scholarly journals New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Michele Conconi ◽  
Alessandro Pompili ◽  
Nicola Sancisi ◽  
Alberto Leardini ◽  
Stefano Durante ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Solid Base ◽  
Reference Systems ◽  
Foot And Ankle ◽  
Foot Bones ◽  
Curvature Variation ◽  
Principal Axes ◽  
Flat Feet ◽  
Ankle Complex ◽  
Definition Of

Abstract Background A complete definition of anatomical reference systems (ARS) for all bones of the foot and ankle complex is lacking. Using a morphological approach, we propose new ARS for these bones with the aim of being highly repeatable, consistent among individuals, clinically interpretable, and also suited for a sound kinematic description. Methods Three specimens from healthy donors and three patients with flat feet were scanned in weight-bearing CT. The foot bones were segmented and ARS defined according to the proposed approach. To assess repeatability, intra class coefficients (ICC) were computed both intra- and inter-operator. Consistency was evaluated as the mean of the standard deviations of the ARS position and orientation, both within normal and flat feet. Clinical interpretability was evaluated by providing a quantification of the curvature variation in the medial-longitudinal and transverse arches and computing the Djiann-Annonier angle for normal and flat feet from these new ARS axes. To test the capability to also provide a sound description of the foot kinematics, the alignment between mean helical axes (MHA) and ARS axes was quantified. Results ICC was 0.99 both inter- and intra-operator. Rotational consistency was 4.7 ± 3.5 ° and 6.2 ± 4.4° for the normal and flat feet, respectively; translational consistency was 4.4 ± 4.0 mm and 5.4 ± 2.9 mm for the normal and flat feet, respectively. In both these cases, the consistency was better than what was achieved by using principal axes of inertia. Curvature variation in the arches were well described and the measurements of the Djiann-Annoier angles from both normal and flat feet matched corresponding clinical observations. The angle between tibio-talar MHA and ARS mediolateral axis in the talus was 12.3 ± 6.0, while the angle between talo-calcaneal MHA and ARS anteroposterior axis in the calcaneus was 17.2 ± 5.6, suggesting good capability to represent joint kinematics. Conclusions The proposed ARS definitions are robust and provide a solid base for the 3-dimensional description of posture and motion of the foot and ankle complex from medical imaging.

scholarly journals Preliminary Results of Subtalar Arthroereisis with Vulpius Procedure for Symptomatic Flatfoot in Patients with Type I Osteogenesis Imperfecta

2020 ◽  
Vol 18 (1) ◽  
pp. 67
Author(s):  
Cheng-Min Hsu ◽  
Sheng-Chieh Lin ◽  
Kuan-Wen Wu ◽  
Ting-Ming Wang ◽  
Jia-Feng Chang ◽  
...  
Keyword(s):  
Osteogenesis Imperfecta ◽  
Weight Bearing ◽  
Life Quality ◽  
Type I ◽  
Foot And Ankle ◽  
Flexible Flatfoot ◽  
Subtalar Arthroereisis ◽  
Viable Approach ◽  
American Orthopaedic

In this retrospective study, we aim to assess the safety and feasibility of adapting subtalar arthroereisis (SA) for type I osteogenesis imperfecta (OI) patients with symptomatic flatfoot. From December 2013 to January 2018, six type I OI patients (five girls and one boy, 12 feet) with symptomatic flexible flatfoot were treated with SA and the Vulpius procedure. All the patients were ambulatory and skeletally immature with failed conservative treatment and unsatisfactory life quality. The median age at the time of surgery was 10 years (range 5–11), and the median follow-up period was 55 months (range 33–83). All functional and radiographic parameters improved (p < 0.05) after the procedure at the latest follow-up. The median American Orthopaedic Foot and Ankle Society ankle-hindfoot scale improved from 68 (range 38–80) to 95 (range 71–97). All of the patients ambulated well without significant complications. The weight-bearing radiographs showed maintained correction of the tarsal bone alignment with intact bony surfaces adjacent to implants during the post-operative follow-up period. This is the very first study on symptomatic flatfoot in pediatric patients with type I OI. Our data suggest that SA is a potentially viable approach, as functional improvements and maintained radiographic correction without significant complication were observed.

