scholarly journals The Role of Cavovarus Deformity in the Pathogenesis of Peroneal Tendon Tears

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0009
Author(s):  
Shannon F. Alejandro ◽  
Akira Taniguchi ◽  
Justin M. Kane ◽  
Samuel E. Ford ◽  
Daniel J. Scott ◽  
...  
Keyword(s):  
Matched Control ◽  
Objective Measures ◽  
Control Group ◽  
Peroneal Tendon ◽  
Significance Level ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Cavus Foot ◽  
Tendon Tears

Category: Other; Sports Introduction/Purpose: While it is a commonly accepted principle peroneal tendon (PT) tears are associated with cavovarus deformity, this is the first study that both quantifies deformity in patients with surgically proven tears using sophisticated and reproducible methods to compare radiographic measurements to a matched control group. Understanding of the anatomy and mechanism of injury affecting the PTs has led to greater recognition of PT tears as an important cause of lateral sided foot and ankle pain. The literature reports a presumed correlation between the cavus foot and PT tears. Little data exist quantifying the correlation between PT tears and the alignment of the foot. We hypothesize the cavovarus foot applies stress over the lateral border of the foot leading to degenerative changes in PTs. Methods: A cohort of 252 consecutive patients operatively treated for peroneal tendon tears (PT) were compared to an age- and sex- matched control (C) group of 104 outpatients treated for isolated forefoot problems. Calcaneal pitch, calcaneal - first metatarsal, talometatarsal, and talocalcaneal angles were compared on standing lateral radiographs. Talometatarsal and talocalcaneal angles, and talonavicular coverage, were compared on standing anteroposterior radiographs. Published radiographic criteria were used to determine cavovarus. ANOVA analysis detected statistically significant differences between patients and controls and a subsequent Tukey-Kramer test compared the control group with each type of PT tear. An a prioripower analysis was performed to calculate the minimum sample size in each cohort to detect a 90% effect size for a significance level of p<0.05. Results: Radiographic cavovarus was found in 9.4% (74/252) of PT group, and 6.7% (7/104) in controls. On lateral radiographs a significant greater calcaneal pitch (p=0.0001), and significant smaller calcaneal-first metatarsal angle (p=0.0084) was noted with PT tears (p=0.0001). On anteroposterior radiographs a significant smaller talometatarsal angle (p=0.0001) and talonavicular coverage (p=0.0001) were noted in PT tears. AP talocalcaneal and lateral talometatarsal and talocalcaneal angles were not correlated with PT tears. Patients treated for PT tears, isolated peroneus brevis tears (PB) accounted for 67.9% (171/252), isolated peroneus longus (PL) tendon tears were 7.5% (19/252), PB and PL tears accounted for 17.5% (44/252). A smaller talometatarsal angle on the AP was associated with PL (0.0098) and combined PB and PL tears (<0.0001) but not PB tears alone (0.1162). Conclusion: The correlation between cavovarus and peroneal pathology in the literature is highly anecdotal. Few studies report objective measures. This is the first study to our knowledge comparing nature and severity of cavovarus according to location of peroneal tear. This study proves and quantifies objective measures of cavovarus that correlate with peroneal tendon tears, when compared to a cohort of matched controls.

Association of Cavovarus Foot Alignment With Peroneal Tendon Tears

2021 ◽  
pp. 107110072199034
Author(s):  
Akira Taniguchi ◽  
Shannon F. Alejandro ◽  
Justin M. Kane ◽  
Yahya Daoud ◽  
Yasuhito Tanaka ◽  
...  
Keyword(s):  
Coordinate System ◽  
Control Group ◽  
Peroneal Tendon ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Retrospective Comparison ◽  
Comparative Cohort Study ◽  
Tendon Tears ◽  
Peroneus Brevis

