scholarly journals Changes of hindfoot alignment after high or low tibial osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
Jun Young Choi ◽  
Jin Soo Suh ◽  
Dong Joo Lee
Keyword(s):  
Ankle Joint ◽  
Normal Values ◽  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Moment Arm ◽  
Varus Alignment ◽  
Hindfoot Alignment ◽  
Radiographic Findings ◽  
Radiographic Parameters ◽  
Significant Change

Category: Hindfoot Introduction/Purpose: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively (P=0.03 and 0.001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change (P=0.001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased (P=0.001 for each), which represented a hindfoot alignment change to the valgus position. Conclusion: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO.

Changes in Hindfoot Alignment After High or Low Tibial Osteotomy

2018 ◽  
Vol 39 (9) ◽  
pp. 1097-1105 ◽  
Author(s):  
Jun Young Choi ◽  
Si Jung Song ◽  
Sung Jung Kim ◽  
Sang Hee Kim ◽  
Ji Soo Park ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Normal Values ◽  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Moment Arm ◽  
Varus Alignment ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Radiographic Findings ◽  
Radiographic Parameters

Background: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively ( P = .03 and .001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change ( P = .001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased ( P = .001 for each), which represented a hindfoot alignment change to the valgus position. Conclusions: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO. Level of Evidence: Level III, comparative series.

scholarly journals Peri-talar Osteotomy as Part of Treatment of Talar Osteochondral Defect of Varus Ankle

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Bibo Wang
Keyword(s):  
Osteochondral Defect ◽  
Corrective Osteotomy ◽  
Varus Deformity ◽  
Lateral View ◽  
Hindfoot Alignment ◽  
Routine Treatment ◽  
Vas Score ◽  
Radiographic Parameters ◽  
Sf36 Score ◽  
Double Osteotomy

Category: Ankle Introduction/Purpose: The etiology of osteochondral defect (OCD) of talus is not fully understood. Besides trauma, malalignment of ankle or hindfoot may play a role in the development of OCD. The aim of this study is to assess the efficacy of peri-talar osteotomy in addition to routine treatment of OCD of talus. Methods: This is a retrospective study of 52 cases of varus talar OCD during the period of 2009.9 to 2014.12. Micro-fracture or autograft transplantation were applied for the OCD first according to the dimension of the lesion in all cases. Then peri-talar osteotomy were performed to correct ankle or hindfoot mal-alignment in 26 cases according to the position of varus deformity, including 18 supramalleolar osteotomy, 6 calcaneal osteotomy and 2 combined distal tibial and calcaneal double osteotomy. Pre- and post-operative radiographic parameters of TAS, TTS, TLS angles and MoA were measured on mortise view, lateral view and hindfoot alignment view respectively. AOFAS-AH score, VAS score and SF36 score were performed to assess both subjective and objective outcome. Results: For the osteotomy group, there were statistically changes (P < 0.05) radiographically (TAS, TTS, MoA, TLS) after surgery. While the radiographic parameters didn’t change in the group without corrective osteotomy. AOFAS-AH score and VAS score increased significantly (P < 0.05) in both the osteotomy group and the non-osteotomy group. The SF36 scores score increased significantly (P < 0.05) in the osteotomy group while not significant in the non-osteotomy group. The AOFAS-AH and SF36 scores were statistically higher in the osteotomy group after surgery (p<0.05), and the VAS score were not statistically different in two groups. There were 5 out of 26 revised cases in the non-osteotomy group while 2 out of 26 revised cases in the osteotomy group. Conclusion: Peri-talar osteotomy in addition to routine treatment of OCD of talus results in better radiographic and functional outcome and lower recurrence for patients of varus talar osteochondral defect. Mechanical malalignment may contribute to progression of OCD of talus and thus should be corrected simultaneously.

scholarly journals Changes in Coronal Alignment of the Knee Joint after Supramalleolar Osteotomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Dong-Il Chun ◽  
Jahyung Kim ◽  
Sung Hun Won ◽  
Jaeho Cho ◽  
Jeongku Ha ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Knee Joint ◽  
Ankle Joint ◽  
Lower Limb ◽  
Varus Deformity ◽  
Limb Alignment ◽  
Coronal Alignment ◽  
Lower Limb Alignment ◽  
Radiographic Parameters ◽  
Supramalleolar Osteotomy

