Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT

2019 ◽  
Vol 40 (12) ◽  
pp. 1430-1437 ◽  
Author(s):  
Noortje Catharina Hagemeijer ◽  
Song Ho Chang ◽  
Mohamed Elghazy Abdelaziz ◽  
Jack Christopher Casey ◽  
Gregory Richard Waryasz ◽  
...  
Keyword(s):  
Internal Control ◽  
Early Recognition ◽  
Interobserver Reliability ◽  
Ankle Injury ◽  
P Value ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Measurement Variation ◽  
Tibiofibular Joint ◽  
Weightbearing Ct

Background: Early recognition of syndesmotic instability is critical for optimizing clinical outcome. Injuries causing a more subtle instability, however, can be difficult to diagnose. The purpose of this study was to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability, thereafter comparing findings between the injured and uninjured sides. We also aimed to define the range of normal measurement variation among patients without syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring operative fixation ( n = 12) underwent preoperative bilateral ankle weightbearing CT. A separate cohort of patients without ankle injury who also underwent bilateral ankle weightbearing CT were included as comparative controls ( n = 24). For each weightbearing CT, a series of 7 axial plane tibiofibular joint measurements, including 1 angular measurement, were utilized to evaluate parameters of the syndesmotic anatomy at a level 1 cm above the tibial plafond. Values were recorded by 2 independent observers to assess for interobserver reliability. Results: Among those with unilateral syndesmotic instability, values differed between the injured and uninjured sides in 4 of the 7 measurements performed including the syndesmotic area: direct anterior, middle, and posterior differences, and sagittal translation ( P < .001, < .001, < .001, and < .001, respectively). In the control population without ankle injury, no differences were identified between any of the bilateral measurements ( P value range, .172-.961). Conclusion: This study highlights the ability of weightbearing CT to effectively differentiate syndesmotic diastasis among patients with surgically confirmed syndesmotic instability from those without syndesmotic instability. It underscores the substantial utility and importance of using the contralateral, uninjured side as a valid internal control whenever the need for confirming potential syndesmotic instability arises. Prospective studies are necessary to fully understand the accuracy of weightbearing CT in diagnosing occult syndesmotic instability among patients for whom the diagnosis remains in question. Level of Evidence: Level III, comparative diagnostic study.

scholarly journals Normal Variation and Instability Values of the Tibiofibular Joint on Weightbearing CT

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0019
Author(s):  
Noortje Hagemeijer ◽  
Song Ho Chang ◽  
Mohamed Abdelaziz Elghazy ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
...  
Keyword(s):  
Internal Control ◽  
Interobserver Reliability ◽  
Weight Bearing ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Ankle Injury ◽  
P Value ◽  
Uninjured Side ◽  
Tibiofibular Joint ◽  
Value Range

Category: Ankle Introduction/Purpose: Prompt management of syndesmotic instability is critical for optimizing clinical outcome, but subtle injuries may be difficult to diagnose. Application of modern imaging modalities such as weight bearing CT (WBCT) may better identify such injuries by virtue of assessing the distal tibiofibular articulation under physiologic load. The aim of this study was to evaluate the distal tibiofibular articulation using WBCT among patients with known syndesmotic instability and compare these findings with their uninjured contralateral sides, and thereafter corroborate such measurement differences with patients devoid of any syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring surgical fixation (n=12) underwent bilateral ankle WBCT that incorporated the entire foot. A separate cohort of patients without ankle injury also underwent bilateral ankle WBCT for assessment of either a Lisfranc injury or forefoot condition (n=24). All WBCT imaging was performed preoperatively. A set of five axial plane tibiofibular joint measurements including one angular measurement were standardly assessed one cm above the tibial plafond. Values were recorded by two independent observers to assess for interobserver reliability scores. Interpretation of the intraclass correlation coefficients was carried out according to the guidelines proposed by Shrout: 0.00-0.10 virtually none, 0.11-0.40 slight, 0.41-0.60 fair, 0.61-0.80 moderate, 0.81 -1.00 substantial. Results: Among the control population without ankle injury, no differences were found between bilateral measurements (p-value range 0.172 - 0.961). Among those with known unilateral syndesmotic instability, values differed between the injured and uninjured side in five of six measurements— including syndesmotic area, direct anterior-, middle-, and posterior- difference, and sagittal translation (p <0.001, <0.001, <0.001, <0.001, 0.039, respectively). Those same measurements also differed when comparing the left-right delta values between uninjured and injured patients (p <0.001, 0.002, <0.001, <0.001, and 0.042, respectively). Fibular rotation differed neither in direct nor delta comparisons (p=0.460 and 0.271 respectively). Substantial agreement was found for all measurements except for sagittal translation, which had only slight agreement. Conclusion: This study highlights the ability of WBCT to effectively differentiate syndesmotic diastasis and fibular translation among patients with surgically-confirmed syndesmotic instability as compared to those without syndesmotic instability. It also underscores the importance of using the contralateral, uninjured side as a valid internal control. Additional studies are necessary to better understand the role of WBCT in prospectively diagnosing more subtle cases of syndesmotic instability among patients for whom the diagnosis remains in question.

