Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity

2021 ◽  
pp. 107110072098290
Author(s):  
Elijah Auch ◽  
Nacime Salomao Barbachan Mansur ◽  
Thiago Alexandre Alves ◽  
Christopher Cychosz ◽  
Francois Lintz ◽  
...  
Keyword(s):  
Case Control Study ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Spearman Correlation ◽  
Foot Deformity ◽  
Weak Correlation ◽  
Level Of Evidence ◽  
Valgus Instability ◽  
Retrospective Comparative Study ◽  
Control Study

Background: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. Methods: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. Results: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% ( P < .001) in FAO and 10.4 mm2 ( P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 ( P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2. Conclusion: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. Level of Evidence: Level III, retrospective comparative study.

Association Between Middle Facet Subluxation and Foot and Ankle Offset in Progressive Collapsing Foot Deformity

2021 ◽  
pp. 107110072110408
Author(s):  
Nacime Salomão Barbachan Mansur ◽  
Matthieu Lalevee ◽  
Connor Maly ◽  
Kevin Dibbern ◽  
Hee Young Lee ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Prediction Models ◽  
Intraclass Correlation ◽  
Multivariate Regression Analysis ◽  
Foot And Ankle ◽  
Foot Deformity ◽  
Level Of Evidence ◽  
Potential Association ◽  
Reliable Marker ◽  
Retrospective Comparative Study

Background: Subtalar middle facet (MF) subluxation was recognized as a reliable marker for progressive collapsing foot deformity (PCFD) diagnosis. Foot and Ankle Offset (FAO) is an established measurement, predictive of malalignment severity. The objective of this study was to assess the potential association between MF subluxation and FAO in PCFD patients. Methods: 56 individuals with flexible PCFD (74 feet) were assessed. Two blinded foot and ankle surgeons calculated MF uncoverage, MF incongruence, and FAO. Agreement was quantified using intraclass correlation coefficient (ICC). A multivariate regression analysis and partition prediction models were applied to assess relationship between values. Results: All ICCs were >0.80. MF subluxation and FAO were found to be correlated ( rs = 0.56; P < .0001). Changes in the MF subluxation were noticeably explained by FAO and BMI ( R2 = 0.33). MF incongruence was not correlated with the assessed variables ( P = .10). In this cohort, an MF subluxation of 27.5% was a threshold for increased FAO (FAO of 3.4%±2.4% when below; FAO of 8.0% ±3.5% when above). Conclusion: We found a correlation between MF subluxation and FAO. An MF subluxation of 27.5% was found to be a threshold for higher FAO, which corresponded to a greater malalignment. These data may help surgeons optimize treatment decisions in PCFD patients. Level of Evidence: Level III, retrospective comparative study.

Three-Dimensional Distance and Coverage Maps in the Assessment of Peritalar Subluxation in Progressive Collapsing Foot Deformity

2021 ◽  
pp. 107110072098322
Author(s):  
Kevin N. Dibbern ◽  
Shuyuan Li ◽  
Victoria Vivtcharenko ◽  
Elijah Auch ◽  
Francois Lintz ◽  
...  
Keyword(s):  
Case Control Study ◽  
Three Dimensional ◽  
Foot Deformity ◽  
Level Of Evidence ◽  
P Values ◽  
3 Dimensional ◽  
Adult Acquired Flatfoot Deformity ◽  
Distance Mapping ◽  
Consecutive Stage ◽  
Control Study

