with the pedCAT data following the Torque Ankle Lever Arm System (TALAS) algorithm. The force/pressure-based COG was defined with the pedography data using a software-based algorithm. The distance between FC and COG and the direction of a potential shift (distal-proximal, mediolateral) was measured and analyzed. COG motion during data acquisition was recorded and analyzed. Mean age of patients was 53.8 (range, 17-84) years, and 57 (63%) were female. Results: The distance between FC and COG was 28.7 mm on average (range, 0-60). FC was distal to COG in 175 feet (97%; mean, 27.5 mm; range, –15 to 60) and lateral in 112 feet (62%; mean, 2.0 mm; range, –18 to 20). Conclusions: There was a constant and major distal longitudinal shift of COG relative to FC and an inconstant minor mediolateral shift. Clinical Relevance: The data might be taken into consideration for planning and follow-up in foot and ankle surgery.

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Kinematic Analysis of the Coupling Between Calcaneal Eversion and Ankle Dorsiflexion in a Contemporary Dancer’s Demi-Plié

Medical Problems of Performing Artists ◽

10.21091/mppa.2021.1007 ◽

2021 ◽

Vol 36 (1) ◽

pp. 45-53

Author(s):

Anna Schrefl ◽

Rolf van de Langenberg ◽

Andrea Schärli

Keyword(s):

Range Of Motion ◽

Lower Leg ◽

Ankle Dorsiflexion ◽

Foot And Ankle ◽

Research Focus ◽

Kinematic Data ◽

Ankle Joints ◽

Leg Alignment ◽

Temporal Coupling ◽

High Range

BACKGROUND: Dancing requires a high range of motion in the foot as well as a good shock-absorbing system formed by the foot and ankle joints. Although there is a broad consensus in dance that excessive calcaneal eversion can cause injury and should be avoided, calcaneal eversion is discussed controversially in the dance literature. An increased research focus on the biomechanics of dance, particularly research pertaining to the foot and ankle joints, might help to resolve this controversy. OBJECTIVES: The study’s main purpose was to generate hitherto lacking kinematic data of calcaneal eversion in a dancer’s demi-plié. METHODS: Thirty-two contemporary dancers performed three trials in two different conditions: demi-plié in parallel and in turned-out positions. The motion capture system FASTRAK was used to measure calcaneal eversion and foot and lower leg alignment during demi-plié. RESULTS: Maximal calcaneal eversion in turned-out demi-pliés was 3.36°±4° and total range of motion (i.e., maximal minus minimal angle) of calcaneal eversion was 3.73°±1.42°, where the large standard deviations indicate substantial variability across participants. Calcaneal eversion was significantly different between turned-out (3.36°±4°) and parallel (1.17°±4.06°) demi-pliés, as was the alignment of the lower leg and foot, where the lower leg tracked more medially relative to the foot during turned-out pliés. Crucially, both the magnitude of calcaneal eversion and its temporal coupling with ankle dorsiflexion were highly variable across participants. CONCLUSIONS: Average calcaneal eversion is a poor indicator of the role calcaneal eversion plays in the demi-plié of contemporary dancers. Rather, the temporal coupling between calcaneal eversion and ankle dorsiflexion needs to be considered.

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Internal Loading of the Foot and Ankle during Impact in Running

Journal of Applied Biomechanics ◽

10.1123/jab.11.1.25 ◽

1995 ◽

Vol 11 (1) ◽

pp. 25-46 ◽

Cited By ~ 21

Author(s):

Gerald K. Cole ◽

Benno M. Nigg ◽

Gordon H. Fick ◽

Michael M. Morlock

Keyword(s):

Internal Loading ◽

Contact Forces ◽

Heel Strike ◽

Foot And Ankle ◽

Ankle Joints ◽

Running Injuries ◽

Impact Phase ◽

The Impact ◽

D Model ◽

General Influence

A 3-D model was used in this study to determine the influence of midsole hardness, as well as the influence of running in shoes in comparison to barefoot, on the contact forces in the joints of the foot and ankle during running. The results showed that there were no statistical differences in the magnitude and rate of joint loading for changing midsole hardness, nor were there any general trends observed in the measured variables. However, both the magnitude and rate of loading in the subtalar and ankle joints during the impact phase were found to be greater in the barefoot condition than the shod condition. The results suggest that if running injuries are assumed to be related to the impact of heel-strike, running in shoes may aid in preventing injuries, whereas it is still questionable whether changes in the midsole hardness have a general influence on the incidence of impact-related injuries.

