3D Biometrics for Hindfoot Alignment Using Weightbearing CT

Background: Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups. Methods: In this retrospective cohort study, 135 data sets (57 normal, 38 varus, 40 valgus) from WBCT (PedCAT; CurveBeam LLC, Warrington, PA) were obtained from a specialized foot and ankle unit. 3D coordinates of specific anatomical landmarks (weightbearing points of the calcaneus, of the first and fifth metatarsal heads and the highest and centermost point on the talar dome) were collected. These data were processed with the TALAS system (CurveBeam), which resulted in an FAO value for each case. Intraobserver and interobserver reliability were also assessed. Results: In normal cases, the mean value for FAO was 2.3% ± 2.9%, whereas in varus and valgus cases, the mean was −11.6% ± 6.9% and 11.4% ± 5.7%, respectively, with a statistically significant difference among groups ( P < .001). The distribution of the normal population was Gaussian. The inter- and intraobserver reliability were 0.99 +/- 0.00 and 0.97 +/-0.02 Conclusions: This pilot study suggests that the FAO is an efficient tool for measuring hindfoot alignment using WBCT. Previously published research in this field has looked at WBCT by adapting 2D biometrics. The present study introduces the concept of 3D biometrics and describes an efficient, semiautomatic tool for measuring hindfoot alignment. Level of Evidence: Level III, retrospective comparative study.

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Detection of Circulating Tissue Factor and Factor VII in a Normal Population

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650365 ◽

1996 ◽

Vol 75 (05) ◽

pp. 772-777 ◽

Cited By ~ 30

Author(s):

Sybille Albrecht ◽

Matthias Kotzsch ◽

Gabriele Siegert ◽

Thomas Luther ◽

Heinz Großmann ◽

...

Keyword(s):

Tissue Factor ◽

Normal Population ◽

Mean Value ◽

Factor Vii ◽

Significant Difference ◽

Age Dependent ◽

The Mean ◽

Highly Correlated ◽

And Gender

SummaryThe plasma tissue factor (TF) concentration was correlated to factor VII concentration (FVIIag) and factor VII activity (FVIIc) in 498 healthy volunteers ranging in age from 17 to 64 years. Immunoassays using monoclonal antibodies (mAbs) were developed for the determination of TF and FVIIag in plasma. The mAbs and the test systems were characterized. The mean value of the TF concentration was 172 ± 135 pg/ml. TF showed no age- and gender-related differences. For the total population, FVIIc, determined by a clotting test, was 110 ± 15% and the factor VIlag was 0.77 ± 0.19 μg/ml. FVII activity was significantly increased with age, whereas the concentration demonstrated no correlation to age in this population. FVII concentration is highly correlated with the activity as measured by clotting assay using rabbit thromboplastin. The ratio between FVIIc and FVIIag was not age-dependent, but demonstrated a significant difference between men and women. Between TF and FVII we could not detect a correlation.

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RELATIONSHIP BETWEEN THE KNEE AND HINDFOOT AXES IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220202805231351 ◽

2020 ◽

Vol 28 (5) ◽

pp. 229-232 ◽

Cited By ~ 1

Author(s):

HENRIQUE MANSUR ◽

FELIPE ALMEIDA ROCHA ◽

PEDRO GUILME TEIXEIRA DE SOUSA FILHO ◽

ISNAR MOREIRA DE CASTRO JUNIOR

Keyword(s):

Mean Value ◽

Foot And Ankle ◽

Moderate Correlation ◽

Varus Knee ◽

Aofas Score ◽

Level Of Evidence ◽

The Mean ◽

American Orthopaedic ◽

Ankle Function ◽

Angular Deformities

ABSTRACT Objective: To evaluate the correlation between knee axis and hindfoot axis in patients with advanced gonarthrosis, and the association between ankle function and angular deformities. Methods: 72 patients were enrolled in the study: 66% were women, and mean age was 58.7 years. The anatomical axis of the knee and hindfoot were measured by short knee radiographs and long axial view of the hindfoot. Results: Among the study group, 79.2% presented varus knee (mean 15º ± 7.69º) and 20.8% valgus (mean 15.9º ± 7.7º). 63.9% had hindfoot varus (mean 8.5º ± 6.07º) and 36.1% valgus (mean 3.9º ± 3.92º) (p < 0.05). The mean value for the American Orthopaedic Foot and Ankle Society (AOFAS) score was 74.26 points, and values were significantly higher among patients with hindfoot varus (p < 0.05). We found no correlation between gender or AOFAS score and knee and hindfoot axes, nor between deformities in the knee and hindfoot axes (p > 0.05). The subgroup genu valgum - hindfoot varus presented a moderate correlation (r = 0.564; p < 0.05). Conclusion: We found no association between the anatomical axes of the knee and hindfoot. Patients with gonarthrosis and hindfoot varus presented a better ankle function. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