Background Although it is a widely accepted clinical principle that cavovarus deformity predisposes to peroneal tendon problems, there are limited data to support that assumption. This study tested the hypothesis that cavovarus is associated with peroneal tendon tears and evaluated which radiographic measures correlated with that association. Methods: A retrospective comparison of radiographic measures of cavovarus in 234 consecutive patients operatively treated for chronically symptomatic peroneal tendon tears was compared to a matched control group. Measures included calcaneal pitch, anteroposterior (AP) talometatarsal and talocalcaneal angles, and talonavicular coverage angle. A novel coordinate system analyzed midfoot and hindfoot components of cavovarus. Analysis of variance was used to compare cohorts, and a Tukey-Kramer test used to analyze 3 subgroups of brevis and longus tears, and concomitant tears. Results: The distribution of tears was 73% peroneus brevis, 8% longus, and 19% both tendons. Compared with controls, the study group, and subgroups, had multiple measures of increased cavovarus, including greater calcaneal pitch ( P = .0001), decreased AP talo–first metatarsal angle ( P = .0001), and increased talonavicular coverage angle ( P = .0001). Elevated medial longitudinal arch, and rotational changes in the radiographic profiles of the hindfoot were found with the coordinate system described by Yokokura. Conclusion: This study found a statistically significant association of increased cavovarus deformity with peroneal tendon tears, compared to controls. It documented the relative incidence of tears of peroneus brevis, peroneus longus, and concomitant tears in a large surgical series. It demonstrated which simple radiographic angles and complex coordinate measurements of cavovarus deformity were significantly associated with peroneal tendon tears. Level of Evidence: Level III, retrospective comparative cohort study.

scholarly journals Is It Possible to Define Reference Values for Radiographic Parameters Evaluating Juvenile Flatfoot Deformity? A Case-Control Study

2020 ◽  
Author(s):  
Johannes Hamel ◽  
Hubert Hörterer ◽  
Norbert Harrasser
Keyword(s):  
Reference Values ◽  
Control Group ◽  
Roc Curve Analysis ◽  
First Metatarsal ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Group A ◽  
Group B ◽  
Control Study

Abstract BackgroundNumerous radiographic parameters are described to evaluate juvenile flexible flatfeet. Reference values for these measurements are based on few studies. The purpose of this study was to determine boundary values among the most widely used radiographic measurements to evaluate juvenile flatfeet.MethodsTwenty-two patients with normal hind-, midfoot configuration (group A: control group; 22 feet, mean age: 12,1 years) and 19 patients with flatfoot deformity (group B: study group; 22 feet, mean age: 12,4 years) were retrospectively analyzed. Nine radiographic parameters were measured (Talocalcaneal-angles, Calcaneal-pitch-angle, Costa-Bartani-angle, Talo-metatarsal-I-angles, Talo-first-metatarsal-base-angle, Talo-navicular-coverage, Calcaneus-fifth-metatarsal-angle). ROC curve analysis was used to calculate optimal differentiating thresholds of each parameter.ResultsFour out of nine parameters (TC-dp, TC-lat, Calc-MTV, Calc-P) were not statistically different between the groups and their ability to distinct between normal foot and flatfoot was low (AUC values= 0,660 - 0,819). Calculation of reference values for these parameters was not performed due to threshold ranges between the groups of >10°. Reference values could be defined only for three parameters: TMTInd >(-)31°, TMTIB >(-)7,5°, TMT-lat >(-)13,5°. The TMTInd was shown to be a very reliable and valid combination of two measurements (TMTIB and TMT-lat) in the differentiation of normal feet and flatfeet (AUC=0,998).ConclusionThe calculation of reference values for established radiographic parameters used to evaluate juvenile flatfeet is difficult for most parameters. The TMTInd as a combination of TMTIB and TMT-lat has been shown to be reliable and valuable to distinct normal feet from flatfeet.

scholarly journals Is it possible to define reference values for radiographic parameters evaluating juvenile flatfoot deformity? A case-control study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Johannes Hamel ◽  
Hubert Hörterer ◽  
Norbert Harrasser
Keyword(s):  
Reference Values ◽  
Control Group ◽  
Roc Curve Analysis ◽  
First Metatarsal ◽  
Radiographic Parameters ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Group A ◽  
Group B ◽  
Control Study

