Reliability of coronal plane rotation measurements in the medial column of the foot: a cadaveric study

Objective: To assess interobserver reliability of previously described coronal plane rotation measurements of medial column bones and to assess their ability to accurately quantify changes in rotational profile. Methods: Two cadaveric below-knee specimens were implanted with pins in each bone of the medial column. Weight-bearing computed tomography (CT) scans were acquired in a simulated standing position under neutral, supinated, and pronated conditions. For each specimen and condition, 2 observers measured the coronal plane rotation of the navicular, medial cuneiform, first metatarsal base, shaft, and head, and proximal phalanx of the hallux as previously described. The rotation of each pin was measured relative to the ground in the coronal plane for each condition. These measurements were defined as benchmarks for the rotational profile of each bone. The correlation between these benchmarks and direct bone measurements was then assessed. Intraclass correlation coeficiente was used to assess interobserver reliability. Pearson’s coefficient was used to evaluate correlations. Results: The interobserver reliability of direct bone measurements ranged from 0.98 to 0.99. Correlations between pin rotation and direct measurements ranged from ρ=0.87 to 0.99 across the neutral, supinated, and pronated conditions. Conclusion: Coronal plane rotation measurements of medial column bones described in this study are reliable tools. Level of Evidence III; Case-Control Study.

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Radiographic Correlation of Hallux MP Fusion Position and Plate Angle

Foot & Ankle International ◽

10.3113/fai.2009.0873 ◽

2009 ◽

Vol 30 (9) ◽

pp. 873-876 ◽

Cited By ~ 10

Author(s):

J. Thaddeus Leaseburg ◽

James K. DeOrio ◽

Shane A. Shapiro

Keyword(s):

Weight Bearing ◽

Proximal Phalanx ◽

Case Series ◽

Statistical Correlation ◽

Titanium Plate ◽

Care Needs ◽

Retrospective Case ◽

Level Of Evidence ◽

Lower Correlation ◽

Proper Weight

Background: This study assessed the variability of plate bend in regard to final metatarsophalangeal (MP) fusion angles and toe-to-floor distance. We hypothesized that the final MP angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance would be dictated solely by the magnitude of the bend in the plate. Materials and Methods: This is a retrospective analysis of 35 sequential patients who underwent MP fusion with a low-contour titanium plate. Postoperative weightbearing radiographs were analyzed for plate angle, MP fusion angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance. Results: We found statistical correlation between plate angle and MP angle and between plate angle and the angle of the proximal phalanx to the floor. However, there was low correlation between plate angle and with toe-to-floor distance. In addition, we noted many outliers, which resulted in higher or lower correlation of the MP angle to the expected plate angle and, thus, a relationship between angles that was far from linear. Conclusion: Care needs to be taken when relying solely on the bend in the plate to determine the final position of the toe in MP fusions. Although the association between plate bend and MP angle and proximal phalanx to floor angle was strong, the association between the bend in the plate and weight bearing toe-to-floor distance was variable. This could result in the toe hitting the shoe or the need to vault over the toe. Therefore, the surgeon must match the plate to each patient's anatomy to ensure proper weight bearing toe-to-floor distance and not rely on plate angle exclusively. Level of Evidence: IV, Retrospective Case Series

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First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/24730114211008514 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110085

Author(s):

Christopher Traynor ◽

James Jastifer

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

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3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

Foot & Ankle International ◽

10.1177/1071100719835492 ◽

2019 ◽

Vol 40 (6) ◽

pp. 720-726 ◽

Cited By ~ 24

Author(s):

Jian Zhong Zhang ◽

François Lintz ◽

Alessio Bernasconi ◽

Shu Zhang ◽

Keyword(s):

Computed Tomography ◽

Comparative Study ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Mean Values ◽

Intraclass Correlation Coefficients ◽

Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

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Tarsometatarsal bone remodelling after subtalar arthroereisis

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190190 ◽

2020 ◽

Vol 14 (3) ◽

pp. 221-229

Author(s):

Matthias Braito ◽

Maria Radlwimmer ◽

Dietmar Dammerer ◽

Philipp Hofer-Picout ◽

Jürgen Wansch ◽

...