Weightbearing CT Scan Assessment of Foot Alignment in Patients With Hallux Rigidus

2017 ◽  
Vol 39 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Zoe B. Cheung ◽  
Mark S. Myerson ◽  
Joseph Tracey ◽  
Ettore Vulcano
Keyword(s):  
Interobserver Reliability ◽  
Correlation Coefficients ◽  
Hallux Rigidus ◽  
Clear Correlation ◽  
Level Of Evidence ◽  
Valgus Angle ◽  
Second Metatarsal ◽  
Grade 3 ◽  
Weightbearing Ct ◽  
Foot Alignment

Background: An association between hallux rigidus and metatarsus primus elevatus (MPE) has been suggested, although there remains no general consensus about the nature of this relationship. Past studies were limited due to inaccuracies of assessing MPE on 2-dimensional radiographs. The aims of this study were to (1) assess and compare foot alignment in patients with and without hallux rigidus using 3-dimensional (3D) reconstructions from weightbearing computed tomography (CT) and (2) assess intraobserver and interobserver reliability of these measurements. Methods: A prospective study was performed in 50 consecutive patients with symptomatic hallux rigidus and 50 control patients who underwent a weightbearing CT. Two investigators measured first and second metatarsal declination angles, first and second metatarsal lengths, first to second intermetatarsal angle (IMA), hallux valgus angle (HVA), and foot width on 3D CT reconstructions. Measurements were repeated after 1 month. Student t tests were performed to compare hallux rigidus and control groups. Intraclass and interclass correlation coefficients were calculated to evaluate reliability. Results: The first to second metatarsal declination ratio was less in patients with hallux rigidus (mean, 0.81) than controls (mean, 0.92; P < .001). Patients with Coughlin and Shurnas grade 3 and 4 hallux rigidus had greater first metatarsal declination than patients with grade 1 and 2 hallux rigidus. Last, IMA was higher (mean, 13 degrees) but HVA was lower (mean, 11 degrees) in patients with hallux rigidus than controls (IMA mean, 12 degrees; HVA mean, 15 degrees; P = .04). Intraobserver (ICC1,1 ≥ 0.93) and interobserver (ICC3,1 ≥ 0.85) reliability were good to excellent for all measured parameters. Conclusions: Patients with hallux rigidus had MPE. Patients with grade 3 and 4 hallux rigidus had more MPE than patients with grade 1 and 2 hallux rigidus. There was no clear correlation between hallux rigidus and bunions. Finally, weightbearing CT proved to be a reliable method of assessing all measured parameters. Level of Evidence: II, prospective comparative series.

scholarly journals Using Area and Volume Measurements on Weightbearing CT to Detect Isolated Lisfranc Instability