Background. Assessing knee joint orientation changes after SMO may help clinical advancement in managing patients with ipsilateral ankle and knee joint arthritis. However, knee joint changes after supramalleolar osteotomy (SMO) have not been reported. We investigated changes in coronal alignment of the knee joint after SMO. Methods. In this multicentre study, from January 2014 to December 2018, 47 ankles with varus osteoarthritis treated with SMO were retrospectively identified. Ankle joint changes were assessed using the tibiotalar angle, talar tilt angle, and lateral distal tibial angle (LDTA); knee joint changes using the medial proximal tibial angle (MPTA), medial and lateral joint space widths (mJSW and lJSW, respectively), and medial and lateral joint line convergence angles (JLCA); and lower limb alignment changes using mechanical axis deviation angle (MADA) and the hip-knee-ankle (HKA) angle measured on full-length anteroposterior radiographs of the lower extremity. Correlation analysis and binary logistic regression analysis were performed. Results. Postoperatively, LDTA ( p < 0.001 ) and tibiotalar angle ( p < 0.001 ) significantly changed, indicating meaningful improvement in the ankle joint varus deformity. Regarding the knee joint changes, JLCA significantly changed into valgus direction ( p = 0.044 ). As for lower limb alignment changes, MADA significantly decreased ( p < 0.001 ), whereas the HKA angle significantly increased ( p < 0.001 ). In univariate and multivariate logistic regression analyses, changes in the MADA ( p < 0.001 ) and the HKA angle ( p < 0.001 ) were significantly correlated with the correction angle. Conclusions. SMO remarkably improves ankle joint varus deformity, followed by significant lower limb alignment changes. Despite meaningful changes in JLCA, the relationship between the amount of osteotomy near the ankle joint and improvement in knee joint radiographic parameters was not significant. Radiographic parameters of the knee joint would less likely be changed following SMO.

scholarly journals Changes in the Ankle Joint and Hindfoot Alignment Following Varus Deformity Correction of the Knee with Total Knee Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Bi O Jeong ◽  
Jong Hun Baek ◽  
Wookjae Song
Keyword(s):  
Knee Joint ◽  
Ankle Joint ◽  
Mechanical Axis ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Hindfoot Alignment ◽  
Total Knee ◽  
The Mean ◽  
Surface Angle

Category: Ankle, Hindfoot Introduction/Purpose: Compensatory changes occur in the ankle joint and the subtalar joint of the hindfoot to maintain neutral alignment in coronal plane when varus or valgus deformity is present in the knee joint. The purpose of this study is (1) to analyze how the ankle and hindfoot joint compensate the changes in mechanical axis that occur with varus deformity of the knee, (2) to analyze the changes in ankle and hindfoot joint alignment when mechanical axis alignment is corrected by correction of varus deformity of the knee with total knee arthroplasty (TKA), and (3) to radiographically evaluate the degree of changes in ankle and hindfoot joint alignment according to the degree of varus deformity correction. Methods: 375 knees that underwent TKA with varus deformity were prospectively studied. The degree of varus deformity of the knee joint was measured in standing long leg anteroposterior views taken before and 6 months after TKA. The angle between the ground surface and the superior dome of the talus, and the talar tilt were measured in standing ankle joint anteroposterior views taken before and 6 months after TKA. Preoperative tibial anterior surface angle and tibial lateral surface angle were measured. Hindfoot alignment was evaluated in hindfoot alignment views taken before and 6 months after operation by measuring the heel ratio, the heel angle, and the heel distance. These measurements were used to analyze the change in ankle joint and hindfoot alignment between before and 6 months after varus deformity correction. The relationship between the degree of varus knee correction and the change in ankle joint and hindfoot alignment was also analyzed. Results: The mean mechanical angle of the knee changed from varus 10.6±5.1° before operation to varus 0.1±3.2° after operation, which was statistically significant (P<0.001). The mean correction angle was 10.6±4.6°. Before operation, the mean tibial anterior surface angle was 89.9±3.1° and the mean tibial lateral surface angle was 81.5±2.9°. Talar tilt changed significantly from 0.3±2.0° to 0.0±1.6°, implying a varus change of the ankle joint (P=0.002). All of the evaluated hindfoot alignment parameters demonstrated a significant varus change (P<0.001), as the heel ratio changed from 0.2±0.2 preoperatively to 0.3±0.2 postoperatively (P<0.001), the heel angle changed from 11.4±7.0° preoperatively to 5.0±7.4°postoperatively (P<0.001), and the heel distance changed from 10.5±6.6 mm preoperatively to 6.4±6.4 mm postoperatively (P<0.000). Conclusion: Varus knee deformity tended to be associated with valgus deformity of the ankle joint and hindfoot alignment. Alignment in the ankle joint and the hindfoot both changed to a varus trend after correction of varus deformity of the knee. Such changes in ankle joint and hindfoot alignment are considered to be due to the compensatory changes following alterations in lower limb alignment. Therefore, it is necessary to perform a meticulous examination of the ankle joint as well as the knee joint and consider subsequent alteration of ankle joint and hindfoot alignment before surgical correction of knee joint alignment.