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FOOT ALIGNMENT IN SYMPTOMATIC NATIONAL FOOTBALL LEAGUE (NFL) ATHLETES: A WEIGHTBEARING CT ANALYSIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212903236709 ◽

2021 ◽

Vol 29 (3) ◽

pp. 118-123

Author(s):

ALESSIO BERNASCONI ◽

CESAR DE CESAR NETTO ◽

LAUREN ROBERTS ◽

FRANÇOIS LINTZ ◽

ALEXANDRE LEME GODOY-SANTOS ◽

...

Keyword(s):

National Football League ◽

Normal Population ◽

Control Group ◽

Medial Longitudinal Arch ◽

Foot And Ankle ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Longitudinal Arch ◽

Medial Cuneiform ◽

Foot Alignment

ABSTRACT Objective: Our aim was to describe the foot alignment in National Football League (NFL) players with different symptomatic foot and ankle pathologies using weightbearing cone-beam computed tomography (WBCBCT), comparing them to normally aligned feet as control group. Methods: 41 feet (36 active NFL players) were assessed using WBCBCT and compared to 20 normally aligned controls from a normal population. Measurements included: Foot and Ankle Offset (FAO); Calcaneal Offset (CO); Hindfoot Alignment Angle (HAA); angle between inferior and superior facets of the talus (Inftal-Suptal); angle between inferior facet of the talus and the horizontal/floor (Inftal-Hor); Forefoot Arch Angle (FAA); navicular- and medial cuneiform-to-floor distance. Results: NFL athletes showed a neutrally aligned hindfoot when compared to controls (FAO: 1% vs 0.5%; CO: 2.3 mm vs 0.8 mm; HAA: 2.9° vs 0.8° in two groups, with all p > 0.05) and a normal morphology of the subtalar joint (no difference in Inftal-Suptal and Inftal-Hor angles). Conversely, in athletes we found a decreased medial longitudinal arch (FAA: 15° vs 18.3°, p = 0.03) with smaller navicular (38.2 mm vs 42.2 mm, p = 0.03) and medial cuneiform (27 mm vs 31.3 mm, p = 0.01) mean distances to the floor when compared to controls. Conclusion: In our series, NFL players presented a lower medial longitudinal arch than controls but a neutrally aligned hindfoot. WBCBCT may help shed light on anatomical risk factors for injuries in professional players. Level of Evidence III, Retrospective comparative study.

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One versus two adjacent interdigital neuroma excision: a patient outcome study

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1582 ◽

2021 ◽

Vol 15 (3) ◽

pp. 236-240

Author(s):

Kefilwe Boineelo Benjamin ◽

Nikiforos Saragas ◽

Paulo Ferrão

Keyword(s):

Patient Outcome ◽

Patient Satisfaction ◽

Retrospective Study ◽

The Self ◽

Outcome Study ◽

Foot And Ankle ◽

Level Of Evidence ◽

Significant Difference ◽

The Mean ◽

Good For

Objective: We aimed to evaluate patient satisfaction after surgery for both single and two adjacent neuromas. Methods: We reviewed the data of patients treated operatively for interdigital neuromas between 2003 and 2016. We interviewed them and administered the Self-Reported Foot and Ankle Score questionnaire. Patient scores were then analyzed categorically, and variation between groups was assessed. Results: Sixty-two patients were available for review. Thirty-one patients had a single interdigital neuroma excised and 31 had two adjacente interdigital neuromas excised. Twenty-eight of the 31 (90%) patients with a single neuroma had good or excellent results while 23 (74.2%) of those with adjacent neuromas had similar outcomes. One patient with a single neuroma had a poor result while four patients with adjacent neuromas had poor results. The mean score was 41 (excellent) for patients with a single interdigital neuroma and 37 (good) for those with adjacent neuromas (p=0.473). The majority of patients in both groups would undergo surgery again. Conclusion: We found no statistically significant difference in outcomes of patients who undergo surgery for either single or two adjacent interdigital neuromas. General patient satisfaction is good and/or excellent post excision. Level of Evidence II; Prognostic Studies; Retrospective Study.