Background: Progressive collapsing foot deformity (PCFD), formerly termed adult-acquired flatfoot deformity, is a complex 3-dimensional (3D) deformity of the foot characterized by peritalar subluxation (PTS). PTS is typically measured at the posterior facet, but recent studies have called this into question. The objective of this study was to use 3D distance mapping (DM) from weightbearing computed tomography (WBCT) to assess PTS in patients with PCFD and controls. We hypothesized that DMs would identify the middle facet as a superior marker for PTS. Methods: We analyzed WBCT data of 20 consecutive stage I patients with PCFD and 10 control patients with a novel DM technique to objectively characterize joint coverage across the entire peritalar surface, including both articular and nonarticular regions. Joint coverage was defined as the percentage of articular area with DMs <4 mm and impingement when distances were <0.5 mm. Comparisons were performed with independent t tests or Wilcoxon tests. P values <.05 were considered significant. Results: Overall, coverage was decreased in articular regions and impingement was increased in nonarticular regions of patients with PCFD with a significant increase in uncoverage in the middle (46.6%, P < .001) but not anterior or posterior facets. Significant increases in sinus tarsi coverage were identified (98.0%, P < .007) with impingement in 6 of 20 patients with PCFD. Impingement of the subfibular region was noted in only 1 of 20 cases but narrowing greater than 2 standard deviations was noted in 17 of 20 patients. Conclusions: Objective DMs identified significant markers of PTS in the middle but not posterior or anterior facets. We confirmed prior 2-dimensional data that suggested uncoverage of the middle facet provided a more robust and consistent measure of PTS than measures in the posterior facet. Level of Evidence: Level III, case-control study.

scholarly journals Peripartum Predictors of the Risk of Postpartum Depressive Disorder: Results of a Case-Control Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8726 ◽  
Author(s):  
Kornelia Zaręba ◽  
Jolanta Banasiewicz ◽  
Hanna Rozenek ◽  
Stanisław Wójtowicz ◽  
Grzegorz Jakiel
Keyword(s):  
Risk Factors ◽  
Mood Disorders ◽  
Medical Records ◽  
Case Control Study ◽  
Uterine Cavity ◽  
Control Group ◽  
Gynecology And Obstetrics ◽  
Increased Risk ◽  
Retrospective Comparative Study ◽  
Control Study

Background: The study aimed at the identification of the risk factors present during delivery, which might be present in prophylactic programs concerning postpartum mood disorders. Material and Method: This was a retrospective comparative study. The study material included data retrieved from the medical records of patients hospitalized in the Teaching Department of Gynecology and Obstetrics of Professor Orłowski Hospital in Warsaw, in the years 2010–2017. The EPDS data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in the EPDS and the control group was made up of 75 women who obtained no more than 5 points in the EPDS. Results: The women in whom we noted an increased risk of developing mood disorders had blood loss >1000 mL and had a significantly longer stage II and III of labor than the control group. Other risk factors were cesarean section, vaginal delivery with the curettage of the uterine cavity, slightly lower APGAR scores (0.4 pts), and lower birth weight (approximately 350 g) of the child. Women at a low risk of postpartum mood disorders more commonly underwent episiotomy during delivery (76%). Conclusions: Increased supervision and support should be offered to women who experienced the above-mentioned risk factors.

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure

2020 ◽  
pp. 107110072097266
Author(s):  
Joseph T. O’Neil ◽  
Otho R. Plummer ◽  
Steven M. Raikin
Keyword(s):  
Computerized Adaptive Testing ◽  
Case Series ◽  
Adaptive Testing ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Ability Measure ◽  
The Impact

Background: Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level of Evidence: Level IV, case series.

scholarly journals Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients

2018 ◽  
Vol 39 (12) ◽  
pp. 1444-1448 ◽  
Author(s):  
Kevin D. Martin ◽  
Trevor McBride ◽  
Jeffrey Wake ◽  
Jeffrey Preston Van Buren ◽  
Cuyler Dewar
Keyword(s):  
Pain Score ◽  
Operative Procedure ◽  
Patient Reported Outcome Measures ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Vas Score ◽  
Pain Scores ◽  
Patient Reported ◽  
The Mean