Keyword(s):

Bone Remodelling ◽

Deformity Correction ◽

Lateral View ◽

Bone Morphology ◽

Level Of Evidence ◽

First Metatarsal ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Angular Measurements ◽

Subtalar Arthroereisis

Purpose Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology. Methods We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41). Results A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001). Conclusion Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot. Level of evidence IV

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Joint-Preserving Surgery for Hyperextension Deformity of the Hallux Interphalangeal Joint in a Patient with Rheumatoid Arthritis

Case Reports in Orthopedics ◽

10.1155/2020/5843095 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Takumi Matsumoto ◽

Yuki Shimizu ◽

Song Ho Chang ◽

Taro Kasai ◽

Jun Hirose ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Plantar Flexion ◽

Weight Bearing ◽

Proximal Phalanx ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Wedge Osteotomy ◽

Opening Wedge ◽

Joint Preserving Surgery ◽

Medial Cuneiform

Interphalangeal hyperextension is one of the major hallux deformities in patients with rheumatoid arthritis; however, there is yet no established surgical method for this deformity. We here present the case of a 69-year-old female patient with rheumatoid arthritis who developed hallux interphalangeal hyperextension and painful callosity on the plantar hallux accompanied by limited dorsiflexion at the metatarsophalangeal joint. Lateral weight-bearing radiograph of the foot revealed misalignment of the medial column and hallux, including a collapsed medial arch, elevated first metatarsal, plantar flexion and deviation of the proximal phalanx, and hyperextension of the distal phalanx. The foot was successfully treated and became symptom-free with opening wedge osteotomy of the medial cuneiform, plantar and proximal translation of the metatarsal head, and tenotomy of the extensor hallucis longus. This case suggests that reconstruction of the sagittal alignment of the medial column and hallux through a combination of osteotomy and soft tissue intervention could be an optional treatment for interphalangeal hyperextension.

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Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00397 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0039

Author(s):

Robbie Ray ◽

Peter W. Robinson ◽

Paul M. Dearden ◽

Thomas A. Goff ◽

Peter Lam ◽

...

Keyword(s):

Sagittal Plane ◽

Weight Bearing ◽

Proximal Phalanx ◽

Valgus Deformity ◽

Coronal Plane ◽

Wound Complications ◽

Wedge Osteotomy ◽

Continuous Variables ◽

Closing Wedge Osteotomy ◽

Closing Wedge

Category: Lesser Toes; Bunion Introduction/Purpose: Deformities of the lesser toes are usually described in the sagittal plane. Coronal plane deviation is also common, yet there is a paucity of literature on the management of these challenging deformities. Traditional soft tissue procedures and translational Weil osteotomies are unpredictable and can lead to post-operative stiffness. We present the results of a novel percutaneous osteotomy of the proximal phalanx to treat valgus deformity of the 2nd toe. Methods: 29 patients underwent 38 osteotomies at a mean age of 59+/-9 years. Through a 2mm dorsomedial incision, a percutaneous proximal metaphyseal medial closing wedge osteotomy is performed using a low speed, high torque 2x8mm burr. The toe is then taped for 2 weeks. Mean follow up was 29+/-18 months. Post-operative weight bearing radiographs were performed at a mean of 27+/-18 months. Dichotomous variables were assessed using a Chi square test. After confirming normality using a Kolomgrov-Smirnov test, continuous variables were measured using paired and independent t-tests. Results: 90% (n=26) patients responded. 88% (n=23) patients were satisfied or extremely satisfied with the procedure. 24% reported a partial (n=4) or complete recurrence (n=2) of deformity. Patients who perceived recurrence were significantly more likely to be dissatisfied (p=0.001). Radiographs were available for 27/38 osteotomies. Mean valgus angle decreased from 21+/-10° to 9+/-8° (p=0.001). All osteotomies united with no delayed union. There were no wound complications or infections. 2 patients reported long term numbness in the toe and 1 patient complained of a floating toe. Conclusion: Percutaneous closing wedge osteotomies to correct (valgus)coronal plane deformity is technically straight forward with a low complication rate and high patient satisfaction. Future studies should assess the role of this technique to correct medial crossover deformities and compare outcomes with other techniques.