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The Effect of Lower Extremity Internal and External Rotation on the Hindfoot Alignment Moment Arm and Hindfoot Alignment Angle

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00373 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0037

Author(s):

Kamil Okroj ◽

Ryan G. Rogero ◽

Daniel Corr ◽

Daniel J. Fuchs ◽

Brian S. Winters ◽

...

Keyword(s):

Lower Extremity ◽

External Rotation ◽

Strong Positive Correlation ◽

Foot And Ankle ◽

Moment Arm ◽

Hindfoot Alignment ◽

Moment Arms ◽

Significant Difference ◽

Alignment Angle ◽

The Mean

Category: Ankle; Hindfoot Introduction/Purpose: The hindfoot moment arm was first described by Saltzman and el-Khoury to evaluate hindfoot varus and valgus alignment and has been well described and validated in the literature. It is commonly used by surgeons for preoperative planning of various hindfoot reconstructive procedures. The hindfoot alignment angle (the angle formed by the intersection between the tibial axis and the calcaneal axis) is another metric of measuring hindfoot alignment commonly utilized by surgeons. The purpose of this study was to determine if rotation of the hindfoot alters the hindfoot alignment moment arm and hindfoot alignment angle. We hypothesize that slight changes in internal and external rotation of the foot during x-ray positioning will have a large effect on the hindfoot moment arm and hindfoot alignment angle. Methods: We prospectively enrolled 29 patients, totaling 58 lower extremities, presenting to outpatient clinic for evaluation of a foot and ankle complaint. Patients <18 years of age, unable to perform bilateral weightbearing radiographs, or presenting for postoperative visits from recent foot and ankle surgery were excluded. Bilateral Saltzman hindfoot radiographs in neutral, 10 degrees of internal rotation, and 10 degrees of external rotation were performed. Marking lines were drawn on the standing platform to standardize rotation, with patients aligning their second ray with the lines. A fellowship-trained foot and ankle orthopaedic surgeon and an orthopaedic surgery resident individually measured the hindfoot moment arms and alignment angles. Analysis of variance (ANOVA) testing was used to assess for differences in hindfoot moment arm and hindfoot alignment angle in neutral, internal, and external rotation. Intra- and inter-observer agreement (95% limits) and intra-class correlation coefficients were calculated to assess for intra- and inter-observer reliability. Results: The cohort consisted of 11 (37.9%) males and 18 (62.1%) females, with a mean age of 48.7 (SD=14.7) years and mean body mass index (BMI) of 29.9 (SD=6.6) kg/m2. The mean hindfoot moment arms were 4.6 (SD=6.7) mm, 11.3 (SD=3.4) mm, and -5.4 (SD=6.2) mm in neutral, internal, and external rotation, respectively. The mean hindfoot alignment angles were 4.5 (SD=5.6) degrees, 18.6 (SD=6.8) degrees, and -10.9 (SD=10.6) degrees in neutral, internal, and external rotation, respectively. There was a significant difference in both the hindfoot moment arm (p<0.001) and hindfoot alignment angle (p<0.001) among rotational positions. A strong positive correlation existed between the amount of rotation and both moment arm (r=0.78; p<0.001) and alignment angle (r=0.84; p<0.001). Conclusion: There appears to be significant variability in both the hindfoot moment arm and hindfoot alignment angle with respect to rotation of the patient’s lower extremity. Orthopaedic surgeons should carefully scrutinize limb rotation when making clinical decisions based on the hindfoot moment arm or alignment angle.

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Reliability of Hindfoot Alignment Using Weightbearing CT Semi Automatic Software

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000058 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Francois Lintz ◽

Matthew Welck ◽

Alessio Bernasconi ◽

James Thornton ◽

Nicholas Cullen ◽

...