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0013
Author(s):  
Rohan Bhimani ◽  
Pongpanot Sornsakrin ◽  
Soheil Ashkani-Esfahani ◽  
Bart Lubberts ◽  
Gregory R. Waryasz ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Contralateral Side ◽  
P Value ◽  
Lisfranc Joint ◽  
Foot Injury ◽  
Value Range ◽  
Volume Measurements ◽  
Weightbearing Ct ◽  
Similar Imaging ◽  
Area And Volume

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Early detection of Lisfranc instability is critical for optimizing clinical outcomes. Injuries causing a more subtle instability, however, can be difficult to diagnose. The aim of this study was to compare the injured Lisfranc joint to the healthy contralateral side using weightbearing computed tomography (CT) in patients with known Lisfranc instability. We also aimed to define the range of normal measurement variation by comparing the Lisfranc joint measurements between the left and right foot in individuals without foot injury who underwent similar imaging. Our hypothesis was that compared to the healthy contralateral side, weightbearing CT area and volume measurements were increased in patients diagnosed with subtle Lisfranc instability. Methods: Patients with unilateral Lisfranc instability requiring operative fixation (n = 14) underwent preoperative bilateral foot and ankle weightbearing CT. A separate group of patients without foot injury who also underwent similar imaging were included as comparative controls (n = 36). For each weightbearing CT, 2 dimensional axial and coronal plane Lisfranc joint parameters, Lisfranc area, intercuneiform area, C1-M2 distance, C1-C2 distance, M1-M2 distance, first and second tarsometatarsal (TMT 1 and 2) alignment; and first and second tarsometatarsal (TMT 1and 2) dorsal step off were measured to evaluate the Lisfranc anatomy at a level 10 mm below the dorsal surface of medial cuneiform (Figures I and II). In addition, the volume of the Lisfranc joint was also evaluated. Values were recorded by two independent observers to assess interobserver reliability. Results: Among those with unilateral Lisfranc instability, values differed largely between the injured and the healthy contralateral side for all measurements performed (p-value range, 0.008 - <0.001). In the control population without foot injury, no differences were identified between any of the bilateral measurements (p-value range, 0.121 - 0.984). Conclusion: Weightbearing CT can effectively differentiate Lisfranc instability from those without instability. The Lisfranc volume and area had the largest difference between the injured and the uninjured feet among surgically treated patients with substantial interrater agreement making them the most relevant parameters for detecting Lisfranc instability. However, prospective studies are needed to validate the role of weightbearing CT in the diagnosis of subtle Lisfranc instability.

scholarly journals Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Grégoire Thürig ◽  
Raùl Panadero-Morales ◽  
Luca Giovannelli ◽  
Franziska Kocher ◽  
José Luis Peris ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Tibial Slope ◽  
Lateral View ◽  
Individual Identification ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
X Ray ◽  
Femoral Intercondylar Notch

Abstract Purpose This study's main objective is to assess the feasibility of processing the MRI information with identified ACL-footprints into 2D-images similar to a conventional anteroposterior and lateral X-Ray image of the knee. The secondary aim is to conduct specific measurements to assess the reliability and reproducibility. This study is a proof of concept of this technique. Methods Five anonymised MRIs of a right knee were analysed. A orthopaedic knee surgeon performed the footprints identification. An ad-hoc software allowed a volumetric 3D image projection on a 2D anteroposterior and lateral view. The previously defined anatomical femoral and tibial footprints were precisely identified on these views. Several parameters were measured (e.g. coronal and sagittal ratio of tibial footprint, sagittal ratio of femoral footprint, femoral intercondylar notch roof angle, proximal tibial slope and others). The intraclass correlation coefficient (ICCs), including 95% confidence intervals (CIs), has been calculated to assess intraobserver reproducibility and interobserver reliability. Results Five MRI scans of a right knee have been assessed (three females, two males, mean age of 30.8 years old). Five 2D-"CLASS" have been created. The measured parameters showed a "substantial" to "almost perfect" reproducibility and an "almost perfect" reliability. Conclusion This study confirmed the possibility of generating "CLASS" with the localised centroid of the femoral and tibial ACL footprints from a 3D volumetric model. "CLASS" also showed that these footprints were easily identified on standard anteroposterior and lateral X-Ray views of the same patient, thus allowing an individual identification of the anatomical femoral and tibial ACL's footprints. Level of evidence Level IV diagnostic study

scholarly journals The PBS Score – a clinical assessment tool for the ambulatory and recurrent clubfoot