scholarly journals Effect of Weight-Bearing in Conservative and Operative Management of Fractures of the Base of the Fifth Metatarsal Bone

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Jae-Yong Park ◽  
Hyong-Nyun Kim ◽  
Yoon-Suk Hyun ◽  
Jun-Sik Park ◽  
Hwan-Jin Kwon ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Weight Bearing ◽  
Operative Management ◽  
Foot And Ankle ◽  
Early Weight Bearing ◽  
Group A ◽  
Vas Scores ◽  
American Orthopaedic ◽  
Group B ◽  
Underlying Diseases

Background. There is no established principle regarding weight-bearing in conservative and operative management of fifth metatarsal base fractures. Methods. We reviewed 86 patients with acute fifth metatarsal base fractures. Conservatively treated late or early weight-bearing patients were assigned to Group A or C, respectively. Operatively treated late or early weight-bearing patients were assigned to Group B or D, respectively. Results were evaluated by clinical union, bone resorption, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores. Results. All 4 groups had bone union at a mean of 6.9 weeks (range, 5.1–15.0). There were no differences between the groups in the AOFAS and VAS scores. In the early weight-bearing groups, there were fewer cases of bone resorption, and the bone unions periods were earlier. Conclusions. Early weight-bearing may help this patient population. Moreover, conservative treatment could be an option in patients with underlying diseases.

scholarly journals Weight Bearing CT and Relative Orientation of Foot Bones: Effect of Loading and Heeled Shoes

2020 ◽  
pp. 10-14
Author(s):  
Sandu Elena Cerasela ◽  
Caravaggi Paolo ◽  
Durante Stefano
Keyword(s):  
Sagittal Plane ◽  
Cone Beam Ct ◽  
Young Subject ◽  
Weight Bearing ◽  
Cone Beam ◽  
Non Invasive ◽  
Foot Bones ◽  
Healthy Young Subject ◽  
Foot Posture ◽  
Metatarsophalangeal Joints

The purpose of this article is to determine the orientation and relative position of the foot bones in Weight Bearing CT, highlighting the effect of the load and the shoe with the heel. Thanks to a Cone Beam CT (OnSight 3D Extremity System, Carestream) equipment, three scans of the foot of a healthy young subject were carried out in three conditions: "unloading", "loading", and wearing a shoe with "heel". In order to assess the accuracy of the articular angles of the foot through non-invasive measurements, a measurement was performed by Gait-Analysis with passive markers in the same conditions. The effect of the "load" resulted in a significant alteration of the foot posture especially in the sagittal plane, with crushing of the longitudinal medial arch. The heeled shoe involves enormous deformations at the level of the metatarsophalangeal joints and the ankle.

scholarly journals Ankle Arthrodesis with Cannulated Screw: Case Series

2020 ◽  
Vol 4 (1) ◽  
pp. 87
Author(s):  
Andre Triadi Desnantyo ◽  
Muhammad Zaim Chilmi ◽  
Hizbillah Yazid
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Ankle Arthrodesis ◽  
Cannulated Screw ◽  
Average Score ◽  
Foot And Ankle ◽  
Early Weight Bearing ◽  
Sf 36 ◽  
Clinical Scoring ◽  
Hind Foot

