scholarly journals Morphometric Measurements of the Calcaneus in Adults with Stage IIb, Posterior Tibial Tendon Dysfunction

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0050
Author(s):  
Kempland Walley ◽  
Evan Roush ◽  
Chris Stauch ◽  
Allen Kunselman ◽  
Kaitlin Saloky ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pediatric Population ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Morphometric Measurements ◽  
Anterior Process ◽  
Lateral Column ◽  
Posterior Tibial

Category: Hindfoot Introduction/Purpose: The pathophysiology of adult-acquired flatfoot deformity (AAFD) is not fully explained by degeneration of the posterior tibial tendon alone. While a shortened or dysplastic lateral column has been implicated in flatfoot deformity in pediatric population, there is no study that has quantified the degree of shortening or dysplasia in adults with a stage IIb flatfoot deformity, or if any exists at all. The purpose of this study was to use reconstructive 3D modeling from computed tomography (CT) scans of the calcaneus in order to perform three-dimensional morphometric measurements of the lateral column in patients with stage IIb posterior tibial tendon dysfunction (PTTD) compared to controls in an effort to better understand the morphology of patients with AAFD. Methods: After IRB approval, an institutional radiology database was queried for patients with PTTD who had CT performed between January 2011 and June 2016. Controls were patients receiving CT scan for an intraarticular distal tibia fracture without preexisting foot or calcaneal pathology. Clinical office notes, physical examination, and weight-bearing radiographs were used to identify patients that met clinical criteria for stage IIb PTTD. A 1:1 match was performed using age, laterality, gender, and BMI. Morphometric measurements of the calcanei were performed involving the length of the calcaneal axis (LCA), height of the anterior process (HAP), and length of the anterior process (LAP) (Figure 1). Linear mixed-effects models were used to assess the differences between control and PTTD patients with respect to LAP, HAP, and LCA measurements, with also considering measurements from 3 independent observers. We considered a difference of ± 4 mm as our threshold of clinical significance. Results: Of the 3586 CT within our institutional database, a total of 14 patients were available for reconstruction and analysis. There were no statistical differences detected between patient characteristics or demographics between these groups. On average, the long axis of the calcaneus (LCA) was 3.1 mm shorter (95% confidence interval: 0.43-5.76 mm) in patients with stage IIb PTTD compared to controls (p<0.05). Additionally, the distance from the articular margin of the posterior facet to the anterior process (LAP) was shorter in PTTD patients compared to controls 3.35 mm (p<0.001; 95% confidence interval: 1.82- 4.88). Comparison of observers demonstrated high agreement between LCA and LAP measurements, as illustrated by satisfactory concordance correlation coefficients. Conclusion: Our results support the hypothesis that the calcaneus of adult patients with stage IIb AAFD is, indeed, dysplastic when compared to healthy controls, which further supports the utility of LCL. Analysis of these results, taken together with previous literature, may suggest the use of a smaller graft between 4-6 mm as ideal when performing this procedure.

Three-Dimensional Morphometric Modeling Measurements of the Calcaneus in Adults with Stage IIB Posterior Tibial Tendon Dysfunction: A Pilot Study

2018 ◽  
Vol 12 (4) ◽  
pp. 316-321 ◽  
Author(s):  
Kempland C. Walley ◽  
Evan P. Roush ◽  
Christopher M. Stauch ◽  
Allen R. Kunselman ◽  
Kaitlin L. Saloky ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Three Dimensional ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Anterior Process ◽  
Clinical Criteria ◽  
Lateral Column ◽  
Posterior Tibial ◽  
Group Assignment ◽  
Lateral Column Lengthening

Background: The pathophysiology of adult-acquired flatfoot deformity (AAFD) is not fully explained by degeneration of the posterior tibial tendon alone. While a shortened or dysplastic lateral column has been implicated in flatfoot deformity in pediatrics, there is no study that has quantified the degree of dysplasia in adults with a stage IIb flatfoot deformity, or if any exists at all. Methods: An institutional radiology database was queried for patients with posterior tibial tendon dysfunction (PTTD) who had computed tomography (CT) performed. Controls were patients receiving CT scan for an intra-articular distal tibia fracture without preexisting foot or calcaneal pathology. Clinical notes, physical examination, and weightbearing radiographs were used to find patients that met clinical criteria for stage IIb PTTD. Morphometric measurements of the calcanei were performed involving the length of the calcaneal axis (LCA), height of the anterior process (HAP), and length of the anterior process (LAP). All measurements were performed independently by separate observers, with observers blinded to group assignment. We considered a difference of ±4 mm as our threshold. Results: 7 patients and 7 controls were available for reconstruction and analysis. On average, the LCA was 3.1 mm shorter in patients with stage IIb PTTD compared with controls ( P < .05). The LAP was shorter in PTTD patients compared with controls 3.4 mm ( P < .001). Conclusions: Our results support the hypothesis that the calcaneus of adult patients with stage IIb AAFD is dysplastic when compared with healthy controls, which further supports the utility of lateral column lengthening. Levels of Evidence: Level III: Case-control study

