Assessment of Progressive Collapsing Foot Deformity Using Semiautomated 3D Measurements Derived From Weightbearing CT Scans

2021 ◽  
pp. 107110072110497
Author(s):  
Nicola Krähenbühl ◽  
Peter Kvarda ◽  
Roman Susdorf ◽  
Arne Burssens ◽  
Roxa Ruiz ◽  
...  
Keyword(s):  
Control Group ◽  
Foot Deformity ◽  
Healthy Individuals ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
3 Dimensional ◽  
3D Measurements ◽  
Sinus Tarsi ◽  
Relevant Variables ◽  
Small Cohort

Background: In progressive collapsing foot deformity (PCFD), hind- and midfoot deformities can be hard to characterize based on weightbearing plain radiography. Semiautomated 3-dimensional (3D) measurements derived from weightbearing computed tomography (WBCT) scans may provide a more accurate deformity assessment. In the present study, automated 3D measurements based on WBCT were used to compare hindfoot alignment of healthy individuals to patients with PCFD. Methods: The WBCT scans of 20 patients treated at our institution with either a flexible (N = 10) or rigid (N = 10) PCFD were compared with the WBCT scans of a control group of 30 healthy individuals. Using semiautomated image analysis software, from each set of 3D voxel images, we measured the talar tilt (TT), hindfoot moment arm (HMA), talocalcaneal angle (TCA; axial/lateral), talonavicular coverage (TNC), and talocalcaneal overlap (TCO). The presence of medial facet subluxation as well as sinus tarsi/subfibular impingement was additionally assessed. Results: With the exception of the TCA (axial/lateral), the analyzed measurements differed between healthy individuals and patients with PCFD. The TCA axial correlated with the TNC in patients with PCFD. An increased TCO combined with sinus tarsi impingement raised the probability of predicting a deformity as rigid. Conclusion: Using 3D measurements, in this relatively small cohort of patients, we identified relevant variables associated with a clinical presentation of flexible or rigid PCFD. An increased TCO combined with sinus tarsi impingement raised the probability of predicting a deformity as rigid. Such WBCT-based markers possibly can help the surgeon in decision-making regarding the appropriate surgical strategy (eg, osteotomies vs realignment arthrodesis). However, prospective studies are necessary to confirm the utility of the proposed parameters in the treatment of PCFD. Level of Evidence: Level III, case-control study.

Consensus for the Use of Weightbearing CT in the Assessment of Progressive Collapsing Foot Deformity

2020 ◽  
Vol 41 (10) ◽  
pp. 1277-1282
Author(s):  
Cesar de Cesar Netto ◽  
Mark S. Myerson ◽  
Jonathan Day ◽  
Scott J. Ellis ◽  
Beat Hintermann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Expert Opinion ◽  
Subtalar Joint ◽  
Surgical Planning ◽  
Foot Deformity ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Sinus Tarsi ◽  
Weightbearing Ct ◽  
Consensus Expert

Recommendation: There is evidence that the use of WEIGHTBEARING imaging aids in the assessment of progressive collapsing foot deformity (PCFD). The following WEIGHTBEARING conventional radiographs (CRs) are necessary in the assessment of PCFD patients: anteroposterior (AP) foot, AP or mortise ankle, and lateral foot. If available, a hindfoot alignment view is strongly recommended. If available, WEIGHTBEARING computed tomography (CT) is strongly recommended for surgical planning. When WEIGHTBEARING CT is obtained, important findings to be assessed are sinus tarsi impingement, subfibular impingement, increased valgus inclination of the posterior facet of the subtalar joint, and subluxation of the subtalar joint at the posterior and/or middle facet. Level of Evidence: Level V, consensus, expert opinion.

3D Assessment in Posttraumatic Ankle Osteoarthritis

2020 ◽  
pp. 107110072096131
Author(s):  
Peter Kvarda ◽  
Lukas Heisler ◽  
Nicola Krähenbühl ◽  
Caspar Samuel Steiner ◽  
Roxa Ruiz ◽  
...  
Keyword(s):  
Ct Scan ◽  
Cone Beam Ct ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Cone Beam ◽  
Healthy Individuals ◽  
Ankle Osteoarthritis ◽  
Level Of Evidence ◽  
3D Measurements ◽  
End Stage