Abstract Background Numerous radiographic parameters are described to evaluate juvenile flexible flatfeet. Reference values for these measurements are based on few studies. The purpose of this study was to determine boundary values among the most widely used radiographic measurements to evaluate juvenile flatfeet. Methods Twenty-two patients with normal hind-, midfoot configuration (group A: control group; 22 ft, mean age: 12,1 years) and 19 patients with flatfoot deformity (group B: study group; 22 ft, mean age: 12,4 years) were retrospectively analyzed. Nine radiographic parameters were measured (Talocalcaneal-angles, Calcaneal-pitch-angle, Costa-Bartani-angle, Talo-metatarsal-I-angles, Talo-first-metatarsal-base-angle, Talo-navicular-coverage, Calcaneus-fifth-metatarsal-angle). ROC curve analysis was used to calculate optimal differentiating thresholds of each parameter. Results Four out of nine parameters (TC-dp, TC-lat, Calc-MTV, Calc-P) were not statistically different between the groups and their ability to distinct between normal foot and flatfoot was low (AUC values = 0,660 - 0,819). Calculation of reference values for these parameters was not performed due to threshold ranges between the groups of > 10°. Reference values could be defined only for three parameters: TMTInd >(−)31°, TMTIB >(−)7,5°, TMT-lat > (−)13,5°. The TMTInd was shown to be a very reliable and valid combination of two measurements (TMTIB and TMT-lat) in the differentiation of normal feet and flatfeet (AUC = 0,998). Conclusion The calculation of reference values for established radiographic parameters used to evaluate juvenile flatfeet is difficult for most parameters. The TMTInd as a combination of TMTIB and TMT-lat has been shown to be reliable and valuable to distinct normal feet from flatfeet.

Reliability and Relevance of Radiographic Measures of Metatarsus Primus Elevatus and Arch Alignment in Individuals with Midfoot Arthritis and Controls

2013 ◽  
Vol 103 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Smita Rao ◽  
Katie Bell
Keyword(s):  
Inclination Angle ◽  
Intraclass Correlation ◽  
Positive Association ◽  
Group Differences ◽  
Control Group ◽  
Arch Height ◽  
First Metatarsal ◽  
Compressive Stresses ◽  
Metatarsal Angle ◽  
The Relationship

Background: Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were 1) to examine the relationship between radiographic measures of arch alignment and MPE and 2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE. Methods: Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05). Results: Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919–0.994) as well as MPE (ICC[2,3] = 0.891–0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal–first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P &lt; .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146). Conclusions: These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance. (J Am Podiatr Med Assoc 103(5): 347–354, 2013)

scholarly journals Suture anchor stabilization of symptomatic accessory navicular in adolescents: Clinical and radiographic outcomes

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091894
Author(s):  
Masataka Kakihana ◽  
Yuki Tochigi ◽  
Takayuki Yamazaki ◽  
Masanori Ohashi ◽  
Satoru Ozeki
Keyword(s):  
Tilt Angle ◽  
Suture Anchor ◽  
Weight Bearing ◽  
Bone Union ◽  
First Metatarsal ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Accessory Navicular ◽  
Stabilization Technique