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Ultrasound Guidance for Intra-articular Injections of the Foot and Ankle

Foot & Ankle International ◽

10.3113/fai.2009.0886 ◽

2009 ◽

Vol 30 (9) ◽

pp. 886-890 ◽

Cited By ~ 51

Author(s):

Shaun Khosla ◽

Ralf Thiele ◽

Judith F. Baumhauer

Keyword(s):

Ankle Joint ◽

Ultrasound Guidance ◽

Foot And Ankle ◽

Needle Placement ◽

Methylene Blue Solution ◽

Ankle Joints ◽

Dynamic Ultrasound ◽

Blue Solution ◽

The One ◽

Joint Injections

Background: Ultrasound has been increasingly utilized in procedures involving intra-articular injections. This study's purpose was to compare the accuracy of intra-articular injections of the foot and ankle using palpation versus dynamic ultrasound in a cadaver model. Materials and Methods: Fourteen lightly embalmed cadaver specimens without notable osteoarthritis were used. A 0.22-gauge needle was placed by a foot and ankle orthopaedic surgeon into the first and second tarsometatarsal joints, subtalar joint, and ankle joint. The needle was initially placed using palpation, evaluated with ultrasound by an experienced rheumatologist, and re-inserted if necessary. Needle placement was confirmed with injection of an Omnipaque™/methylene blue solution and examined under fluoroscopy, followed by dissection. Results: Palpation and ultrasound were 100% accurate in subtalar and ankle joint injections. Using palpation, the needle was correctly placed into the first TMT joint in three of 14 cadavers, and in four of 14 cadavers for the second TMT joint. Using ultrasound, the needle was correctly placed into the first TMT joint in ten of 14 cadavers, and into the second TMT joint in eight of 14 cadavers. When grouped, ultrasound was significantly more accurate for intra-articular needle placement compared to palpation in the midfoot ( p = 0.003). On three specimens, dye extended beyond the second TMT joint. Conclusion: Intra-articular injections of the subtalar and ankle joints can be successfully performed utilizing palpation alone. Ultrasound guidance significantly increases injection accuracy into the TMT joints compared to palpation alone and therefore US or Fluoroscopy is performed when injecting these TMT joints. When using selective diagnostic injections into a TMT joint to assess for the symptomatic joint and potential need for arthrodesis, the injected anesthetic may not remain isolated within that joint. These isolated TMT injections should not be done to answer that question without fluoroscopy confirmation with radiopaue dye demonstrating the injected fluid remained within the one joint of interest.

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Understanding the Rotational Positioning of the Bones in the Medial Column of the Foot: A Weightbearing CT Analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00449 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0044

Author(s):

Thiago A. Silva ◽

Daniel Baumfeld ◽

Shuyuan Li ◽

Nacime S. Mansur ◽

Francois Lintz ◽

...

Keyword(s):

Hallux Valgus ◽

Proximal Phalanx ◽

Foot And Ankle ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Rotational Position ◽

Medial Cuneiform ◽

Bone Segment ◽

Essential Components ◽

Weightbearing Ct

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Rotational deformities of the first ray have been described as essential components of hallux valgus (HV) deformity, influencing its severity and progression. The exact deformity location along the medial column, as well as the typical rotational pattern of each bone, is yet to be fully understood. The objective of this study was to evaluate the rotational position of the navicular, medial cuneiform, first metatarsal and proximal phalanx using three-dimensional weightbearing CT (WBCT) images of a diversity of patients with foot pathologies. Our goal was to describe the rotational profile of medial column bones, serving as a reference for future studies. Methods: A retrospective review of patients that underwent WBCT assessment of multiple foot and ankle pathologies was conducted in a single Institution. A blinded and independent Fellowship-Trained Foot and Ankle Orthopedic Surgeon performed measurements in Multiplanar Reconstruction (MPR) WBCT images assessing the rotational profile of each bone of the medial column (navicular, medial cuneiform, first metatarsal and proximal phalanx of the great toe), as demonstrated in the attached figure. The first metatarsal, representing a long bone, was evaluated on its proximal and distal ends. A total of 110 patients were included. As standard, we considered pronation as positive values and supination as negative values. Comparisons were performed using independent t-tests or Wilcoxon tests. P-values of <0.05 were considered significant. Results: The mean values and 95% Confidence Interval for the rotational profile of the medial column bones were found to be respectively: Navicular, pronated 43.2o (41.1 to 45.2); Medial Cuneiform, supinated -2.5o (-4.3 to -0.7); Proximal First Metatarsal, supinated -28.1o (-32 to -24.1); Distal Metatarsal, pronated 18.5o (16.3 to 20.7); First Toe Proximal Phalanx, pronated of 21.6o (18.7 to 24.5). Significant differences were found in the rotational position of each bone/segment (p<0.0001), with the exception of the distal metatarsal/proximal phalanx (p=0.11), that demonstrated similar amounts of pronation. When considering each segment/joint in isolation, the highest rotational deformity was found to exist within the first metatarsal (pronated 46.6o), naviculo-cuneiform joint (supinated 45.7o), first tarsometatarsal joint (supinated 25.5o) and first metatarsophalangeal joint (pronated 3.1 o). Conclusion: Our study described the rotational profile of the medial column bones using WBCT images, in a population of patients with diverse foot and ankle pathologies. We found significant differences in the rotational position of most of the bones along the medial column. The greatest amount of rotation was found to happen within the first metatarsal, which undergoes an average of 46o of pronation from proximal to distal, probably compensating a considerable amount of supination of the naviculo- cuneiform and first tarsometatarsal joints. Further studies comparing hallux valgus patients and controls are needed.

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