scholarly journals Correlation Between Three-Dimensional Biometric Weightbearing CT Assessment of Hindfoot Alignment and Conventional Measurements of Adult Acquired Flatfoot

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0005
Author(s):  
Nacime S. Mansur ◽  
Cesar de Cesar Netto ◽  
Katrina E. Bang ◽  
Chris Cychosz ◽  
Jonathan H. Garfinkel ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Interobserver Reliability ◽  
Three Dimensional ◽  
Foot And Ankle ◽  
Moment Arm ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Horizontal Angle ◽  
Retrospective Comparative Study ◽  
Weightbearing Ct

Category: Hindfoot; Ankle; Other Introduction/Purpose: Semi-automatic three-dimensional (3D) biometric weightbearing CT (WBCT) tools have been shown to accurately 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 to 86) years. Three-dimensional 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 harvested by two 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 plane were manually measured. Results: We found overall good to excellent intra (range, 0.84-0.99) and interobserver reliability (range, 0.71-0.96) for manual AAFD measurements. FAO semi-automatic measurements demonstrated excellent intra (0.99) and interobserver reliabilities (0.98). Hindfoot moment arm (p<0.00001), subtalar horizontal angle (p<0.00001), talonavicular uncoverage angle (p=0.00004) and forefoot arch angle (p=0.0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R-squared value of 0.79. A value of hindfoot moment arm of 19.8mm 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 19.8mm and 14.6 when the HMA was equal or higher than 19.8mm. Conclusion: We found that 3D WBCT semi-automatic measurements of Foot and Ankle Offset (FAO) significantly correlated with traditional markers of pronounced AAFD. HMA, subtalar horizontal angle, talonavicular uncoverage angle and forefoot arch angle were found to explain 79% of the variations in FAO measurements. FAO Measurements were also found to be more reliable than the manual measurements. The FAO offers a more complete biomechanical and multiplanar assessment of the AAFD, that that accounts for relative positioning of the foot tripod and the center of the ankle joint, representing in a single measurement the three-dimensional components of the deformity.

Hindfoot Alignment Change After Total Ankle Arthroplasty for Varus Osteoarthritis

2020 ◽  
pp. 107110072097093
Author(s):  
Hyuck Sung Son ◽  
Jung Gyu Choi ◽  
Jungtae Ahn ◽  
Bi O Jeong
Keyword(s):  
Ankle Joint ◽  
Case Series ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Ankle Arthroplasty ◽  
End Stage ◽  
Surface Angle

Background: In patients with end-stage varus ankle osteoarthritis (OA), hindfoot varus malalignment resulting from the varus deformity of the ankle joint is common. Although total ankle arthroplasty (TAA) performed to correct varus deformity of the ankle joint has the effect of correcting hindfoot alignment, no reports to date have described how much hindfoot alignment correction can be achieved. The purpose of this study was to identify correlation between ankle deformity correction and hindfoot alignment change after performing TAA in patients with end-stage varus ankle OA. Methods: A total of 61 cases that underwent TAA for end-stage varus ankle OA and followed up for at least 1 year were enrolled for this study. Correlation between changes of tibial-ankle surface angle (TAS), talar tilt (TT), and tibiotalar surface angle (TTS) and changes of hindfoot alignment angle (HA), hindfoot alignment ratio (HR), and hindfoot alignment distance (HD) measured preoperatively and at postoperative year 1 was analyzed. Results: TAS, TT, and TTS changed from 83.9 ± 4.1 degrees, 5.8 ± 5.0 degrees, and 78.1 ± 5.9 degrees, respectively, before operation to 89.2 ± 2.1 degrees, 0.4 ± 0.5 degrees, and 88.7 ± 2.3 degrees, respectively, after operation. HA, HR, and HD also changed from −9.2 ± 4.6 degrees, 0.66 ± 0.18, and −11.2 ± 6.9 mm to −3.7 ± 4.1 degrees, 0.48 ± 0.14, and −5.0 ± 5.3 mm. All the changes were statistically significant ( P < .001, respectively). The regression slope of correlation was 0.390 ( R2 = 0.654) between TTS and HA; 0.017 ( R2 = 0.617) between TTS and HR; and 0.560 ( R2 = 0.703) between TTS and HD. Conclusion: In patients with end-stage varus ankle OA, changes of hindfoot alignment could be predicted based on degree of ankle deformity corrected with TAA. Level of Evidence: Level IV, case series.