Introduction: Auto-generated 3-dimensional (3D) measurements based on weightbearing cone-beam computed tomography (CT) scan technology may allow for a more accurate hind- and midfoot assessment. The current study evaluated the reliability and clinical relevance of such measurements in patients with posttraumatic end-stage ankle osteoarthritis. Methods: Seventy-two patients treated at our institution for posttraumatic end-stage ankle osteoarthritis, with available weightbearing conventional radiographs and a cone-beam CT scan, were analyzed. Twenty healthy individuals aged between 40 and 70 years served as controls. Seven variables were measured on weightbearing conventional radiographs (2D) and compared to 3D measurements that were based on reconstructions from weightbearing cone-beam CT scans. The reliability of each measurement was calculated and subgroups formed according to commonly observed deformities. Results: Inter- and intraobserver reliability was superior for 3D compared to 2D measurements. The accuracy of 3D measurements performed on osteoarthritic ankles was similar to 3D measurements performed on healthy individuals. Thirty-three of the 72 included patients (46%) evidenced an inframalleolar compensation of a supramalleolar/intra-articular ankle deformity (78% = varus compensation; 22% = valgus compensation), whereas 24 of those 72 patients (33%) showed no compensation or a further increase of a supramalleolar/intra-articular ankle deformity (67% = varus deformity; 33% = valgus deformity). Conclusion: Auto-generated 3D measurements of the hind- and midfoot were found to be reliable in both healthy individuals and patients with posttraumatic end-stage ankle osteoarthritis. Such measurements may be crucial for a detailed understanding of the location and extent of hindfoot deformities, possibly impacting decision making in the treatment of end-stage ankle osteoarthritis. Level of Evidence: Level III, comparative study.

scholarly journals Plantar flexion, dorsiflexion, range of movement and hindfoot deviation are important determinants of foot function in children

2019 ◽  
Vol 13 (5) ◽  
pp. 486-499
Author(s):  
C. Alves ◽  
M. Lysenko ◽  
G. A. Tomlinson ◽  
J. Donovan ◽  
U. G. Narayanan ◽  
...  
Keyword(s):  
Plantar Flexion ◽  
Control Group ◽  
Foot Deformities ◽  
Physical Domain ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Level Ii ◽  
Children And Parents ◽  
Foot Function

Purpose Paediatric foot surgery is often performed to restore anatomical shape or range of movement (ROM). The purpose of this study was to determine how foot morphology and ROM are associated with foot function in children aged five to 16 years of age. Methods Participants included 89 patients with foot disorders and 58 healthy controls. In addition to measuring children’s foot alignment and ankle ROM, children and parents completed the Oxford Ankle and Foot Questionnaire (OxAFQ). Results Mean age was 10.3 years for patients and 10.6 years for controls; 53 of 89 patients had clubfoot. All foot measurements and scores on the OxAFQ significantly differed (p < 0.001) between patients and controls. Patients and their parents significantly differed on the physical (p = 0.03) and emotional (p = 0.02) domains of the OxAFQ, with parents’ ratings being lower than their children. Moderate correlations (r = 0.54 to 0.059; p < 0.001) were found between physical domain (reported by parents on the OxAFQ) and dorsiflexion-knee flexed, and foot- arc-of-movement. Moderate correlations were found between physical domain (reported by children on OxAFQ) and foot-arc-of-movement (r = 0.56; p < 0.001). Patients in the surgical group showed moderate correlations (r = 0.57;, p < 0.001) between physical domain (reported by children on OxAFQ) and plantar flexion, and foot arc-of-movement. The control group and the patients in non-surgical subgroup showed no significant correlations. Conclusion Plantar flexion, arc of ankle ROM and hindfoot alignment impact foot function in children with foot deformities. Parents report significantly lower scores on the OxAFQ when judging foot functioning. Level of evidence Level II. Prognostic Studies

scholarly journals Evaluation of surgical outcomes of arthroscopic subtalar arthrodesis performed through two lateral portals

2018 ◽  
Vol 12 (4) ◽  
Author(s):  
Rafael Freitas Villela ◽  
João Murilo Brandão Magalhães ◽  
Rogério de Andrade Gomes ◽  
Anderson Humberto Gomes ◽  
Bernardo Cardoso Pinto Coelho ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Case Series ◽  
Varus Deformity ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Bone Consolidation ◽  
Subtalar Arthrodesis ◽  
Postoperative Score ◽  
Sinus Tarsi ◽  
The Mean

Objective: The purpose of this study is to present the surgical outcomes of twelve patients undergoing arthroscopic subtalar arthrodesis using two lateral portals (anterior and medial) in the sinus tarsi. Methods: A retrospective study was conducted with twelve patients (7 men and 5 women) with a mean age of 55.1 (36-74) years who underwent arthroscopic subtalar arthrodesis through the sinus tarsi between May 2015 and December 2016. The post-surgical follow-up was 12 months. Consolidation time and postoperative complications were evaluated, and a validated functional questionnaire from the American OrthopedicFoot and Ankle Society (AOFAS) and the visual analog scale (VAS) for pain were applied both before and after surgery. Results: The mean bone fusion time was 11.5 weeks. Bone consolidation was observed in all analyzed patients. Four patients developed late complications, three of which were related to screw positioning in the calcaneus, while one was related to residual hindfoot varus deformity. Screw-related complications are common with all subtalar arthrodesis techniques, and such complications are considered less relevant when evaluating the effectiveness of the presented technique. The mean preoperative AOFAS score was 42.3 (27-66) points, while the mean postoperative score was 83 (73-94) points. The mean preoperative VAS score for pain was 8.1 (5-10) points, and the mean postoperative score was 2.1 (0-5) points. The above data are similar to those reported in other published studies and reflect high bone consolidation rates. Conclusion: Arthroscopic subtalar arthrodesis through two lateral portals in the sinus tarsi is a safe and effective technique for the treatment of primary and secondary disorders of the subtalar joint. Correct positioning of screws and hindfoot alignment must be carefully ensured to avoid complications related to the synthesis material and hindfoot varus deformity. Level of Evidence IV; Therapeutic Studies; Case Series.