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Radiographic Evaluation of First Metatarsal and Medial Cuneiform Morphology in Juvenile Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100718789696 ◽

2018 ◽

Vol 39 (10) ◽

pp. 1223-1228 ◽

Cited By ~ 2

Author(s):

Philip Kaiser ◽

Kristin Livingston ◽

Patricia E. Miller ◽

Collin May ◽

Susan Mahan

Keyword(s):

Hallux Valgus ◽

Multivariable Analysis ◽

Metatarsophalangeal Joint ◽

Radiographic Evaluation ◽

High Recurrence Rate ◽

Level Of Evidence ◽

First Metatarsal ◽

Valgus Angle ◽

Medial Cuneiform ◽

Highly Correlated

Background: Operative treatment of juvenile hallux valgus (JHV) has a high recurrence rate. The aim of this study was to better understand the pattern of radiographic deformity. Methods: Standing radiographs of 93 feet in 57 patients with JHV, and 50 feet in 36 normal patients were measured. Measurements included: hallux valgus angle (HVA), first metatarsal physis status (open or closed), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), Meary’s angle, medial cuneiform angle (MCA), relative first to second metatarsal length ratio (1:2 MT ratio), cuneiform obliquity (CO), and congruency of the metatarsophalangeal joint (MTPJ). JHV groups were defined as normal (HVA 0-15 degrees), mild-moderate (HVA 15-35), or severe (HVA > 35) and were analyzed. Results: Seventy of 93 feet (75%) with JHV presented with mild-moderate JHV (average HVA of 26.2 ± 5.6 degrees), and 23 feet (25%, 23/93) presented with severe JHV (average HVA of 41.9 ± 5.3 degrees). Multivariable analysis determined that DMAA ( P < .001), MCA ( P = .04), and congruency ( P < .001) were independently associated with JHV and its severity (normal vs mild-moderate vs severe). Severe JHV cases had larger DMAA ( P = .01), larger IMA ( P = .01), larger 1:2 MT ratio ( P = .02), and were less frequently congruent ( P = .03) compared with mild-moderate JHV cases. Conclusion: Deformity in JHV was highly correlated with both the proximal and distal morphology of the first metatarsal and medial cuneiform. Severe JHV was associated with increased bony deformity and increased incongruity of the MTPJ. Treatment should be individualized, but JHV treatment algorithms can take this information into account. Level of Evidence: Level III, comparative study.

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3D biometrics for hindfoot alignment using Weight Bearing CT

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00323 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0032

Author(s):

Francois Lintz ◽

Shu Zhang ◽

Alessio Bernasconi ◽

Jianzhong Zhang

Keyword(s):

Interobserver Reliability ◽

Weight Bearing ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Continuous Series ◽