Keyword(s):

Gaussian Distribution ◽

Normal Population ◽

Interobserver Reliability ◽

Weight Bearing ◽

Mean Value ◽

Measurement Tool ◽

Hindfoot Alignment ◽

Clinically Normal ◽

Automatic Software ◽

Weightbearing Ct

Category: Ankle, Hindfoot, Imaging Introduction/Purpose: Hindfoot Alignment (HA) on 2D radiographs presents anatomical and operator-related bias. In this study, weightbearing CT (WBCT) was used to measure HA using a semi-automatic software which gives HA as a value of Foot Ankle Offset (FAO) after selecting four landmarks (weight bearing points of first and fifth Metatarsals, Calcaneus and center of the ankle joint). We assessed the intra and interobserver reproducibility and the distribution of FAO values in a series of datasets from clinically normal, varus and valgus cases. We hypothesized that reproducibility would be excellent. Furthermore, FAO in normals should have a Gaussian distribution and be significantly different to the varus and valgus groups. Methods: In this level 3, retrospective comparative study, WBCT (PedCAT ®, CurveBeam LLC, Warrington, PA, USA) datasets were obtained from an existing database. The 135 feet were assessed by a senior foot and ankle surgeon as normal, varus or valgus (57, 38 and 40 respectively). Two surgeon investigators (one senior and one trainee) independently analyzed each case using a semi-automatic HA measurement tool (TALAS ™, CurveBeam LLC, Warrington, PA, USA). A third, independent investigator conducted the statistical analysis using Stata® Software. Results: The overall intraoberver and interobserver reliability were 0.99 ± 0.002 and 0.97 ± 0.02 respectively. In normal cases, mean value for FAO was 2.38% ± 2.96, whereas in varus and valgus cases mean was -11.67% ± 6.90 and 11.47% ± 5.79, respectively (p<0.001). The normal population had a Gaussian distribution with a Kolmogorov-Smirnov test > 0.8 Conclusion: This study reports excellent reliability and discriminative power of a semi-automatic 3D measurement tool for Hindfoot Alignment in WBCT.

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Functional evaluation of diabetic patients with foot ulcers

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.781 ◽

2018 ◽

Vol 12 (2) ◽

pp. 136-139

Author(s):

Thiago Santos Fernando ◽

Vinicius Quadros Borges ◽

Gabriel Ferreira Ferraz ◽

Kelly Cristina Stéfani

Keyword(s):

Comprehensive Evaluation ◽

Diabetic Patients ◽

Functional Evaluation ◽

Foot And Ankle ◽

Aofas Score ◽

Level Of Evidence ◽

Significant Difference ◽

Plantar Ulcers ◽

The Mean ◽

American Orthopaedic

Objective: The objective of this study was to perform a functional evaluation of diabetic patients with plantar ulcers using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: In this prospective cohort study, 50 diabetic patients treated in an outpatient clinic under conservative management were consecutively evaluated for active ulcers on the foot. The ulcer mean progression time, size and classification and the AOFAS score were evaluated. Results: Among the sample, 38 (76%) were men, the mean age was 64 years, and the mean body mass index was 28.27 kg/m2. The mean ulcer progression time was 9 months, and 40 (80%) patients were classified as Wagner grade 1. There was a significant difference in AOFAS scoresbetween ulcer grades. Conclusion: The AOFAS score can be used for functional evaluation in diabetic patients with ulcers. However, due to the peculiarities of this population, it is important to search for new and more comprehensive evaluation instruments. Level of Evidence II; Prognostic Studies; Prospective Study.

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A new simpler approach to measure the strength of toe plantar flexion requiring no mechanical restraint with a light-weight device

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/09544119211002932 ◽

2021 ◽

pp. 095441192110029

Author(s):

Yuko Komuro ◽

Yuji Ohta

Keyword(s):