ABSTRACT Ankle osteoarthritis patients are young and lack of available long last treatment. Ankle arthrodesis remains the gold standard and is the procedure of choice for younger patients who are heavy laborers. These case series evaluate and report five patients undergone ankle arthrodesis at RSUD Dr. Soetomo Surabaya on 2012-2016. The data were collected from patient files, radiographs, and a recent physical examination. The outcome has been assessed with SF-36 score and clinical scoring system Ankle-Hind foot American Foot and Ankle Society. Three male patients and two female patients underwent ankle arthrodesis with cannulated screw, caused by neglected severe ankle dislocation. One patient had open dislocation. Based on SF-36 scoring, the five patients had average score 76,7 with highest and lowest score were 95,9 and 56,7. Based on clinical score ankle-hind foot American Ankle and Foot Society, the average score was 68(51 – 88). The scoring result includes general health, physic, emotional, and social. And clinical scoring ankle-hind foot American Foot and Ankle Society evaluation includes pain, function, and alignment. It shows that there was patient that gains an almost perfect result. Patient with the lowest score also had knee osteoarthritis contralateral from the operated ankle. Early weight bearing on ankle arthrodesis with cannulated screw was the major factor caused unsatisfactory result of this patient. Ankle arthrodesis with cannulated screw has satisfactory result eventhough remain complain on one patient. Nevertheless, ankle arthrodesis with cannulated screw still has an important role in the treatment of choice on ankle reconstruction.Keywords                   : Ankle arthrodesis, cannulated screw, ankle joint fusion 

Common Foot and Ankle Disorders in Adults and Children

2015 ◽  
Vol 19 (2) ◽  
pp. 54-65 ◽  
Author(s):  
Ganesan Balasankar ◽  
Luximon Ameersing
Keyword(s):  
Soft Tissues ◽  
Adult Population ◽  
Complex Structure ◽  
Whole Body ◽  
Clinical Aspects ◽  
Foot Deformities ◽  
Foot And Ankle ◽  
Human Foot ◽  
Flat Feet ◽  
Adults And Children

The human foot is a complex structure, which includes bones, joints, muscles, ligaments, soft tissues, nerves and veins. It supports the weight of the whole body and helps one to walk, run, and jump. Ankle and foot biomechanical functions that are interrupted by various pathological deformities lead to pain or other deformities, and result in difficulties during mobility. Foot problems are very common in children and adults. In this article, attempts are made to explore the clinical aspects of the most common foot and ankle deformities and their management by children and adults. Foot deformities may be congenital or acquired, and may involve arthritis conditions, such as rheumatoid arthritis and osteoarthritis. In children, congenital clubfoot, cavus, and flat feet are the most common disorders and can be treated by non-operative means or surgical management. Hallux valgus and rigidus, lesser toe deformities, and arthritis are mostly present with or without pain in the adult population.

In Silico Finite Element Analysis of the Foot Ankle Complex Biomechanics: A Literature Review

2021 ◽  
Author(s):  
Phong Phan ◽  
Anh Vo ◽  
Amirhamed Bakhtiarydavijani ◽  
Reuben Burch ◽  
Brian K. Smith ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
In Silico ◽  
Real Life ◽  
Ankle Injuries ◽  
Fe Model ◽  
Foot And Ankle ◽  
Element Analysis ◽  
Ankle Complex ◽  
Biomechanics Of The Foot

Abstract Computational approaches, especially Finite Element Analysis (FEA), have been rapidly growing in both academia and industry during the last few decades. FEA serves as a powerful and efficient approach for simulating real-life experiments, including industrial product development, machine design, and biomedical research, particularly in biomechanics and biomaterials. Accordingly, FEA has been a "go-to" high biofidelic software tool to simulate and quantify the biomechanics of the foot-ankle complex, as well as to predict the risk of foot and ankle injuries, which are one of the most common musculoskeletal injuries among physically active individuals. This paper provides a review of the in silico FEA of the foot-ankle complex. First, a brief history of computational modeling methods and Finite Element (FE) simulations for foot-ankle models is introduced. Second, a general approach to build a FE foot and ankle model is presented, including a detailed procedure to accurately construct, calibrate, verify, and validate a FE model in its appropriate simulation environment. Third, current applications, as well as future improvements of the foot and ankle FE models, especially in the biomedical field, are discussed. Lastly, a conclusion is made on the efficiency and development of FEA as a computational approach in investigating the biomechanics of the foot-ankle complex. Overall, this review integrates insightful information for biomedical engineers, medical professionals, and researchers to conduct more accurate research on the foot-ankle FE models in the future.