scholarly journals The Association Between a Hindfoot Deformity Assessed by Weightbearing CT and the Full Leg Alignment

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001
Author(s):  
Arne Burssens ◽  
Kristian Buedts ◽  
Alexej Barg ◽  
Elizabeth Vluggen ◽  
Patrick Demey ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Varus Alignment ◽  
Hindfoot Alignment ◽  
Leg Alignment ◽  
Hindfoot Deformities ◽  
Study Population ◽  
Hindfoot Deformity ◽  
Weightbearing Ct

Category: Hindfoot Introduction/Purpose: The exact relationship between different types of hindfoot deformities and the full leg alignment is currently unclear. Therefore, our aim is to assess hindfoot alignment on a weight-bearing CT (WBCT) and its association with the full leg radiographic alignment. Methods: A retrospective analysis was performed on a study population of 109 patients (mean age of 53 years ± 14.49) with a varus or valgus hindfoot deformity and the presence or absence of ankle osteoarthritis (OA) based on the Takakura classification. The mechanical hindfoot - (mHA) and subtalar vertical angle (SVA) were determined on WBCT, while the mechanical tiba – (mTA) and mechanical tibiofemoral angle (mTFA) were measured on full leg radiographs. Results: In patients with ankle OA, a hindfoot valgus deformity was associated with a significantly higher mean varus alignment of the knee (mTFA = -1.8°±2.1; mTAx= -4.3°±1.9) compared to a valgus alignment of the knee (mTFA = 0.3°±2.6; mTAx= -1.4°±2.2; P <0.001) in patients with a varus hindfoot (Fig1A, B). The opposite relation was found in patients without ankle OA (P <0.001). The SVA was significantly more orientated in valgus (mean=106.9°±8.0) for patients with a hindfoot valgus compared to a higher varus orientation (mean=89.3°±13.9) in patients with a hindfoot varus deformity (P <0.001). The same pattern was found in patients without ankle OA, but not significant (P >0.05). Conclusion: A valgus hindfoot deformity demonstrated a higher varus alignment of the knee when compared to patients with a hindfoot varus deformity, if ankle OA was present. The subtalar joint did not attain an overall compensatory correction towards the hindfoot deformity as opposed to a compensatory orientation of the tibia alignment. In clinical practice, these findings could improve the current understanding of both joint preserving as well as joint replacing procedures of the hindfoot and the knee.

Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography

2021 ◽  
pp. 107110072110141
Author(s):  
Christopher B. Arena ◽  
Yantarat Sripanich ◽  
Richard Leake ◽  
Charles L. Saltzman ◽  
Alexej Barg
Keyword(s):  
Computed Tomography ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Motion Artifact ◽  
Imaging Modalities ◽  
Moment Arm ◽  
Varus Alignment ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Highly Correlated

Background: Hindfoot alignment view (HAV) radiographs are widely utilized for 2-dimensional (2D) radiographic assessment of hindfoot alignment; however, the development of weightbearing computed tomography (WBCT) may provide more accurate methods of quantifying 3-dimensional (3D) hindfoot alignment. The aim of this study was to compare the 2D calcaneal moment arm measurements on HAV radiographs with WBCT. Methods: This retrospective cohort study included 375 consecutive patients with both HAV radiographs and WBCT imaging. Measurement of the 2D hindfoot alignment moment arm was compared between both imaging modalities. The potential confounding influence of valgus/varus/neutral alignment, presence of hardware, and motion artifact were further analyzed. Results: The intraclass correlation coefficients (ICCs) of interobserver and intraobserver reliability for measurements with both imaging modalities were excellent. Both modalities were highly correlated (Spearman coefficient, 0.930; P < .001). HAV radiographs exhibited a mean calcaneal moment arm difference of 3.9 mm in the varus direction compared with WBCT (95% CI, –4.9 to 12.8). The difference of hindfoot alignment between both modalities was comparable in subgroups with neutral/valgus/varus alignment, presence of hardware, and motion artifact. Conclusion: Both HAV radiographs and WBCT are highly reliable and highly correlated imaging methods for assessing hindfoot alignment. Measurements were not influenced by severe malalignment, the presence of hardware, or motion artifact on WBCT. On average, HAV radiographs overestimated 3.9 mm of varus alignment as compared with WBCT. Level of Evidence: Level III, retrospective comparative study.

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