Background: Patient-reported outcome measures (PROMs) are taking a more prominent role in orthopedics as health care seeks to define treatment outcomes. The visual analog scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in patients that do not undergo an operative procedure. We hypothesized that patients’ VAS pain scores reported to the surgeon vs the nurse would be the same. Methods: This study is a retrospective cohort of 201 consecutive nonoperative foot and ankle patients treated by a single surgeon. Patients were asked to rate pain intensity by a nurse followed by the surgeon using a horizontal VAS, 0 “no pain” to 10 “worst pain.” Differences in reported pain levels were compared with data from the previous cohort of 201 consecutive operative foot and ankle patients. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the surgeon was 4.2 ( P < .001). The mean difference in VAS scores reported for operative patients was 2.9, whereas the mean difference for nonoperative patients was 1.0 ( P < .001). Conclusion: This study found statistically significant differences between VAS pain scores reported to the surgeon vs the nurse in nonoperative patients. These results support the trend found in our previous study, where operative patients reported significantly higher pain scores to the surgeon vs the nurse. The mean difference between reported pain scores was significantly higher for operative patients compared to nonoperative patients. Level of Evidence: Level III, comparative study.

scholarly journals Does Flipping the Tubercle for Improved Cartilage Repair Exposure Increase the Risk for Arthrofibrosis?

Cartilage ◽  
2020 ◽  
pp. 194760352096820
Author(s):  
Gergo Merkely ◽  
Jakob Ackermann ◽  
Emily Sheehy ◽  
Andreas H. Gomoll
Keyword(s):  
Logistic Regression ◽  
Cartilage Repair ◽  
Regression Models ◽  
Case Control Study ◽  
Level Of Evidence ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Repair Procedure ◽  
Control Study

Objective We sought to determine whether rates of postoperative arthrofibrosis following tibial tuberosity osteotomy (TTO) with complete mobilization of the fragment (TTO-HD) are comparable to TTOs where the hinge remained intact (TTO-HI). Design Patients who underwent TTO with concomitant cartilage repair procedure between January 2007 and May 2017, with at least 2 years of follow-up were included in this study. Postoperative reinterventions following TTO-HD and TTO-HI were assessed and multivariant logistic regression models were used to identify whether postoperative reinterventions can be attributed to either technique when controlled for defect size or defect number. Results A total of 127 patients (TTO-HD, n = 80; TTO-HI, n = 47) were included in this study. Significantly more patients in the TTO-HD group (31.2%) developed postoperative arthrofibrosis compared with TTO-HI (6.4%; P < 0.05). Multivariant logistic regression revealed that TTO-HD is an independent risk factor for predicting postoperative arthrofibrosis (OR 6.5, CI = 1.7-24.2, P < 0.05). Conclusion Patients who underwent TTO with distal hinge detachment and a proximally flipped tubercle for better exposure during concomitant cartilage repair were at a significantly higher risk of postoperative arthrofibrosis than patients with similar size and number of defects treated without mobilization of the tubercle. While certain procedures can benefit from larger exposure, surgeons should be aware of the increased risk of postoperative arthrofibrosis. Level of Evidence Level III, case-control study.

scholarly journals Association between risk of preeclampsia and maternal plasma trimethylamine-N-oxide in second trimester and at the time of delivery

2020 ◽  
Author(s):  
Xin Huang ◽  
Zuodong Li ◽  
Zhou Gao ◽  
Dapeng Wang ◽  
Xiaohui Li ◽  
...  
Keyword(s):  
Case Control Study ◽  
Late Onset ◽  
Maternal Plasma ◽  
Second Trimester ◽  
Spearman Correlation ◽  
The Mean ◽  
Nested Case Control ◽  
Control Study ◽  
Risk Of Preeclampsia

