scholarly journals Comparative analysis of the validity of goniometric, inclinometric, and radiographic methods to measure ankle joint dorsiflexion

TRAUMA ◽  
2021 ◽  
Vol 22 (6) ◽  
pp. 26-31
Author(s):  
I.V. Kucher
Keyword(s):  
Ankle Joint ◽  
Weight Bearing ◽  
Optimal Method ◽  
Mean Values ◽  
X Ray ◽  
First Metatarsal ◽  
Ankle Joint Dorsiflexion ◽  
Metatarsal Angle ◽  
X Ray Imaging ◽  
Double Plane

Background. The search for an optimal method to assess the amplitude of ankle joint dorsiflexion remains topical for scientific discussions. The purpose of the research was to analyze the validity of goniometric and inclinometric methods for measuring the scope of ankle joint (AJ) dorsiflexion compared to radiological data. Materials and methods. The research included 25 healthy and physically active people (50 ankle joints), 18 men and 7 women with an average age of 25.8 ± 5.2 years; their mean body mass index was 25.01 ± 5.01 kg/m2. Ankle dorsiflexion measures were obtained in a weight-bearing lunge position using a double-plane goniometer and inclinometer, then compared with X-ray data. The measurement results were evaluated by descriptive statistics. Results. Mean values of AJ dorsiflexion obtained with a double-plane goniometer were 37.62 ± 5.56°; with an inclinometer — 40.61 ± 5.15°; radiological results — 23.69 ± 7.25°. Their difference was significant (p < 0.001). The mean variability index for the radiological method was 0.31 prevailing over goniometric (0.15) and inclinometric (0.13) methods (p < 0.001). X-ray ima-ging of a weight-bearing AJ at its maximum dorsiflexion raises the indicator of a talus-first metatarsal angle. Conclusions. The values of the dorsiflexion angle parameters of an AJ, measured using goniometric and inclinometric methods, significantly exceed those obtained by X-ray imaging. Higher variation index for radiological imaging demonstrates better reproducibility of inclinometry and goniometry when evaluating AJ dorsiflexion. A weight-bearing AJ radiogram at maximum extended position demonstrates an increase in a talus-first metatarsal angle compared to normal values that should be considered when interpreting the results of X-ray imaging of an AJ dorsiflexion.

Single Hemicerclage for Lateral Type B Malleolar Fracture - A Novel, Minimal and Reliable Osteosynthesis

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 283-288
Author(s):  
Maurer ◽  
Stamenic ◽  
Stouthandel ◽  
Ackermann ◽  
Gonzenbach
Keyword(s):  
Ankle Joint ◽  
Weight Bearing ◽  
Fracture Type ◽  
Type B ◽  
Malleolar Fracture ◽  
Metallic Wire ◽  
Long Term Outcome ◽  
X Ray ◽  
Upper Ankle Joint ◽  
Upper Ankle

Aim of study: To investigate the short- and long-term outcome of patients with isolated lateral malleolar fracture type B treated with a single hemicerclage out of metallic wire or PDS cord. Methods: Over an 8-year period 97 patients were treated with a single hemicerclage for lateral malleolar fracture type B and 89 were amenable to a follow-up after mean 39 months, including interview, clinical examination and X-ray controls. Results: The median operation time was 35 minutes (range 15-85 min). X-ray controls within the first two postoperative days revealed an anatomical restoration of the upper ankle joint in all but one patient. The complication rate was 8%: hematoma (2 patients), wound infection (2), Sudeck's dystrophy (2) and deep vein thrombosis (1). Full weight-bearing was tolerated at median 6.0 weeks (range 2-26 weeks). No secondary displacement, delayed union or consecutive arthrosis of the upper ankle joint was observed. All but one patient had restored symmetric joint mobility. Ninety-seven percent of patients were satisfied or very satisfied with the outcome. Following bone healing, hemicerclage removal was necessary in 19% of osteosyntheses with metallic wire and in none with PDS cord. Conclusion: The single hemicerclage is a novel, simple and reliable osteosynthesis technique for isolated lateral type B malleolar fractures and may be considered as an alternative to the osteosynthesis procedures currently in use.

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 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.

OP45 HTA Of A Pediatric Biplanar Low-Dose X-Ray Imaging System

2018 ◽  
Vol 34 (S1) ◽  
pp. 17-18
Author(s):  
Martina Andellini ◽  
Francesco Faggiano ◽  
Roxana di Mauro ◽  
Pietro Derrico ◽  
Matteo Ritrovato
Keyword(s):  
3D Reconstruction ◽  
Low Dose ◽  
Imaging System ◽  
Weight Bearing ◽  
Ct Scanning ◽  
Lower Limbs ◽  
Final Decision ◽  
X Ray ◽  
Congenital Deformities ◽  
X Ray Imaging

Introduction:Patients with adolescent idiopathic scoliosis frequently receive X-ray imaging at diagnosis and subsequent follow monitoring. To achieve the ALARA concept of radiation dose, a biplanar low-dose X-ray system (BLDS) has been proposed. The aim of the study is to gather evidence on safety, accuracy and overall effectiveness of a BLDS compared with CT scanning, in a pediatric population, in order to support the final decision on possible acquisition of such innovative diagnostic system.Methods:The new method Decision-oriented HTA (DoHTA) was applied to carefully assess the diagnostic technology. It was developed starting from the EUnetHTA Core Model® integrated with the analytic hierarchy process in order to identify all the relevant assessment aspects of the technology involved, identified from scientific literature, experts’ judgments and specific context analysis of Bambino Gesù Children's Hospital. A weight was associated to each assessment element and the alternatives’ ranking was defined.Results:This innovative system provides orthopedic images in standing or sitting position, being able to examine the spine and lower limbs under normal weight-bearing conditions. This system is recommended for particular clinical indications as scoliosis and other congenital deformities of the spine. It is able to acquire simultaneous posteroanterior and lateral images in a single scan without vertical distortion and with lower radiation exposure than CT scanning. 2D images acquired can be combined to obtain a 3D reconstruction scanning based on a semi-automated statistical model.Conclusions:The major advantages of BLDS are the relatively low dose of radiation and the possibility of obtaining a 3D reconstruction of the bones. Our preliminary results show that data on the clinical effectiveness are limited but the technical advancements of BLDS appear promising in terms of patient management and patient health outcomes associated with its use.