Background: Screw fixation used in modified Kidner procedures to treat persistent symptomatic accessory navicular in adult cases is often challenging in adolescent cases with a small accessory fragment. The present study aimed to document the clinical effect of a suture anchor stabilization technique applicable to such cases where osteosynthesis is considered an ideal outcome. Methods: Consecutive clinical cases who received this surgical treatment from 2009 to 2016 were retrospectively reviewed. The focus of interest included radiographic union of the accessory bone, changes in symptoms evaluated using a validated clinical outcome scale introduced by the Japanese Society for Surgery of the Foot, and changes in the medial arch bony alignment measured in lateral weight-bearing plain radiographs. Results: Twenty-two feet in 15 individuals (11 females and 4 males, age at surgery 10–16 years) were identified. In 14 feet (64%), radiographic bone union was confirmed within 8 weeks postoperatively. At the final follow-up ranging 12–51 months postoperation, the clinical scores have significantly improved ( p < 0.001) to 96 ± 5.71 (mean ± standard deviation, range 87–100), from 54 preoperatively. Radiographic measurements revealed significant postoperative increase of the sagittal talar tilt angle ( p < 0.001, increment 4 ± 3°, range 0–11) and the talo-first metatarsal angle ( p < 0.001, increment 5 ± 4°, range 0–12). No significant changes were identified in the calcaneal pitch angle, first metatarsal tilt angle, calcaneo-navicular angle, and the navicular height. Conclusion: Despite the modest bone union rate, the clinical outcomes suggest distinct symptom-relieving effect, at least in the short- to midterm, while the radiographic measurements suggest positive biomechanical effects. The present suture-anchor stabilization concept appears to be a promising treatment option for persistent symptomatic accessory navicular in adolescent cases.

scholarly journals The Positive Association Between Metatarsal Length and Meary’s Angle and Hammertoe Deformity

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Jesse King ◽  
Chris M. Stauch ◽  
Ryan M. Ridenour ◽  
Umur Aydogan
Keyword(s):  
Average Length ◽  
Articular Surface ◽  
Positive Association ◽  
Lower Extremity Injury ◽  
Control Group ◽  
First Metatarsal ◽  
Diagnosis Codes ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
Icd 10

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Hammertoe deformities are the most common pathology of the forefoot, accounting for up to 48% of all forefoot operations. There is currently limited evidence documenting differences in foot radiographs and radiographic measurements that may represent a predisposition to developing hammertoe deformity. The purpose of this study was to investigate whether patients with hammertoe deformity demonstrate increased radiographic measurements of first, second, or third metatarsal (MT) lengths as well as Meary’s angle compared to a healthy control group. Methods: Following IRB approval, an institutional radiology database was queried from January 2009-2018 for patients with ICD- 9 and ICD-10 diagnosis codes for hammertoe deformity of the 2nd or 3rd phalange. Control cases were selected using diagnosis codes for acute plantar fascial pain in the same timeframe with medical record review to exclude patients with prior lower extremity injury, surgery or pathology. 234 hammertoe and 110 control patients met inclusion and exclusion criteria. Automated 1:1 case-control matching was performed to control for age, sex and laterality. Following matching, the sample size consisted of 80 patients in each cohort. Proximal to distal end-to-end articular surface radiographic lengths were documented for metatarsals and phalanges of the 1st, 2nd and 3rd rays on anteroposterior radiographs. Lateral talar-first metatarsal (Meary’s) angle was measured using weightbearing sagittal radiographs by calculating the angle formed by lines that bisect the talar neck and anatomic neck of the first metatarsal. Results: A total of 160 patients (80 cases and 80 controls) were included in the study. Mean age was 47.7 years among hammertoe cases and 47.5 years among controls (p=0.92). 54 of 80 cases in each group were female. There was a statistically significant increase in the average Meary’s angle among hammertoe patients (5.23 +- 8.60°) compared to controls (2.15 +- 5.96°) (p<0.01). The average length for the 1st, 2nd and 3rd metatarsals were 65.6, 80.0, and 76.7 mm, respectively for the hammertoe patients and 62.8 mm, 76.0 mm, and 73.5 mm among control cases, respectively. For all three metatarsals, this difference was statistically significant (p<0.01; Table 1). There was no statistically significant difference between lengths of the proximal or distal phalanges. Conclusion: Patients with hammertoe deformity were associated with an increased length on the 1st, 2nd and 3rd metatarsals. Also, these patients demonstrated an increased Meary’s angle creating pes planus deformity. These results illustrate the importance of both medial column instability and long metatarsal length in the development of hammertoe deformity. [Table: see text]

scholarly journals Roentgenographs Study of Cavus Foot Deformity in Friedreich Ataxia Patients: Preliminary Report