Classification and Nomenclature: Progressive Collapsing Foot Deformity

2020 ◽  
Vol 41 (10) ◽  
pp. 1271-1276 ◽  
Author(s):  
Mark S. Myerson ◽  
David B. Thordarson ◽  
Jeffrey E. Johnson ◽  
Beat Hintermann ◽  
Bruce J. Sangeorzan ◽  
...  
Keyword(s):  
Classification System ◽  
Consensus Statement ◽  
Classification Systems ◽  
Posterior Tibial Tendon ◽  
Foot Deformity ◽  
New Classification ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Posterior Tibial ◽  
Consensus Statements

Recommendation: The historical nomenclature for the adult acquired flatfoot deformity (AAFD) is confusing, at times called posterior tibial tendon dysfunction (PTTD), the adult flexible flatfoot deformity, posterior tibial tendon rupture, peritalar instability and peritalar subluxation (PTS), and progressive talipes equinovalgus. Many but not all of these deformities are associated with a rupture of the posterior tibial tendon (PTT), and some of these are associated with deformities either primarily or secondarily in the midfoot or ankle. There is similar inconsistency with the use of classification schemata for these deformities, and from the first introduced by Johnson and Strom (1989), and then modified by Myerson (1997), there have been many attempts to provide a more comprehensive classification system. However, although these newer more complete classification systems have addressed some of the anatomic variations of deformities encountered, none of the above have ever been validated. The proposed system better incorporates the most recent data and understanding of the condition and better allows for standardization of reporting. In light of this information, the consensus group proposes the adoption of the nomenclature “Progressive Collapsing Foot Deformity” (PCFD) and a new classification system aiming at summarizing recent data published on the subject and to standardize data reporting regarding this complex 3-dimensional deformity. Level of Evidence: Level V, consensus, expert opinion. Consensus Statements Voted: CONSENSUS STATEMENT ONE: We will rename the condition to Progressive Collapsing Foot Deformity (PCFD), a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus. Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%. (Unanimous, strongest consensus) CONSENSUS STATEMENT TWO: Our current classification systems are incomplete or outdated. Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%. (Unanimous, strongest consensus) CONSENSUS STATEMENT THREE: MRI findings should be part of a new classification system. Delegate vote: agree, 33% (3/9); disagree, 67% (6/9); abstain, 0%. (Weak negative consensus) CONSENSUS STATEMENT FOUR: Weightbearing CT (WBCT) findings should be part of a new classification system. Delegate vote: agree, 56% (5/9); disagree, 44% (4/9); abstain, 0%. (Weak consensus) CONSENSUS STATEMENT FIVE: A new classification system is proposed and should be used to stage the deformity clinically and to define treatment. Delegate vote: agree, 89% (8/9); abstain, 11% (1/9). (Strong consensus)

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

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.

High Reliability for Semiautomated 3D Measurements Based on Weightbearing CT Scans

2021 ◽  
pp. 107110072110345
Author(s):  
Peter Kvarda ◽  
Nicola Krähenbühl ◽  
Roman Susdorf ◽  
Arne Burssens ◽  
Roxa Ruiz ◽  
...  
Keyword(s):  
High Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Intraclass Correlation Coefficients ◽  
3D Measurements ◽  
Reliable Assessment ◽  
Bland Altman Method ◽  
Treatment Concepts

Background: A reliable assessment of the ankle using weightbearing radiography remains challenging. Semiautomated 3-dimensional (3D) measurements derived from weightbearing computed tomography (WBCT) scans may provide a more reliable approach. Methods: Thirty healthy individuals without any foot and ankle disorder were analyzed. We assessed 6 widely used ankle parameters (4 angles and 2 distances) using either semiautomated 3D (based on WBCT scans) or traditional 2-dimensional (2D; based on conventional radiographs) measurements. The reliability and discrepancy between both techniques were compared using intraclass correlation coefficients and the Bland-Altman method. Results: Five of 6 variables showed a lower reliability when derived from 2D measurements. The mean of 3 variables differed between the techniques: the 3D technique assessed that the talonavicular coverage angle was 18.9 degrees higher, the axial talocalcaneal angle was 5.5 degrees higher, and the talocalcaneal overlap was 3.7 mm lower when compared with 2D measurements. Conclusion: Semiautomated 3D measurements derived from WBCT scans provide more reliable information on ankle alignment compared with 2D measurements based on weightbearing radiographs. Future studies may show to what extent these parameters could contribute to current diagnostic algorithms and treatment concepts. Level of Evidence: Not applicable.