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 Comparison between Weight Bearing Radiographs and Weight Bearing ConeBeam CT Examinations in the Assessment of Adult Acquired Flatfoot Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Cesar de Cesar Netto ◽  
Lew Schon ◽  
Apisan Chinanuvathana ◽  
Francois Lintz ◽  
Lucas Furtado Da Fonseca
Keyword(s):  
Pearson Correlation ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Imaging Modalities ◽  
Anatomical Landmarks ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Adult Acquired Flatfoot Deformity ◽  
Conebeam Ct

Category: Hindfoot Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) represents a biomechanical derangement involving the three- dimensional (3D) midfoot and hindfoot osseous complex, and can be challenging to optimally characterize using conventional two- dimensional (2D) plain radiographs. Weightbearing (WB) ConeBeam CT (CBCT) can better demonstrate the deformity of the 3D structures during WB. Therefore, we compared validated AAFD measurements between WB conventional radiographs and WB CBCT images. Methods: In this prospective, IRB approved and HIPAA compliant study, 20 patients (20 feet, 15 right and 5 left) with clinical diagnosis of flexible AAFD were included, 12 males and 8 females, with a mean age of 52.2 years (range, 20 to 88 years of age), and average BMI of 30.35 kg/m2 (range, 19.00 to 46.09 kg/m2). Involved feet underwent standing (WB) anteroposterior (AP) and lateral radiographs, and were also scanned by WB CBCTs. Both imaging modalities were assessed with traditional AAFD measurements obtained at sagittal (lateral view on radiograph) and axial (anteroposterior view on radiograph) planes using predefined anatomical landmarks, by two independent and blinded foot and ankle fellowship-trained observers. Intra- and Inter- observer reliabilities for both imaging modalities were calculated using Pearson correlation. WB radiograph and WB CBCT measurements were compared by T-Test of the means. P- values < 0.05 were considered significant. Results: There was good to excellent intra and inter-observer agreements for most of the measurements on both radiographs and WB CBCT images, with slightly better results favoring WBCT measurements. When comparing WB radiographs and WB CBCT images, we found significant differences in the mean values for some of the measurements, including: talus-first metatarsal angle in the sagittal plane (11.34° x 21.73°, p<0.0001), navicular-medial cuneiform angle (13.19° x 7.63°, p<0.0004), medial cuneiform to floor distance (6.70 mm x 5.50 mm, p<0.0003) and navicular to floor distance (31.34 mm x 23.22 mm, p<0.0001). No significant differences were found when measuring: talus-first metatarsal angle in the axial plane, talar uncoverage angle, cuboid to floor distance and calcaneal inclination angle. Conclusion: Traditional adult acquired flatfoot deformity radiographic measurements are obtainable using high resolution 3D WB CBCT imaging. Measurements performed on WB CBCT have similar intra-observer and overall higher inter-observer reliability when compared to WB radiographs. The statistically significant differences found in some of the measurements, when comparing both imaging techniques, might be related to a better characterization of the three-dimensional deformity on WB CBCT images.

scholarly journals Radiographic Measurements Associated with the Natural Progression of the Hallux Valgus Deformity during at Least Two Years of Follow-up

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002 ◽  
Author(s):  
Kyoung Min Lee ◽  
Seung Yeol Lee ◽  
Sonya Ahmed ◽  
Byung Chae Cho ◽  
Moon Seok Park ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Binary Logistic Regression ◽  
Valgus Deformity ◽  
Binary Logistic Regression Analysis ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Metatarsal Angle ◽  
Radiographic Measurements

Category: Bunion Introduction/Purpose: There have been few longitudinal studies regarding hallux valgus deformity. This retrospective study aimed to investigate the radiographic measurements associated with the progression of hallux valgus deformity during at least two years of follow-up. Methods: Seventy adult patients (mean age, 58.0 years; standard deviation [SD], 12.3 years; 13 males and 57 females) with hallux valgus who were followed-up for at least two years and underwent weight-bearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Progression of hallux valgus deformity was defined as an increase of 5 degrees or more in the HVA during follow-up. Patients were divided into progressive and non-progressive groups. Binary logistic regression analysis was performed to identify factors that significantly affect the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. Results: Eighteen out of 70 patients showed progression of 5 degrees or more in the HVA during the mean follow-up of 47.0 months (SD, 19.8 months). The DMAA (p=0.027) and AP talo-first metatarsal angle (p=0.034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA (r=0.423; p=0.001) and DMAA (r=0.541; p<0.001). Conclusion: Special attention needs to be given to patients with pes planovalgus and increased DMAA during follow-up. Change in HVA was significantly correlated with changes in IMA and DMAA. Therefore, progression of hallux valgus deformity is considered to be closely related to the progressive instability of the first tarsometatarsal joint.

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