Plantar Flexion ◽

Mean Value ◽

Simple Approach ◽

Light Weight ◽

New Approach ◽

Mean Values ◽

Mechanical Restraint ◽

Significant Difference ◽

Ankle Joints ◽

The Mean

Conventionally, the strength of toe plantar flexion (STPF) is measured in a seated position, in which not only the target toe joints but also the knee and particularly ankle joints, are usually restrained. We have developed an approach for the measurement of STPF which does not involve restraint and considers the interactions of adjacent joints of the lower extremities. This study aimed to evaluate this new approach and comparing with the seated approach. A thin, light-weight, rigid plate was attached to the sole of the foot in order to immobilize the toe area. Participants were 13 healthy young women (mean age: 24 ± 4 years). For measurement of STPF with the new approach, participants were instructed to stand, raise the device-wearing leg slightly, plantar flex the ankle, and push the sensor sheet with the toes to exert STPF. The sensor sheet of the F-scan II system was inserted between the foot sole and the plate. For measurement with the seated approach, participants were instructed to sit and push the sensor with the toes. They were required to maintain the hip, knee, and ankle joints at 90°. The mean values of maximum STPF of the 13 participants obtained with each approach were compared. There was no significant difference in mean value of maximum STPF when the two approaches were compared (new: 59 ± 23 N, seated: 47 ± 33 N). The coefficient of variation of maximum STPF was smaller for data obtained with the new approach (new: 39%, seated: 70%). Our simple approach enables measurement of STPF without the need for the restraints that are required for the conventional seated approach. These results suggest that the new approach is a valid method for measurement of STPF.

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Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia

BMC Women s Health ◽

10.1186/s12905-021-01360-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tilahun Fufa Debela ◽

Zerihun Asefa Hordofa ◽

Aster Berhe Aregawi ◽

Demisew Amenu Sori

Keyword(s):

Quality Of Life ◽

Surgical Repair ◽

Obstetric Fistula ◽

Medical Center ◽

Mean Value ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

Jimma University

Abstract Background The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair. Methods Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019–October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance. Result The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains. Conclusion The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.

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Assessment of the Tissue Response to Modification of the Surface of Dental Implants with Carboxyethylphosphonic Acid and Basic Fibroblastic Growth Factor Immobilization (Fgf-2): An Experimental Study on Minipigs

Biology ◽

10.3390/biology10050358 ◽

2021 ◽

Vol 10 (5) ◽

pp. 358

Author(s):

Javier Aragoneses ◽

Ana Suárez ◽

Nansi López-Valverde ◽

Francisco Martínez-Martínez ◽

Juan Manuel Aragoneses

Keyword(s):

Surface Treatment ◽

Test Group ◽

Mean Value ◽

Control Group ◽

P Value ◽

Implant Surface ◽

Bone Contact ◽

Bone Implant ◽

Significant Difference ◽

The Mean

The aim of this study was to evaluate the effect of implant surface treatment with carboxyethylphosphonic acid and fibroblast growth factor 2 on the bone–implant interface during the osseointegration period in vivo using an animal model. The present research was carried out in six minipigs, in whose left tibia implants were inserted as follows: eight implants with a standard surface treatment, for the control group, and eight implants with a surface treatment of carboxyethylphosphonic acid and immobilization of FGF-2, for the test group. At 4 weeks after the insertion of the implants, the animals were sacrificed for the histomorphometric analysis of the samples. The means of the results for the implant–bone contact variable (BIC) were 46.39 ± 17.49% for the test group and 34.00 ± 9.92% for the control group; the difference was not statistically significant. For the corrected implant–bone contact variable (BICc), the mean value of the test group was 60.48 ± 18.11%, and that for the control group, 43.08 ± 10.77%; the difference was statistically significant (p-value = 0.035). The new bone formation (BV/TV) showed average results of 27.28 ± 3.88% for the test group and 26.63 ± 7.90% for the control group, meaning that the differences were not statistically significant (p-value = 0.839). Regarding the bone density at the interthread level (BAI/TA), the mean value of the test group was 32.27 ± 6.70%, and that of the control group was 32.91 ± 7.76%, with a p-value of 0.863, while for the peri-implant density (BAP/TA), the mean value of the test group was 44.96 ± 7.55%, and that for the control group was 44.80 ± 8.68%, without a significant difference between the groups. The current research only found a significant difference for the bone–implant contact at the cortical level; therefore, it could be considered that FGF-2 acts on the mineralization of bone tissue. The application of carboxyethylphosphonic acid on the surface of implants can be considered a promising alternative as a biomimetic coating for the immobilization of FGF-2. Despite no differences in the new bone formation around the implants or in the interthread or peri-implant bone density being detected, the biofunctionalization of the implant surface with FGF-2 accelerates the mineralization of the bone–implant interface at the cortical level, thereby reducing the osseointegration period.

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