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.

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.

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.

Assessment of Posterior and Middle Facet Subluxation of the Subtalar Joint in Progressive Flatfoot Deformity

2020 ◽  
Vol 41 (10) ◽  
pp. 1190-1197 ◽  
Author(s):  
Cesar de Cesar Netto ◽  
Thiago Silva ◽  
Shuyuan Li ◽  
Nacime Salomao Mansur ◽  
Elijah Auch ◽  
...  
Keyword(s):  
Prediction Model ◽  
Subtalar Joint ◽  
Paired Comparison ◽  
Intraclass Correlation ◽  
Fold Increase ◽  
Wilcoxon Test ◽  
Bivariate Analysis ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Spearman’S Correlation

Background: Adult acquired flatfoot deformity (AAFD) is a complex 3-dimensional pathology characterized by peritalar subluxation (PTS) of the hindfoot. For many years, PTS was measured at the posterior facet of the subtalar joint. More recently, subluxation of the middle facet has been proposed as a more accurate and reliable marker of symptomatic AAFD, enabling earlier detection. The objective of this study was to compare the amount of subluxation between the medial and posterior facets in patients with AAFD. Methods: In this institutional review board-approved retrospective comparative study, a total of 76 patients with AAFD (87 feet) who underwent standing weightbearing computed tomography (WBCT) as a standard baseline assessment of their foot deformity were analyzed. Two blinded fellowship-trained orthopedic foot and ankle surgeons with >10 years of experience measured subtalar joint subluxation (as a percentage of joint uncoverage) at the both posterior and middle facets. One of the readers also measured the foot and ankle offset (FAO). PTS measurements were performed at the sagittal midpoint of the articular facets using coronal plane WBCT images. Intra- and interobserver agreement was measured for PTS measurements using the intraclass correlation coefficient (ICC). The intermethod agreement between the posterior and middle facet subluxation was assessed using Spearman’s correlation and bivariate analysis. Paired comparison of the measurements was performed using the Wilcoxon test. A multivariate analysis and a partition prediction model were used to assess influence of PTS measurements on FAO values. P values of <.05 were considered significant. Results: ICCs for intra- and interobserver reliabilities were 0.97 and 0.93, respectively, for posterior and 0.99 and 0.97, respectively, for middle facet subluxation. The intermethod Spearman’s correlation between subluxation of the posterior and middle facets was measured at 0.61. In a bivariate analysis, both measurements were found to be significantly and linearly correlated ( P < .0001; R2 = 0.42). Measurements of middle facet subluxation were found to be significantly higher than those for posterior facet subluxation, with a median difference (using the Hodges-Lehman factor) of 17.7% ( P < .001; 95% CI, 10.9%-23.6%). We also found that for every 1% increase in posterior facet subluxation there was a corresponding 1.6-fold increase in middle facet subluxation. Only middle facet subluxation measurements were found to significantly influence FAO calculations ( P = .003). The partition prediction model demonstrated that a middle facet subluxation value of 43.8% represented an important threshold for increased FAO. Conclusion: This study is the first to compare WBCT measurements of subtalar joint subluxation at the posterior and middle facets as markers of PTS in patients with AAFD. We found a positive linear correlation between the measurements, with subluxation of the middle facet being significantly more pronounced than that of the posterior facet by an average of almost 18%. This suggests that middle facet subluxation may provide an earlier and more pronounced marker of progressive PTS in patients with AAFD. Level of Evidence: Level III, retrospective comparative cohort study.

Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity

2020 ◽  
Vol 41 (7) ◽  
pp. 839-848
Author(s):  
Cesar de Cesar Netto ◽  
Katrina Bang ◽  
Nacime Salomao Mansur ◽  
Jonathan H. Garfinkel ◽  
Alessio Bernasconi ◽  
...  
Keyword(s):  
Comparative Study ◽  
Ankle Joint ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Mean Values ◽  
3 Dimensional ◽  
Biomechanical Assessment ◽  
Adult Acquired Flatfoot Deformity ◽  
Retrospective Comparative Study ◽  
The Relationship

Background: Semiautomatic 3-dimensional (3D) biometric weightbearing computed tomography (WBCT) tools have been shown to adequately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the foot and ankle offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD. Methods: In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20-86) years. 3D coordinates (x, y, and z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were assessed by 2 blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse planes were manually measured. Results: We found overall good to excellent intra- (range, 0.75-0.99) and interobserver (range, 0.73-0.99) reliability for manual AAFD measurements. FAO semiautomatic measurements demonstrated excellent intra- (0.99) and interobserver (0.99) reliabilities. Hindfoot moment arm (HMA) ( P < .00001), subtalar horizontal angle ( P < .00001), talonavicular coverage angle ( P = .00004), and forefoot arch angle ( P = .0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R2 value of 0.79. An HMA value of 19.8 mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8 mm and 14.6 when the HMA was equal to or higher than 19.8 mm. Conclusion: We found that 3D WBCT semiautomatic measurements of FAO significantly correlated with some traditional markers of pronounced AAFD. Measurements of FAO were also found to be slightly more reliable than the manual measurements. The FAO offers a simple and more complete biomechanical and multiplanar assessment of the AAFD, representing in a single measurement the 3D components of the deformity. Level of Evidence: Level III, retrospective comparative study.