Abstract Background: The data on the association between the microbiota-dependent metabolite trimethylamine-N-oxide (TMAO) during pregnancy and risk of preeclampsia (PE) is limited. Methods: We, therefore, conducted a prospective nested case control study during Sep 2017 to Dec 2018 to examine the association between plasma TMAO measured during pregnancy and the risk of PE. Total of 17 patients diagnosed with EOPE (early onset PE), 49 with LOPE (late onset PE) and 198 healthy controls were enrolled. Blood samples were collected at 15-23 gestational weeks and time at delivery. The Logistic regression model was used to assess the odds ratio (OR) and 95% confidence interval (CI) for TMAO and risk of PE, EOPE, LOPE, mild PE, and severe PE. Results: We found that the mean TMAO levels of overall subjects in the second trimester (T2) and at the time of delivery (TD) were 90.39 µg/m 3 (SD=45.91) and 175.01 µg/m 3 (SD=160.97), respectively. No significant spearman correlation was found between the TMAO in those two periods ( p > 0.05). T2 TMAO was not significantly associated with risk of PE or risk of any PE subtypes ( p >0.05). However, TD TMAO was significant associated with risk of PE, EOPE and severe PE (adjusted OR and 95%CI were 1.24(1.09, 1.40), 1.62(1.29, 2.03), and 1.41(1.17, 1.70)) per 50µg/m 3 increment, respectively). Conclusion: Our study found that plasma TMAO level would alter over the course of pregnancy. The major role of TMAO in PE development might be in the accelerating process not in the initiation.

scholarly journals Twenty-four-hour Blood Pressure Monitoring in Central Serous Chorioretinopathy – A Case-control Study

2013 ◽  
Vol 07 (01) ◽  
pp. 42
Author(s):  
Pradeep Venkatesh ◽  
Vikas Jain ◽  
Satpal Garg ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Central Serous Chorioretinopathy ◽  
Case Control Study ◽  
Blood Pressure Monitoring ◽  
Case Control ◽  
Mean Difference ◽  
National Committee ◽  
The Mean ◽  
The Difference ◽  
Control Study

Purpose:A case-control study to explore the diurnal variation of blood pressure (BP) in patients with central serous chorioretinopathy (CSCR).Methods:One-hundred patients (50 cases with central serous chorioretinopathy and 50 age- and sex-matched controls) participated in this study. Twenty-four-hour BP was recorded by auscultatory method using manual standard mercury sphygmomanometer by a single, trained observer. Hypertension was categorised according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII) classification.Results:Mean systolic BP (SBP) and diastolic BP (DBP) in cases and controls were 123.4 mmHg (range 112.3–134.6), 81.72 mmHg (range 73.0–90.5); 118.33 mmHg (range 108.4–128.2); and 77.50 mmHg (range 71.4–83.6), respectively. The difference in SBP and DBP was statistically significant at p=0.02 for the former and p=0.006 for the latter. The mean difference in maximum and minimum SBP in cases was 18 (±15.81) mmHg versus 9.04 (±3.08) mmHg in controls (p=0.001). Mean difference for DBP in cases was 15.16 (±7.86) mmHg versus 9.16 (±3.68) mmHg in controls (0.001). On the JNC-VII classification scale for hypertension, 66 % of cases were found to be pre-hypertensive (60 %) or hypertensive (6 %). Comparative figures for controls were pre-hypertension (30 %) and hypertension (2 %). The mean SBP and DBP was consistently higher in patients with CSCR compared with controls over the entire 24-hour period. The difference in variation between maximum and minimum SBP and DBP was also found to be statistically significant between the groups.Conclusion:A significant correlation exists between higher values BP and central serous chorioretinopathy. Screening of CSCR patients for pre-hypertension may be useful in decreasing the risk of progression to established hypertension, with its associated risks.

scholarly journals Association Between Subtalar Articular Surface Typing and Flat Foot Deformity: Which Type is More Likely to Cause Flat Foot Deformity

2021 ◽  
Author(s):  
Lei Zhang ◽  
Xiaoyao Peng ◽  
Siyuan He ◽  
Xin Zhou ◽  
Gang Yi ◽  
...  
Keyword(s):  
Articular Surface ◽  
Type I ◽  
Type Ii ◽  
Foot Deformity ◽  
Imaging Data ◽  
Level Of Evidence ◽  
Flat Foot ◽  
Wide Range ◽  
Retrospective Comparative Study ◽  
Böhler’S Angle