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.

Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity

2020 ◽  
Vol 41 (10) ◽  
pp. 1295-1298
Author(s):  
Beat Hintermann ◽  
Jonathan T. Deland ◽  
Cesar de Cesar Netto ◽  
Scott J. Ellis ◽  
Jeffrey E. Johnson ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
External Rotation ◽  
Plantar Flexion ◽  
Posterior Tibial Tendon ◽  
Foot Deformity ◽  
Level Of Evidence ◽  
Lateral Column ◽  
3 Dimensional ◽  
Joint Fusion ◽  
First Ray

Recommendation: Peritalar subluxation represents an important hindfoot component of progressive collapsing foot deformity, which can be associated with a breakdown of the medial longitudinal arch. It results in a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and pronation. Loss of peritalar stability allows the talus to rotate and translate on the calcaneal and navicular bone surfaces, typically moving medially and anteriorly, which may result in sinus tarsi and subfibular impingement. The onset of degenerative disease can manifest with stiffening of the subtalar (ST) joint and subsequent fixed and possibly arthritic deformity. While ST joint fusion may permit repositioning and stabilization of the talus on top of the calcaneus, it may not fully correct forefoot abduction and it does not correct forefoot varus. Such varus may be addressed by a talonavicular (TN) fusion or a plantar flexion osteotomy of the first ray, but, if too pronounced, it may be more effectively corrected with a naviculocuneiform (NC) fusion. The NC joint has a curvature in the sagittal plane. Thus, preserving the shape of the joint is the key to permitting plantarflexion correction by rotating the midfoot along the debrided surfaces and to fix it. Intraoperatively, care must be also taken to not overcorrect the talocalcaneal angle in the horizontal plane during the ST fusion (eg, to exceed the external rotation of the talus and inadvertently put the midfoot in a supinated position). Such overcorrection can lead to lateral column overload with persistent lateral midfoot pain and discomfort. A contraindication for an isolated ST fusion may be a rupture of posterior tibial tendon because of the resultant loss of the internal rotation force at the TN joint. In these cases, a flexor digitorum longus tendon transfer is added to the procedure. Level of Evidence: Level V, consensus, expert opinion.

Prevalence of Toxoplasma gondii and Toxocara canis among Myositis Patients in Southwest of Iran

2019 ◽  
Vol 20 ◽  
Author(s):  
Jasem Saki ◽  
Karim Mowla ◽  
Reza Arjmand ◽  
Forough Kazemi ◽  
Somayeh Fallahizadeh
Keyword(s):  
Toxoplasma Gondii ◽  
Nested Pcr ◽  
Healthy Subjects ◽  
Toxocara Canis ◽  
Control Group ◽  
Igg Antibodies ◽  
Healthy Individuals ◽  
High Prevalence ◽  
Acute Toxoplasmosis ◽  
Southwest Of Iran

Introduction: Parasitic myositis is caused by some parasites such as T. gondii and T. canis. So, the aim of the study was to evaluate the prevalence T. gondii and T. canis in patients with myositis and healthy individuals. Methods: A total of 108 samples were randomly selected as the control (54 healthy individuals) and test (54 myositis patients) groups. IgG and IgM antibodies against T. gondii and IgG antibodies against T. canis were measured by the ELISA. The detection of chronic and acute toxoplasmosis was performed by the ELISA IgG avidity. The presence of T. gondii in blood was evaluated by the nested-PCR. Results: Of 108, 33 (30.6%) cases were detected positive for IgG against T. gondii that 19 (35.2%) and 14 (25.9%) were observed in myositis patients and healthy individuals, respectively (P=0.296). Of 19 positive cases, 12 (63.2%) and 7 (36.8%) cases were detected as chronic and acute toxoplasmosis, respectively, while, all positive cases in the control group had chronic toxoplasmosis (P=0.013). One (1.9%) sample was detected positive for anti- Toxoplasma gondii IgM and two (3.7%) samples were found positive for IgG against T. canis by the ELISA that these positive cases were observed only in myositis patients (P=1.000 P=0.495, respectively). B1 T. gondii gene was amplified in 12 (63.2%) and 1 (7.1%) in myositis patients and healthy subjects (P=0.001). Conclusions: Our findings showed that there was a relatively high prevalence of acute toxoplasmosis in myositis patients in comparison with the control subjects in southwest of Iran.

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