1982 ◽  
Vol 9 (2) ◽  
pp. 113-117 ◽  
Author(s):  
P. Allard ◽  
J.P. Sirois ◽  
P.S. Thiry ◽  
G. Geoffroy ◽  
M. Duhaime
Keyword(s):  
Inclination Angle ◽  
Weight Bearing ◽  
Friedreich Ataxia ◽  
Quantitative Description ◽  
Foot Deformity ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Cavus Foot ◽  
Three Stages

SUMMARY:The preliminary results based on a three year retrospective study in cavus foot deformity of forty-four Friedreich ataxia patients regularly seen at the Neuromuscular Disease Clinic of Sainte-Justine Hospital have been presented. An accurate “weight-bearing” foot stereoradiographic technique has been recently developed by our group. Since the follow-up period with this device is not sufficient to provide statistical information, the conventional non-weight bearing technique has been utilized in this study to enable a possible comparison between the radiographs of ambulant and non-ambulant patients. Due to the present technique, the results of this study must be interpreted with caution.For 132 pairs of radiographs, 28 parameters have been analyzed. Four of these, namely the calcaneal inclination angle, the first metatarsal inclination angle, the inferior cortex of calcaneus-first metatarsal angle and the first-fifth metatarsals angle, were of particular interest. From these parameters, a preliminary quantitative description of cavus foot deformity in Friedreich’s ataxia has been attempted. Three stages of evolution have been tentatively identified for this type of neurological disorder.

The Influence of Percentage Weight-Bearing on Foot Radiographs

2018 ◽  
Vol 12 (4) ◽  
pp. 363-369 ◽  
Author(s):  
Trevor J. Shelton ◽  
Sohni Singh ◽  
Eduardo Bent Robinson ◽  
Lorenzo Nardo ◽  
Eva Escobedo ◽  
...  
Keyword(s):  
Body Weight ◽  
External Rotation ◽  
Weight Bearing ◽  
Case Series ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
Percentage Weight ◽  
A Prospective Study

Introduction: Clinical decisions are often made on weight-bearing radiographs. However, it is unknown whether various weight-bearing conditions alter specific radiographic measurements. The purpose of this study was to determine whether percentage weight-bearing influences radiographic measurements of the normal foot. Methods: A prospective study with 20 healthy individuals had radiographs of the foot under 5 weight-bearing conditions (non–weight-bearing, 10% body weight, 25% body weight, 50% body weight, and 100% body weight). Measurements were made of hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), talonavicular coverage angle (TNCA), talocalcaneal angle (TCA), forefoot width, LisFranc distance, cuboid height to ground (CHG), and talo–first metatarsal angle (TMA) of each weight-bearing condition. Statistical differences of each measurement for each weight-bearing condition were determined. Results: The TNCA and TCA increased significantly, whereas the CHG decreased significantly with increased percentage body weight. There were no differences in HVA, IMA, forefoot width, LisFranc distance, and TMA with increased percentage body weight. Conclusions: This study shows an increase in TNCA and TCA, and decrease in CHG, demonstrating a flattening of the medial arch, increasing hindfoot valgus, and midfoot external rotation and abduction with increasing percentage body weight applied to a foot. Percentage weight-bearing does not change radiographs in the foot between 25% and 100% weight-bearing. The clinical relevance of this finding is that graduated postinjury or postoperative weight-bearing regimens may only be relevant if the patient is either less than or greater than 25% of body weight on their extremity. Levels of Evidence: Case Series, Level IV: Prospective

scholarly journals Risk Factors for Failure of Cheilectomy for Hallux Rigidus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Austin Sanders ◽  
Joseph Nguyen ◽  
Jonathan Deland ◽  
Scott Ellis
Keyword(s):  
Risk Factors ◽  
Medical History ◽  
Hallux Rigidus ◽  
Categorical Variables ◽  
Failure Group ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
Success Group