scholarly journals A non-rotating origin on the instantaneous equator

1988 ◽  
Vol 128 ◽  
pp. 33-38 ◽  
Author(s):  
N. Capitaine ◽  
B. Guinot
Keyword(s):  
Specific Rotation ◽  
Universal Time ◽  
Reference Systems ◽  
The Earth ◽  
Adopted Model ◽  
Fixed Reference ◽  
Rotation Of The Earth ◽  
Definition Of ◽  
Clear Description ◽  
Angle Of Rotation

In order to give an exact and clear description of the angle of rotation of the Earth, we propose to use, as the reference point in space, a “non-rotating origin” (Guinot 1979) such that its hour angle, reckoned from the origin of the longitudes (or “non-rotating origin” in the Earth), represents strictly the specific rotation of the Earth. The position of this origin on the instantaneous equator depends only on the trajectory of the pole of rotation. We show that the estimation of the deduced angle of rotation is not critically affected by the precision with which this trajectory is known. We give therefore the formulae to obtain the non-rotating origin, at any date t, from a chosen fixed reference, and we propose a definition of the Universal Time which will remain valid, even if the adopted model for the precession and the nutation is revised. We show that the use of the non-rotating origin also simplifies the transformation of coordinates between the terrestrial and celestial reference systems.

scholarly journals Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maurizio Ortolani ◽  
Alberto Leardini ◽  
Chiara Pavani ◽  
Silvia Scicolone ◽  
Mauro Girolami ◽  
...  
Keyword(s):  
Reference Frames ◽  
Weight Bearing ◽  
Principal Component ◽  
Longitudinal Axis ◽  
3D Models ◽  
Shape Reconstruction ◽  
Skeletal Structure ◽  
Foot Deformities ◽  
Foot And Ankle ◽  
Linear Measurements

AbstractAcquired adult flatfoot is a frequent deformity which implies multiple, complex and combined 3D modifications of the foot skeletal structure. The difficult thorough evaluation of the degree of severity pre-op and the corresponding assessment post-op can now be overcome by cone-beam (CBCT) technology, which can provide access to the 3D skeletal structure in weight-bearing. This study aims to report flatfoot deformities originally in 3D and in weight-bearing, with measurements taken using two different bone segmentation techniques. 21 such patients, with indication for surgical corrections, underwent CBCT (Carestream, US) while standing on one leg. From these scans, 3D models of each bone of the foot were reconstructed by using two different state-of-the-art segmentation tools: a semi-automatic (Mimics Innovation Suite, Materialise, Belgium), and an automatic (Bonelogic Ortho Foot and Ankle, Disior, Finland). From both reconstructed models, Principal Component Analysis was used to define anatomical reference frames, and original foot and ankle angles and other parameters were calculated mostly based on the longitudinal axis of the bones, in anatomical plane projections and in 3D. Both bone model reconstructions revealed a considerable valgus of the calcareous, plantarflexion and internal rotation of the talus, and typical Meary’s angles in the lateral and transverse plane projections. The mean difference from these angles between semi-automatic and automatic segmentations was larger than 3.5 degrees for only 3 of the 32 measurements, and a large number of these differences were not statistically significant. CBCT and the present techniques for bone shape reconstruction finally provide a novel and valuable 3D assessment of complex foot deformities in weight-bearing, eliminating previous limitations associated to unloaded feet and bidimensional measures. Corresponding measurements on the bone models from the two segmentation tools compared well. Other more representative measurements can be defined in the future using CBCT and these techniques.

Basic Clinical Examination of the Foot and Ankle

2020 ◽  
Vol 158 (06) ◽  
pp. 657-660
Author(s):  
Michael Kehrer ◽  
Hendrik Kohlhof ◽  
Desiree Schwetje ◽  
Adnan Kasapovic ◽  
Andreas Kehrer ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Clinical Signs ◽  
Accurate Diagnosis ◽  
Foot And Ankle ◽  
Functional Tests ◽  
Provocation Tests ◽  
Examination Methods ◽  
The Common ◽  
Ankle Complex ◽  
Structured Approach