Development of an Expectations Survey for Patients Undergoing Foot and Ankle Surgery

2016 ◽  
Vol 37 (12) ◽  
pp. 1277-1284 ◽  
Author(s):  
Elizabeth A. Cody ◽  
Carol A. Mancuso ◽  
Aoife MacMahon ◽  
Anca Marinescu ◽  
Jayme C. Burket ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Phase 1 ◽  
Intraclass Correlation ◽  
Weighted Kappa ◽  
Phase 2 ◽  
Foot And Ankle ◽  
Phase 3 ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Ankle Surgery

Background: Many authors have reported on patient satisfaction from foot and ankle surgery, but rarely on expectations, which may vary widely between patients and strongly affect satisfaction. In this study, we aimed to develop a patient-derived survey on expectations from foot and ankle surgery. Methods: We developed and tested our survey using a 3-phase process. Patients with a wide spectrum of foot and ankle diagnoses were enrolled. In phase 1, patients were interviewed preoperatively with open-ended questions about their expectations from surgery. Major concepts were grouped into categories that were used to form a draft survey. In phase 2, the survey was administered to preoperative patients on 2 occasions to establish test-retest reliability. In phase 3, the final survey items were selected based on weighted kappa values for response concordance and clinical relevance. Results: In phase 1, 94 preoperative patients volunteered 655 expectations. Twenty-nine representative categories were discerned by qualitative analysis and became the draft survey. In phase 2, another 60 patients completed the draft survey twice preoperatively. In phase 3, 23 items were retained for the final survey. For retained items, the average weighted kappa value was 0.54. An overall score was calculated based on the amount of improvement expected for each item on the survey and ranged from zero to 100, with higher scores indicating more expectations. For patients in phase 2, mean scores for both administrations were 65 and 66 and approximated normal distributions. The intraclass correlation coefficient between scores was 0.78. Conclusion: We developed a patient-derived survey specific to foot and ankle surgery that is valid, reliable, applicable to diverse diagnoses, and includes physical and psychological expectations. The survey generates an overall score that is easy to calculate and interpret, and thus offers a practical and comprehensive way to record patients’ expectations. We believe this survey may be used preoperatively by surgeons to help guide patients’ expectations and facilitate shared decision making. Level of Evidence: Level II, cross-sectional study.

scholarly journals Association between subtalar articular surface typing and flat foot deformity: which type is more likely to cause flat foot deformity

2021 ◽  
Vol 22 (1) ◽  
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.

Intratissue Percutaneous Electrolysis vs Corticosteroid Infiltration for the Treatment of Plantar Fasciosis

2018 ◽  
Vol 39 (6) ◽  
pp. 704-711 ◽  
Author(s):  
Álvaro Iborra-Marcos ◽  
Juan José Ramos-Álvarez ◽  
Guillermo Rodriguez-Fabián ◽  
Federico Del Castillo-González ◽  
Antonio López-Román ◽  
...  
Keyword(s):  
Comparative Study ◽  
Visual Analog Scale ◽  
Clinical Examination ◽  
Plantar Fascia ◽  
Foot And Ankle ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Level Of Evidence ◽  
Clinical Assessments ◽  
Retrospective Comparative Study

Background: Corticosteroid infiltration (CI) is commonly used for treatment of plantar fasciosis. In recent years, however, interest has grown in the use of intratissue percutaneous electrolysis (EPI) for the treatment of tendinopathies. The aim of our study was to compare the effectiveness of the above techniques in the treatment of plantar fasciosis. Methods: The results achieved over a period of 1 year following the use of these techniques to treat plantar fasciosis were examined. There were 64 patients; 32 of whom were treated with ultrasound-guided EPI and 32 with ultrasound-guided CI. A clinical examination was performed and ultrasound taken before treatment and at 3, 6, and 12 months. Clinical assessments were made using a visual analog scale (VAS) to record pain and the Foot and Ankle Disability Index (FADI) to evaluate function. Ultrasound was used to determine the thickness of the plantar fascia. Results: Both the ultrasound-guided EPI and CI techniques were associated with significant clinical and echographic improvements at 12 months post-treatment ( P < .001). Conclusion: Both techniques were effective in the treatment of PF, providing excellent VAS pain and FADI results at 12 months. However, CI required fewer patient visits and appeared to provide somewhat better VAS and FADI results. Level of Evidence: Level III, retrospective comparative study.

