Reliability of the “Clinical Tibiofibular Line” Technique for Open Syndesmosis Reduction Assessment

2020 ◽  
Vol 13 (6) ◽  
pp. 516-521
Author(s):  
Anthony A. Pollizzi ◽  
Daniel C. Herman ◽  
Gregory C. Berlet ◽  
Christopher W. Reb
Keyword(s):  
Computed Tomography ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Lower Limbs ◽  
Diagnostic Study ◽  
Radiographic Assessment ◽  
Open Technique ◽  
Safe Alternative ◽  
Intraoperative Computed Tomography ◽  
Measurement Series

Background: When intraoperative computed tomography (CT) is unavailable, open syndesmosis assessment is a universally available, safe alternative that is more accurate than radiographic assessment. However, it has a documented malreduction rate of up to 16%. This may be improved upon with a validated technique for assessing the accuracy of open syndesmosis reductions. The “tibiofibular line” (TFL) is a CT-based technique found to be sensitive for malreduction. The purpose of this study was to assess the feasibility of adapting the CT-TFL method into a reliable intraoperative open technique by refining the methodology of previous work exploring the clinical TFL technique. Methods: Three observers were instructed to clinically simulate the TFL on cadaveric lower limbs. For each specimen, observers repeated and recorded 3 clinical TFL measurements for each of 4 measurement series representing different degrees of fibula reduction. Intraclass correlation was used to assess intra- and interobserver reliabilities. Results: Mean intraobserver reliability was .88. Mean interobserver reliability was .75. Both intra- and interobserver reliabilities were highest for anatomic syndesmosis reduction. Conclusion: The findings of excellent to near perfect intraobserver and good to excellent interobserver reliability indicate the feasibility of translating the CT-TFL into a reliable open technique. Levels of Evidence: Level III: Diagnostic study

scholarly journals Reliability of the “Clinical Tibiofibular Line” Technique for Open Syndesmosis Reduction Assessment

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Christopher Reb ◽  
Gregory Berlet ◽  
Daniel Herman
Keyword(s):  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Distal Tibia ◽  
Intraobserver Reliability ◽  
Lower Limbs ◽  
Tibial Tubercle ◽  
Open Technique ◽  
Cost Constraints ◽  
Anterior Tibial ◽  
Measurement Series

Category: Ankle, Trauma Introduction/Purpose: When intraoperative CT is unavailable, open syndesmosis assessment is a universally available safe alternative that is more accurate than radiographic assessment. However, it has a documented malreduction rate of up to 16%. This may be improved by a validated technique for assessing the accuracy of the open syndesmosis reduction but none currently exists. The ‘tibiofibular line’ (TFL) was described as a tangential line between the flat anterolateral surface of the distal fibula and the anterolateral tubercle of the distal tibia as viewed on ankle axial CT images 10 millimeters (mm) above the plafond (Figure 1a). This finding was sensitive for syndesmosis malreduction. The purpose of this study was to assess the feasibility of adapting the CT-based TFL method into a reliable intraoperative open technique. Methods: This was an IRB-exempt study utilizing 10 cadaveric lower limbs. Three observers were instructed to clinically simulate the TFL by using two surgical rulers. The axial plane was marked 10 mm above the tibial plafond (Figure 1b and 1c). The first ruler was held tangent to the flat anterolateral surface of the fibula (Figure 1d). Then, it was advanced anteromedially until it either contacted or overhung the anterior tibial tubercle (Figure 1e). Then, a second ruler was used to measure the narrowest distance between the first ruler and anterior tibial tubercle (Figure 1f). Observers repeated and recorded clinical TFL measurements three times per measurement series. Four measurement series were conducted: one with syndesmosis intact followed by three series with sagittal plane fibular displacements of known magnitudes. Intraclass correlation was used to assess intraobserver and interobserver reliability. Accuracy of clinical TFL measurements was not assessed due to lack of CT. Results: The three observers generated a total of 1080 clinical TFL measurements. Mean intraobserver reliability was 0.88 (range, 0.72 to 0.98). For observers 1, 2, and 3, respectively, mean intraobserver reliability was 0.92 (range, 0.86 to 0.98), 0.92 (range, 0.78 to 0.98), and 0.80 (range, 0.72 to 0.97). Mean interobserver reliability was 0.75 (range, 0.68 to 0.93). Both intraobserver and interobserver reliability were highest for anatomic syndesmosis reduction (Intraobserver reliability mean 0.97, range, 0.96 to 0.98; Interobserver reliability 0.93) and lowest for the greatest magnitude of malreduction (Intraobserver reliability mean 0.81, range, 0.76 to 0.88; Interobserver reliability 0.77). Conclusion: Intraoperative computed tomography is the gold standard for syndesmosis reduction assessment but its availability is limited due to feasibility and cost constraints. The importance of the current study is the concept of translating the objectivity of a CT-based technique into the otherwise highly subjective open technique. The current findings indicate that this can be done with excellent to near perfect intraobserver and good to excellent interobserver reliability. Future work is merited to assess the accuracy of the clinical TFL measurements against a CT facilitated TFL measurement.