Abstract Background Previous studies have shown a wide range of anatomical classifications of the subtalar joint (STJ) in the population and this is related to the different force line structures of the foot. Different subtalar articular surface morphology may affect the occurrence and development of flat foot deformity, and there are fewer studies in this area. The main objective of our study was to determine the association of different subtalar articular surface with the occurrence and severity of flat foot deformity. Methods We analyzed the imaging data of 289 cases of STJ. The articular surface area, Gissane's angle and Bohler's angle of subtalar articular surface of different types were counted. The occurrence and severity of flat foot deformity in different subtalar articular surface were judged by measuring the Meary angle of foot. Results We classified 289 cases of subtalar articular surface into five types according to the morphology. According to Meary angle, the flat foot deformity of Type Ⅰ and Type Ⅳ are significantly severer than Type Ⅱ (P < 0.05). Type II (7.65 ± 1.38 cm2) was significantly smaller than Type I (8.40 ± 1.79 cm2) in the total joint facet area(P < 0.05). Type III (9.15 ± 1.92 cm2) was smaller than Type I (8.40 ± 1.79 cm2), II(7.65 ± 1.38 cm2) and Ⅳ(7.81 ± 1.74 cm2 ) (P < 0.05).Type II (28.81 ± 7.44∘) was significantly smaller than Type I (30.80 ± 4.61 degrees), and IV (32.25 ± 5.02 degrees) in the Bohler’s angle (P < 0.05). Type II (128.49 ± 6.74 degrees) was smaller than Type I (131.58 ± 7.32 degrees), and IV (131.94 ± 5.80 degrees) in the Gissane’s angle (P < 0.05). Conclusions After being compared and analyzed the measurement of morphological parameters, joint facet area and fusion of subtalar articular surface were closely related to the severity of flat foot deformity and Type I and IV were more likely to develop severer flat foot deformity. Level of evidence: Level III, retrospective comparative study.

scholarly journals CORRELATION BETWEEN AHLBÄCK CLASSIFICATION AND GONARTHROSIS RISK FACTORS

2018 ◽  
Vol 26 (4) ◽  
pp. 240-243 ◽  
Author(s):  
Paulo Alvim Borges ◽  
Mauro Henrique José De Almeida ◽  
Lucas Moura Araújo ◽  
Junji Miller Fukuyama ◽  
Fernando Yukio Umada ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Case Control Study ◽  
Sedentary Lifestyle ◽  
Positive Association ◽  
Level Of Evidence ◽  
History Of ◽  
Control Study ◽  
Radiographic Classification

ABSTRACT Objective: To demonstrate whether or not there is a correlation between the risk factors for gonarthrosis and the radiographic classification of Ahlbäck. Methods: We studied patients with primary gonarthrosis attended at the knee outpatient clinic of the General Hospital of Vila Penteado during their routine visit. We collected data on patient age (years), weight (kg), height (meters), body mass index (BMI = patient weight/height2), personal history of hypertension or diabetes mellitus (positive or negative), sedentarism (physical activity less than three times per week, 30 minutes per session), functional demand (how many blocks walked weekly), time of onset of symptoms (in years) and laterality or bilaterality. The data were correlated with the Ahlbäck classification applied to the radiographs performed at the time of the consultation. Results: A sample of 108 patients was studied. We did not find an association between the Ahlbäck classification and the patient's age, smoking, sedentary lifestyle, laterality, number of blocks walked per week, diabetes mellitus, and sex; however, a positive association was observed in hypertensive patients as well as a weak correlation with height and weight of the patient and moderate correlation with BMI. Conclusion: The Ahlbäck classification is unrelated to most of the risk factors for primary gonarthrosis. Level of evidence III, Case-control study.

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