2019 ◽  
Vol 13 (3) ◽  
pp. 282-292 ◽  
Author(s):  
S. Böhm ◽  
M. F. Sinclair
Keyword(s):  
Correlation Coefficient ◽  
Clinical Assessment ◽  
Assessment Tool ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Rank Correlation ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Spearman’S Rank Correlation ◽  
Spearman’S Rank Correlation Coefficient

Purpose The signs for clubfoot relapse are poorly defined in the literature and there is a lack of a scoring system that allows assessment of clubfeet in ambulatory children. The aim of this study is to develop an easy to use, reliable and validated evaluation tool for ambulatory children with a history of clubfoot. Methods A total of 52 feet (26 children, 41 clubfeet, 11 unaffected feet) were assessed. Three surgeons used the seven-item PBS Score to rate hindfoot varus, standing and walking supination, early heel rise, active/passive ankle dorsiflexion and subtalar abduction blinded to the other examiners. All parents answered the modified Roye score questionnaire prior to the clinical assessment. Correlation between the mean PBS Score and the Roye score was evaluated using Spearman’s rank correlation coefficient. Interobserver reliability was tested using weighted and unweighted Cohen’s Kappa coefficients. Results The Spearman’s rank correlation coefficient for correlation between mean PBS Score and Roye score was 0.73 (moderate to good correlation).The interobserver agreement for the total PBS Score resulted in an intraclass correlation coefficient of 0.93 (almost perfect agreement). Conclusion The PBS score is an easy to use, clinical assessment tool for walking age children with clubfoot deformity. It includes passive and active criteria with a very good interobserver reliability and moderate to good validity. Level of Evidence: Level I - Diagnostic study

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

2021 ◽  
pp. 107110072110581
Author(s):  
Hee Young Lee ◽  
Nacime Salomao Barbachan Mansur ◽  
Matthieu Lalevee ◽  
Kevin N. Dibbern ◽  
Mark S. Myerson ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Reliability ◽  
Joint Involvement ◽  
Posterior Tibial Tendon ◽  
Diagnostic Study ◽  
Foot Deformity ◽  
New Classification ◽  
Posterior Tibial Tendon Dysfunction ◽  
Level Of Evidence ◽  
Radiographic Findings

Background: Historical concept of flatfoot as posterior tibial tendon dysfunction (PTTD) has been questioned. Recently, the consensus group published a new classification system and recommended renaming PTTD to Progressive Collapsing Foot Deformity (PCFD). The new PCFD classification could be effective in providing comprehensive information on the deformity. To date, there has been no study reporting intra- and interobserver reliability and the frequency of each class in PCFD classification. Methods: This was a single-center, retrospective study conducted from prospectively collected registry data. A consecutive cohort of PCFD patients evaluated from February 2015 to October 2020 was included, consisting of 92 feet in 84 patients. Classification of each patient was made using characteristic clinical and radiographic findings by 3 independent observers. Frequencies of each class and subclass were assessed. Intraobserver and inteobserver reliabilities were analyzed with Cohen kappa and Fleiss kappa, respectively. Results: Mean sample age was 54.4, 38% was male and 62% were female. 1ABC (25.4%) was the most common subclass, followed by 1AC (8.7%) and 1ABCD (6.9%). Only a small percentage of patients had isolated deformity. Class A was the most frequent component (89.5%), followed by C in 86.2% of the cases. Moderate interobserver reliability (Fleiss kappa = 0.561, P < .001, 95% CI 0.528-0.594) was found for overall classification. Very good intraobserver reliability was found (Cohen kappa = 0.851, P < .001, 95% CI 0.777-0.926). Conclusion: Almost half (49.3%) of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B), (C) with or without subtalar joint involvement (D). The new system may cover all possible combinations of the PCFD, providing a comprehensive description and guiding treatment in a systematic and individualized manner, but this initial study suggests an opportunity to improve overall interobserver reliability. Level of Evidence: Level III, retrospective diagnostic study.