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

2019 ◽  
Vol 40 (6) ◽  
pp. 720-726 ◽  
Author(s):  
Jian Zhong Zhang ◽  
François Lintz ◽  
Alessio Bernasconi ◽  
Shu Zhang ◽  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Intraclass Correlation Coefficients ◽  
Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

scholarly journals The Validity of In Vivo Tooth Volume Determinations From Cone-Beam Computed Tomography

2010 ◽  
Vol 80 (1) ◽  
pp. 160-166 ◽  
Author(s):  
Yi Liu ◽  
Raphael Olszewski ◽  
Emanuel Stefan Alexandroni ◽  
Reyes Enciso ◽  
Tianmin Xu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Interobserver Reliability ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Volumetric Analysis ◽  
Cone Beam ◽  
Water Displacement

Abstract Objective: To determine the accuracy of volumetric analysis of teeth in vivo using cone-beam computed tomography (CBCT). Materials and Methods: The physical volume (Vw) of 24 bicuspids extracted for orthodontic purposes (16 were imaged with the I-CAT and 8 with the CB MercuRay) were determined using the water displacement technique. Corresponding pretreatment CBCT image data were uploaded into Amira 4.0 for segmentation and radiographic volume (Va). All measurements were performed twice by two observers. The statistical difference between Vw and Va was assessed using a paired t-test. The intraobserver and interobserver reliability were determined by calculating Pearson correlation coefficients and intraclass correlation coefficients. Results: The overall mean Vw of teeth specimens was 0.553 ± 0.082 cm3, while the overall mean Va was 0.548 ± 0.079 cm3 (0.529 ± 0.078 cm3 for observer 1 and 0.567 ± 0.085 cm3 for observer 2). There were statistically significant differences between Va and Vw (P < .05). Between observer 1 and observer 2, Va measurements were statistically significantly different (P < .05). The interobserver and intraobserver correlation coefficient for Vw was high. Lastly, surface smoothing reduced the volume by 3% to 12%. Conclusions: In vivo determination of tooth volumes from CBCT data is feasible. The measurements slightly deviate from the physical volumes within −4% to 7%. Smoothing operations reduce volume measurements. Currently, no requirements for accuracy of volumetric determinations of tooth volume have been established.

scholarly journals How Accurate Is Clinical Evaluation in Hindfoot Coronal Alignment?

2017 ◽  
Vol 2 (4) ◽  
pp. 247301141773156 ◽  
Author(s):  
Gastón Slullitel ◽  
Victoria Álvarez ◽  
Valeria Lopez ◽  
Juan Pablo Calvi ◽  
Ana Belén Calvo
Keyword(s):  
Clinical Evaluation ◽  
Pearson Correlation ◽  
Lower Limbs ◽  
Measurement Tool ◽  
Diagnostic Study ◽  
Radiographic Assessment ◽  
Coronal Alignment ◽  
Posterior View ◽  
Hindfoot Alignment ◽  
Axial View

Background: Hindfoot coronal alignment is an important factor in the assessment of patients with many different foot and ankle complaints. A number of clinical and radiographic techniques have been described to measure hindfoot coronal alignment, but none of them are widely accepted. The purpose of the present study was to assess the correlation between clinical and radiographic hindfoot alignment measures and to evaluate the reproducibility of each. Methods: We evaluated 85 patients with foot and/or ankle symptoms. Hindfoot clinical alignment was measured from photographs. Each patient was placed at a distance of 1 m from the observer, with both feet placed parallel. Four photographs were taken, at a height of 40 cm: a posterior view of both lower limbs including knees, a posterior view focalized on the studied hindfoot, an anterior view of the foot, and the last view of the medial aspect of the foot. Radiographic alignment was quantified on long axial view radiographs. Patients were lying over the film cassette with a focus distance of 1 m and the beam pointed to the ankle joint. The inclination angle of the beam was 45 degrees to the floor. Measurements were independently made by 2 observers, who were asked to classify pictures into 3 categories: varus, neutral, and valgus. Radiographic measurements were made using the angle measurement tool on the radiograph viewer. The intraclass correlation coefficients (ICCs) and the 95% confidence interval (CI) of the ICC were used to quantify the inter- and intraobserver reliability for clinical assessment. Radiographic parameters were correlated by calculating the Pearson correlation coefficient (r). Results: The intraobserver ICC for clinical analysis was good for both observers, while the interobserver ICC was moderate for both measurements. Regarding radiographic assessment, there was significant intra- and interobserver reliability. The correlation between both methods was weak for both observers. Conclusions: We found only weak intra- and interobserver correlations between the clinical and radiographic assessment of hindfoot coronal alignment. It is therefore necessary to complement the clinical evaluation of hindfoot alignment with an objective measurement method such as a long axial view radiograph. Further studies comparing different measurement methods need to be performed to establish the most objective evaluation. Level of Evidence: Level III, diagnostic study.