AbstractSuccessful treatment of foot and ankle diseases requires an accurate diagnosis. In addition to differentiated history taking, clinical examination is the most important component in the diagnosis of foot and ankle diseases. The present video explains the common provocation tests and functional tests that are used in the basic clinical examination of the foot and ankle complex. In addition to general inspection and palpation, the focus is on different diagnostic tests and clinical signs that improve diagnostic accuracy. The present basic clinical examination methods allow a structured approach to clinical issues and can be a good basis, if supplemented by further specific and individual tests.

scholarly journals Benefit of weight-bearing CT - what have we learned from more than 8,000 scans at a foot and ankle center

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Martinus Richter ◽  
Francois Lintz ◽  
Alexej Barg ◽  
Arne Burssens
Keyword(s):  
Cost Effectiveness ◽  
Radiation Dose ◽  
Image Acquisition ◽  
Weight Bearing ◽  
Metatarsal Head ◽  
Foot And Ankle ◽  
Yearly Average ◽  
Radiology Technicians ◽  
Skyline View ◽  
Conventional Ct

Category: Other Introduction/Purpose: Weight-bearing CT (WBCT) has been proven to allow for more precise and valid measurement of bone position than conventional weight-bearing radiographs (R) and conventional CT without weight-bearing (CT). Time spent for image acquisition has been shown to be lower for WBCT than for R and CT2. Radiation dose for WBCT has been shown to be lower for WBCT than for CT. A WBCT device (PedCAT, Curvebeam, Warrington, PA, USA) had been brought on line July 1, 2013 in the first author´s foot and ankle department. The purpose of this study was to assess the benefit of using WBCT instead of R and/or CT in a foot and ankle center regarding time spent for image acquisition, radiation dose, disturbances, and cost effectiveness. Methods: All patients who obtained WBCT July 1, 2013 until December 31, 2017 were included in the study. Age, sex and primary pathology were analyzed. The time spent for image acquisition (T) was calculated based on an analysis of a previous study as follows: R (bilateral feet dorsoplantar and lateral, metatarsal head skyline view), 902 seconds; CT (bilateral feet and ankle), 415 seconds; WBCT (bilateral), 207 seconds. Radiation dose (RD) per patient was calculated based on previous phantom measurements as follows: R, 1.4 uSV; CT, 25 uSv; WBCT 4.2 uSv. For analysis of cost effectiveness device cost, reimbursement and working time cost of radiology technicians were taken into consideration within the local circumstances. All parameters were compared between the time period using WBCT (yearly average) with the parameters from 2012, i.e. before availability of WBCT. Results: 8,129 WBCT scans were obtained in 3,874 patients (3,874 (48%) preoperatively, 4,255 (52%) follow-up; mean age, 52.2; 39% male). Primary pathologies were forefoot deformities (n=728 (19%) and ankle osteoarthritis/cartilage defect (n=412 (11%)). 1,804 WBCT scans were obtained on average yearly, and 10 CTs (WBCT group). In 2012, 1,750 R and 250 CTs were obtained (R(+CT) group). Yearly RD was 4.3 uSv for WBCT group and 5.0 uSv for R(+CT) group (difference 0.6 uSv decrease with WBCT 13%, p<0.01). Yearly T was 105 hours in total (3.5 minutes per patient) for WBCT group and 961 hours in total (16.0 minutes per patient) for R(+CT) group (difference, 752.0 hours, decrease with WBCT, 78%, p<0.01). Yearly profit was 34,300 Euro for WBCT group, -846 Euro for R(+CT) group. Conclusion: 8,129 WBCT scans in 3,874 patients as substitution of R(+CT) over a 4.5 year period at a foot and ankle center resulted in 13% decreased RD (minus 0.7 uSV on average per patient). Yearly T decreased 752 hours (78%) in total (12.5 minutes per patient). Yearly financial profit increased 35,000 Euro in total (19 Euro per patient). RD decreased despite higher radiation dose for WBCT than for R alone, based on substitution of a high number of CTs by WBCT. Other centers with low usage of CT might not decrease RD by substituting R alone by WBCT.

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