scholarly journals Validation of 9-Grid Scheme for Localizing Osteochondral Lesions of the Talus

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142094492
Author(s):  
Kevin D. Martin ◽  
Trevor J. McBride ◽  
Dylan P. Horan ◽  
Amgad Haleem ◽  
Jeannie Huh ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Accurate Method ◽  
Magnetic Resonance Images ◽  
Senior Author ◽  
High Rate ◽  
Osteochondral Lesions ◽  
Diagnostic Study ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Grid Scheme

Background: A 9-grid scheme has been integrated into the foot and ankle literature to help clinicians and researchers localize osteochondral lesions of the talus (OLTs). We hypothesized that fellowship-trained orthopedic foot and ankle surgeons would have a high rate of intra/inter-observer reliability when localizing OLTs, therefore validating the scheme. Methods: We queried our institution’s foot and ankle radiographic database for magnetic resonance images with OLTs. Each MRI was reviewed by the senior author, and 2 key images (widest OLT diameter) from each tangential view were copied and combined onto one slide. Fifty consecutive deidentified images of ankles were then sent to 4 practicing fellowship-trained foot and ankle surgeons. Each was asked to identify which zone the OLT was localized within. A radiologist’s report served as the control. Statistical analyses were performed using Cohen and Fleiss kappa tests. Results: The reviewers demonstrated majority consensus on 45/50 images with substantial agreement for zones 4 and 6. The interobserver reliability was moderate with a κ = 0.55. The mean intraobserver reliability was substantial, with a κ = 0.79. A musculoskeletal radiologist determined there were 3 lesions in zone 7, 18 lesions in zone 4, and 29 lesions in zone 6. Conclusion: This study is the first to critically evaluate the 9-grid scheme and its reliability among orthopedic foot and ankle surgeons. Our study found that the 9-grid scheme is an accurate method of localization for OLTs with high intra- and moderate interobserver reliability between surgeons. Level of Evidence: Level IV, retrospective diagnostic study.

scholarly journals Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients

2017 ◽  
Vol 07 (02) ◽  
pp. 115-120 ◽  
Author(s):  
Tiffany Liu ◽  
Chia Wu ◽  
David Steinberg ◽  
David Bozentka ◽  
L. Levin ◽  
...  
Keyword(s):  
Physical Examination ◽  
Medical Center ◽  
Academic Medical Center ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Academic Medical ◽  
De Quervain ◽  
Clinical Records ◽  
Surgical Release

Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT). Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice. Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs. Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically. Conclusion Wrist radiography does not influence management of patients presenting DQT. Level of Evidence This is a level III, diagnostic study.

scholarly journals The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hao Li ◽  
Rui Li ◽  
L. L. Li ◽  
Wei Chai ◽  
Chi Xu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Periprosthetic Joint Infection ◽  
Retrospective Cohort Study ◽  
Persistent Infection ◽  
Retrospective Cohort ◽  
Joint Infection ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Coagulation Profile ◽  
Significant Difference

Abstract Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

2021 ◽  
pp. 107110072110028
Author(s):  
Thos Harnroongroj ◽  
Theerawoot Tharmviboonsri ◽  
Bavornrit Chuckpaiwong
Keyword(s):  
Regression Analysis ◽  
Conservative Treatment ◽  
Demographic Characteristics ◽  
Classification Systems ◽  
Clinical Severity ◽  
P Value ◽  
Level Of Evidence ◽  
Factors Associated ◽  
Radiographic Parameters ◽  
Significant Difference

Background: Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between “successful” and “failure” conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment. Methods: We retrospectively reviewed 68 patients with MWD divided into 29 “failure” and 39 “successful” conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A P value <.05 was considered a statistically significant difference. Results: We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group ( P < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment. Conclusion: Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors. Level of evidence: Level III, retrospective comparative study.

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