scholarly journals 3-D Morphometric Analysis of Talocalcaneal Joint in Stage II Posterior Tibial Tendon Dysfunction

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Jarrett D. Cain ◽  
Gregory Lewis ◽  
Allen Kunselman
Keyword(s):  
Subtalar Joint ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Morphometric Measurements ◽  
Posterior Tibial ◽  
Computed Tomography Images ◽  
Joint Contact Pressure

Category: Hindfoot Introduction/Purpose: Posterior Tibial Tendon Dysfunction (PTTD) is common disorder that can lead to changes in function during the gait cycle due to decreased arch, increased hindfoot valgus, and forefoot abduction. These kinematic changes can have a structural impact on the joints throughout the foot. While previous studies have evaluated anatomical three-dimensional (3D) position of the subtalar joint, the purpose of this study was to perform morphological analysis of the anterior, middle and posterior facets in patients with stage II posterior tibial tendon dysfunction compared to normal controls. Methods: Clinical computed tomography images from 10 matched feet (i.e., 10 normal and 10 stage II PTTD) were obtained and used for 3D reconstruction in Mimics software (Materialise). From the3D reconstructions, morphometric evaluations of the subtalar joint were completed including 3D anatomic point placement and measurements of the length and width of the anterior, middle and posterior facets (Fig. 1) by 3 independent evaluators. Evaluators were blinded to experimental groups and to one another’s measurements. A linear mixed-effects model was used to assess the differences between control and PTTD subtalar joints with respect to morphometric measurements (mm). The concordance correlation coefficient (CCC) was used to assess the agreement between the 3 evaluators with respect to their recorded morphometric measurements per location (e.g., anterior, middle, posterior). Results: Although the mean distance of the length and width of the middle facet trended higher in the stage II PTTD compared to controls, this difference was not statistically significant (Table 1). Similarly, there was no difference detected between control and PTTD with respect to morphometric measurements in the anterior and posterior facets (Table 1). The agreement among the 3 evaluators with respect to morphometric measurements was the strongest in the length and width of the middle facets. Conclusion: Stage II posterior tibial tendon dysfunction has been shown to cause increase subtalar joint kinematics, joint contact pressure. Based on the results, there is a positive correlation involving morphologic changes of subtalar joint with the middle facet measurements being larger in the PTTD group. Further studies are needed with weight bearing CT scans in correlation with advance stages of posterior tibial tendon dysfunction.

Osteolysis of Structural Autograft after Calcaneocuboid Distraction Arthrodesis for Stage II Posterior Tibial Tendon Dysfunction

2002 ◽  
Vol 23 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Stephen F. Conti ◽  
Yue Shuen Wong
Keyword(s):  
Structural Integrity ◽  
Nonoperative Treatment ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Soft Tissue Reconstruction ◽  
Posterior Tibial Tendon Dysfunction ◽  
Lateral Column ◽  
Posterior Tibial ◽  
Tendon Lengthening ◽  
Tissue Reconstruction

Surgical treatment of stage II posterior tibial tendon dysfunction that fails nonoperative treatment is amenable to operative treatment. This commonly consists of a medial soft-tissue reconstruction and lateral column lengthening. We report on 32 patients undergoing distraction calcaneocuboid arthrodesis using an autogenous tricortical iliac crest graft. Almost 50% of patients did not go on to complete and uneventful incorporation of the graft at the arthrodesis site. Two different types of failure were noted. The first was classic nonunion which maintained structural integrity of the graft. The second was osteolysis and collapse of the graft accompanying the nonunion. Risk factors included smoking, K-wire fixation and possibly larger deformities requiring Achilles tendon lengthening. Complications of nonunion were salvageable with reoperation.

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