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in 2.5% of the population over 50 years of age and is commonly treated with cheilectomy or arthrodesis. While long-term outcomes following cheilectomy for hallux rigidus are promising, questions remain concerning indicators for failure of a cheilectomy. The goal of this study was to use clinical, radiographic, and subjective assessments to determine potential risk factors for failure of cheilectomy and indicators for success of cheilectomy. Methods: A retrospective review of 66 patients with hallux rigidus treated with cheilectomy by two orthopaedic foot and ankle surgeons between 2007 and 2016. A list of patients was generated using the CPT code 28289. Patients were excluded if they had prior forefoot surgery, a cheilectomy with fusion involving the first metatarsal, or if they did not have postoperative FAOS scores. Data was collected regarding demographics, clinical classification, medical history/comorbidities, radiographic measurements, surgical information, complications, and pre and postoperative FAOS. The cheilectomy was considered a failure if the patient was converted to a metatarsophalangeal fusion following the cheilectomy or if their postoperative FAOS score failed to improve compared to their preoperative FAOS score. Independent samples t-test and chi-square tests were used to analyze the continuous variables and categorical variables, respectively. A two-way repeated measures ANOVA was used to analyze the pre and postoperative radiographic outcomes between and within the two groups. Results: 21 out of 66 patients had decreased postoperative FAOS scores and were considered the failure group. There was no difference between the two groups for age at surgery, BMI, gender, ASA, diagnoses, or medical history. Clinically, the failure group had more subsequent surgeries compared to the success group (p=0.039), resulting in longer postoperative follow-up time (10 months vs. 32.4 months, p=0.005). Radiographically, the failure group had a lower mean AP talar-1st Metatarsal Angle pre- operatively (8.10 mm) compared to the success group (12.77 mm, p=0.028). Postoperatively, the failure group had an increased Calcaneal Pitch (p=0.048), despite no significant difference between groups preoperatively (p=0.087). The failure group also demonstrated a reduced ratio of first metatarsal to second metatarsal length postoperatively (p=0.007), which was not seen in the success group. Conclusion: Our study found radiographic measurements to be different in patients with a failed cheilectomy as compared to patients with a successful cheilectomy. Preoperatively, a decreased AP Talar-1st Metatarsal Angle may be a risk factor for failure of cheilectomy. Postoperatively, a decreased length of the first metatarsal and an increase in Calcaneal Pitch may result in worse outcomes following cheilectomy.

Radiographic Assessment of Adult Flatfoot

2005 ◽  
Vol 26 (10) ◽  
pp. 820-825 ◽  
Author(s):  
Alastair S. Younger ◽  
Bonita Sawatzky ◽  
Peter Dryden
Keyword(s):  
Patient Group ◽  
Correct Diagnosis ◽  
Radiographic Assessment ◽  
Reconstructive Procedures ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Medial Cuneiform ◽  
The Difference ◽  
And Control

Background: The accurate measurement of flatfoot on standing radiographs allows correct diagnosis of the condition and evaluation of reconstructive procedures. Method: The standing radiographic measurements of patients with symptomatic, adult flatfoot were compared to controls using blinded observers. Results: On the lateral radiograph, the talar-to-first metatarsal angle, the calcaneal pitch angle, and the medial cuneiform-fifth metatarsal height differed significantly between the patient group and the controls. The difference in the talar-to-first metatarsal angles on lateral radiographs was the most statistically significant (patient group 21.1 ±10.8 degrees and control 7.1 ± 10.7 degrees, p < 0.0001) with good correlation between readings (intraobserver 0.75, interobserver 0.83). On the anteroposterior (AP) radiograph, the talar head uncoverage distance was the most significantly different measurement between these groups. Conclusions: These findings support the hypothesis that the talar-first metatarsal angle is an accurate radiographic identifier of patients with symptomatic, adult flatfoot.

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