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 Intraobserver and interobserver reliability of computed tomography measurements of the soft palate in French bulldogs

2019 ◽  
Vol 6 (1) ◽  
pp. e000373
Author(s):  
Pauline Deprez ◽  
Iban Irubetagoyena ◽  
Jean-Guillaume Grand ◽  
Nathaniel Harran
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Endotracheal Tube ◽  
Soft Palate ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Ct Image ◽  
Sectional Area ◽  
Cross Sectional

BackgroundCT imaging has been used to document the soft palate dimensions in brachycephalic dogs but reliability of such measurements has not been evaluated. The aims of this study were to propose a method of measurements of the soft palate in French bulldogs and determine its reliability.MethodsThirty French bulldogs were prospectively included. Five measurements of the soft palate were performed on soft tissue and bone window mid-sagittal images: length, thickness at 25, 50 and 75 per cent of its length and sagittal plane cross-sectional area. Three sets of data were separately acquired by three observers. Intraobserver and interobserver reliability for all measurements was assessed using intraclass correlation coefficient (ICC).ResultsThe median ICCs showed excellent reliability (0.90 to 0.99) for all intraobserver measurements except for thickness at 75 per cent which showed good (0.80 to 0.89) to excellent reliability. The median ICC showed excellent reliability for all interobserver measurements.ConclusionThe soft palate measurements on a single CT image are reproducible and repeatable. Further study is needed to assess the reliability of these measurements in the same patient with different endotracheal tube positions.

scholarly journals Orientation of Cone-Beam Computed Tomography Image: Pursuit of Perfect Orientation Plane in Three Dimensions—A Retrospective Cross-Sectional Study

2019 ◽  
Vol 55 (04) ◽  
pp. 202-209
Author(s):  
Rajiv Balachandran ◽  
Om Prakash Kharbanda ◽  
Karthik Sennimalai ◽  
Bala Chakravarthy Neelapu
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
T Test ◽  
Three Dimensions ◽  
Cone Beam ◽  
Intraobserver Agreement ◽  
Interobserver Error ◽  
Paired T Test

Abstract Objective This study aimed to evaluate the reproducibility of nine reference planes used in orientation of as-received cone-beam computed tomography (CBCT) images in all three dimensions. Materials and Methods The study was conducted on CBCT images of 15 adult subjects (mean age 21.2 ± 5.8 years). The anonymized CBCT images were oriented using five different methods created from nine reference planes by two experienced orthodontists. For each subject, pitch, yaw, and roll changes with five orientation methods were recorded twice by each observer. Statistical Analysis The inter- and intraobserver agreement was tested using intraclass correlation (ICC) and Bland–Altman plot. The intra- and interobserver error was analyzed using paired t-test. Analysis of variance and paired t-test were used to analyze the differences among the various pitch, roll, and yaw orientation planes. Results Inter- and intraobserver agreement (ICC, 0.9) was excellent for all the nine reference planes. The interobserver reliability showed statistically significant differences for four planes namely Frankfort horizontal plane constructed on right side (p = 0.014) and left side (p = 0.000), transorbital plane (p = 0.001), and midsagittal plane on top view (p = 0.036); however, the mean differences were clinically insignificant. Conclusion The landmark-based nine reference planes used in this study to orient CBCT images showed good reproducibility. Therefore, these reference planes can be used to orient CBCT images and can be incorporated into automated software.

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

scholarly journals Scoring Osteoarthritis Reliably in Large Joints and the Spine Using Whole-Body CT: OsteoArthritis Computed Tomography-Score (OACT-Score)

2020 ◽  
Vol 11 (1) ◽  
pp. 5
Author(s):  
Willem Paul Gielis ◽  
Harrie Weinans ◽  
Frank J. Nap ◽  
Frank W. Roemer ◽  
Wouter Foppen
Keyword(s):  
Computed Tomography ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Weighted Kappa ◽  
Reference Points ◽  
The Body ◽  
Whole Body ◽  
Kappa Statistics ◽  
Convenience Sample ◽  
Observer Reliability