Functional Capacity Evaluation for Injuries to the Foot and Ankle

2019 ◽  
Vol 40 (11) ◽  
pp. 1282-1287
Author(s):  
Alexander J. Idarraga ◽  
Adam Wright-Chisem ◽  
Daniel D. Bohl ◽  
Simon Lee ◽  
Johnny Lin ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Functional Capacity Evaluation ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Capacity Evaluation ◽  
The Mean ◽  
Orthopedic Injuries ◽  
Retrospective Comparative Study ◽  
Mean Time

Background: The functional capacity evaluation (FCE) is used to determine physical ability after treatment of a workplace-related injury. This evaluation is a determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study was to characterize FCE results and ability to RTW after treatment for workplace-related orthopedic injuries to the foot or ankle. Methods: A retrospective medical record review from the practices of 4 orthopedic foot and ankle surgeons was conducted. Inclusion criteria were a workplace-related injury to the foot or ankle, at least 2 years of follow-up, and an associated FCE. The FCE report and clinic notes were used to determine the patient’s preinjury job requirement, postinjury FCE-determined ability, specific FCE- or physician-imposed work restrictions, and clearance to RTW. A total of 188 patients met inclusion criteria. Results: In total, 74.4% of patients had FCE-determined work abilities at or above their preinjury job requirements, and 63.3% of patients were cleared to RTW. The mean time from injury to FCE was 1.9 ± 1.5 years, and the mean time to clearance for RTW was 2.0 ± 1.3 years. A less strenuous preinjury job requirement was positively associated with both the FCE-determined ability meeting the preinjury job requirement ( P < .001) and clearance to RTW ( P = .034). Conclusion: Two in 3 patients were cleared to RTW following workplace-related injuries to the foot or ankle culminating in an FCE. However, it took a mean of 2 years to achieve this clearance. Patients with more strenuous jobs were less likely to be able to RTW after injury. Level of Evidence: Level III, retrospective comparative study.

Influence of Diagnosis and Other Factors on Patients’ Expectations of Foot and Ankle Surgery

2018 ◽  
Vol 39 (6) ◽  
pp. 641-648 ◽  
Author(s):  
Elizabeth A. Cody ◽  
Huong T. Do ◽  
Jayme C. B. Koltsov ◽  
Carol A. Mancuso ◽  
Scott J. Ellis
Keyword(s):  
Multivariate Regression ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Multivariate Regression Analysis ◽  
Foot And Ankle ◽  
Patient Factors ◽  
Outcome Score ◽  
Caucasian Race ◽  
Ankle Surgery ◽  
Preoperative Expectations

Background: Many patient factors have been associated with higher or lower expectations of orthopedic surgery. In foot and ankle surgery, the diverse diagnoses seen may also influence expectations. The aim of this study was to investigate the relationship between diagnosis and patients’ preoperative expectations of elective foot and ankle surgery. Methods: Two hundred seventy-eight patients undergoing elective foot or ankle surgery for 1 of 7 common diagnoses were enrolled in a prospective cohort study. Preoperative expectations were assessed with the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed the Foot & Ankle Outcome Score, Short Form 12, pain visual analog scale, and questionnaires for depressive and anxiety symptoms. Demographic and clinical data were collected. Patient factors and diagnosis were analyzed using multivariate regression analysis to identify independent predictors of higher expectations and determine the effect of diagnosis relative to other patient factors on expectations. Results: The multivariate regression analysis adjusting for demographics and other clinical characteristics showed that diagnosis contributed the most to the model, accounting for 10.5% of the variation in expectations survey scores. Patients with mid- or hindfoot arthritis ( P < .001), hallux valgus ( P = .001), or hallux rigidus ( P = .005) had lower scores (lower expectations) than those with ankle instability or osteochondral lesion. In the model, female sex ( P = .001), non-Caucasian race ( P = .031), and lower scores on the Foot & Ankle Outcome Score daily activities subscale ( P = .024) were associated with higher scores. Conclusions: Diagnosis of ankle instability or osteochondral lesion, female sex, non-Caucasian race, and lower Foot & Ankle Outcome Score daily activities subscale score were all associated with higher expectations. These findings may help inform and guide surgeons as they counsel patients preoperatively. Level of Evidence: Level II, cross-sectional study.

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