A standardized method to assess structural osteoarthritis (OA) burden thorough the body lacks from literature. Such a method can be valuable in developing personalized treatments for OA. We developed a reliable scoring system to evaluate OA in large joints and the spine—the OsteoArthritis Computed Tomography (OACT) score, using a convenience sample of 197 whole-body low-dose non-contrast CTs. An atlas, containing example images as reference points for training and scoring, are presented. Each joint was graded between 0–3. The total OA burden was calculated by summing scores of individual joints. Intra- and inter-observer reliability was tested 25 randomly selected scans (N = 600 joints). Intra-observer reliability and inter-observer reliability between three observers was assessed using intraclass correlation coefficient (ICC) and square-weighted kappa statistics. The square-weighted kappa for intra-observer reliability for OACT-score at joint-level ranged from 0.79 to 0.95; the ICC for the total OA grade was 0.97 (95%-CI, 0.94 to 0.99). Square-weighted kappa for interobserver reliability ranged from 0.48 to 0.95; the ICC for the total OA grade was 0.95 (95%-CI, 0.90 to 0.98). The OACT score, a new reproducible CT-based grading system reflecting OA burden in large joints and the spine, has a satisfactory reproducibility. The atlas can be used for research purposes, training, educational purposes and systemic grading of OA on CT-scans.

scholarly journals Intraobserver and Interobserver Reliability of Cone Beam Weightbearing Semiautomatic Three- Dimensional Measurements in Symptomatic Pes Cavovarus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0010
Author(s):  
Alessio Bernasconi ◽  
Lucy Cooper ◽  
Shirley Lyle ◽  
Shelain Patel ◽  
Nicholas Cullen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subgroup Analysis ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Three Dimensional ◽  
Correlation Coefficients ◽  
Varus Deformity ◽  
Cone Beam ◽  
Foot And Ankle ◽  
Hindfoot Alignment

Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Pes cavovarus is a three-dimensional complex foot deformity variably involving a varus hindfoot, high longitudinal arch and forefoot adduction. Two-dimensional radiographs may be flawed by rotational bias and operator-related bias, while standard computed tomography (CT) cannot be perfomed in loading conditions. Three-dimensional (3D) cone beam weightbearing computed tomography (WBCT) may overcome these drawbacks, obtaining physiological weightbearing images with low-dose radiation. New 3D semiautomatic tools have been proposed to measure hindfoot alignment, but reliability in pes cavovarus has never been tested. The aim of this study was to assess intra and interobserver reliability of 3D biometrics on WBCT imaging in pes cavovarus. Our hypothesis was that foot and ankle offset, calcaneal offset and hindfoot angle were reliable measures regardless of type and severity of deformity. Methods: Cone beam WBCT anonymised datasets from 34 pes cavovarus (PC) (17 neurological, 17 non-neurological) and 17 normal feet were retrospectively reviewed. All WBCTs were performed during routine investigation. Inclusion criteria consisted of no previous ipsilateral foot/ankle surgery and ability to heel weightbear. Three foot and ankle surgeons (blinded to patient diagnosis) independently measured the following variables on 51 feet: foot and ankle offset (FAO), calcaneal offset (CO) and hindfoot angle (HA) using dedicated software. Each observer repeated all measurements two-weeks apart. The Shapiro–Wilk test was used to assess normality of data distribution. The Pearson or Spearman correlation test and Intraclass Correlation Coefficients (ICCs) and were used to assess intra and interobserver reliability, respectively. Subgroup analysis was performed to assess whether clinical diagnosis (neurological PC, non-neurological PC, normal controls) or severity of varus deformity (4 groups based on FAOs 25th, 50th and 75th centiles) could affect reliability of FAO measurements. Results: Intra and interobserver reliability for FAO (r= 0.98; ICC: 0.98), CO (r=0.94; ICC 0.89) and HA measurements (r=0.93; ICC:0.89) were excellent. Subgroup analysis showed that FAOs intra and interobserver reliability remained excellent in neurological PC (r= 0.96; ICC: 0.97), non-neurological PC (r=0.95; ICC: 0.96) and normal feet (r=-0.97; ICC: 0.94). Also, intraobserver (r=0.95, r=0.76, r=0.82 and r=0.92 for FAO >0%, from -7% to 0%, from -13% to -7%, and <-13%, respectively) and interobserver reliability for FAO measurements (ICC: 0.78, ICC: 0.76, ICC: 0.85 and ICC: 0.92) scored excellent regardless of the deformity. Conclusion: This study confirms that three-dimensional semiautomatic tools used on weightbearing CT datasets have excellent intra and interobserver reliability in the assessment of hindfoot alignment in pes cavovarus. The nature and severity of the deformity does not affect the reliability of the measurements. This infers that these 3D biometric tools on WBCT images can be reliably used in severe neurological cavovarus feet to evaluate and monitor cavovarus deformity and assess response to intervention.

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