Hindfoot Alignment ◽

Group 3 ◽

Group 2 ◽

Weightbearing Ct ◽

Group 1

Category: Hindfoot Introduction/Purpose: Hindfoot alignment is an important reference for foot and ankle surgery, and the Foot Ankle Offset (FAO) using semi-automatic software has been reported as a valuable hindfoot alignment measurement in weightbearing CT(WBCT). The objective was to assess the clinical relevance and reproducibility of the FAO value for hindfoot alignment and compare it with previous findings. Methods: A prospective study was conducted, with ethics committee approval. Patients were included, clinically examined and divided into 3 groups: normal alignment (Group 1), valgus (Group 2), varus (Group 3). A continuous series of 140 feet (71 patients) were referred from September to December 2017 (65 normal, 41 valgus, and 34 varus). All patients had a bilateral weight bearing CT, and the FAO values were recorded. The long axial view angle(HAct)was measured on Digitally Reconstructed Radiographs (DRR) as comparison. All values were measured and compared by two different investigators. The reproducibility of FAO and HAct were calculated using intraclass correlation coefficients(ICCs) and regression analysis was conducted to study the correlation between the two methods. Results: In Group 1, the mean value for FAO/HAct was 1.69%±2.58%/4.13±2.67, in Group 2, the FAO/HAct was 7.46%±3.18%/9.00±3.43; in Group 3 the values were -6.11%±4.55%/-7.49±6.06. The intra- and interobserver reliability were 0.991/0.992 and 0.976/0.976. There was a good linear correlation between HAct and FAO (R2=0.778, and the regression slope was 1.083. Conclusion: The use of weightbearing CT can help characterize hindfoot alignment objectively using WBCT. The present study is the first prospective comparative assessment of this technology and shows that FAO has good repeatability, and it correlates well with clinical examination,, X ray findings and previous literature. The FAO is a clinically relevant and reproducible method for measuring hindfoot alignment.

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Assessment of the ankle joint in clubfeet and normal feet to the age of four years by ultrasonography

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170217 ◽

2018 ◽

Vol 12 (3) ◽

pp. 262-272 ◽

Cited By ~ 1

Author(s):

A. Johansson ◽

Y. Aurell ◽

B. Romanus

Keyword(s):

Ankle Joint ◽

Interobserver Reliability ◽

Plantar Flexion ◽

Intraclass Correlation ◽

Neutral Position ◽

Healthy Children ◽

Level Of Evidence ◽

Posterior Aspect ◽

Talocrural Joint ◽

Interexaminer Reliability

Purpose To establish reproducible posterior ultrasonographic projections for evaluation of the movement in the talocrural joint in clubfeet and normal feet from the perinatal period up to the age of four years. Methods The feet in 105 healthy children and 46 patients (71 clubfeet and 21 normal feet) were examined. In all, 14 feet in seven patients were examined twice by two examiners independently to evaluate the repeatability of the ultrasonography scans. A posterior sagittal projection was used. The distance from the posterior aspect of the tibial physis to the posterior border of the talocalcaneal joint (Tib. phys – TCJ) was measured with the foot in neutral position and dorsiflexion. In plantar flexion the shortest distance between the tibial physis and the calcaneus was measured. The distance from the skin to the tibial epiphyses and the talus was measured in neutral position. The intraclass correlation coefficient (ICC) was calculated to evaluate the repeatability of the measurements. Results The interexaminer reliability was 0.71 to 0.89 ICC. The intra- and interobserver reliability measured as ICC was 0.68 to 0.99 for all measurements. The correlation between Tib. phys. – TCJ and clinical dorsiflexion varied much between the age groups. Conclusion Ultrasonography of the posterior aspect of the ankle joint can be done with high interexaminer reliability. The repeatability of image evaluation was high. Correlation to clinical measurements varied, therefore dynamic ultrasound in real time is clinically more useful than single measurements on frozen ultrasound images. Level of Evidence III

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Three-Dimensional Quantification of Glenoid Bone Loss in Anterior Shoulder Instability: The Anatomic Concave Surface Area Method

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211011058 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110110

Author(s):

Marine Launay ◽

Muhammad Naghman Choudhry ◽

Nicholas Green ◽

Jashint Maharaj ◽

Kenneth Cutbush ◽

...

Keyword(s):

Bone Loss ◽

Surface Area ◽

Shoulder Instability ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Glenoid Bone Loss ◽

Concave Surface ◽

Anterior Shoulder Instability ◽

Level Of Evidence ◽

Best Fit

Background: Recurrent shoulder instability may be associated with glenoid erosion and bone loss. Accurate quantification of bone loss significantly influences the contemplation of surgical procedure. In addition, assessment of bone loss is crucial for surgical planning and accurate graft placement during surgery. Purpose: To quantify the concave surface area of glenoid bone loss by using 3-dimensional (3D) segmented models of the scapula and to compare this method with the best-fit circle and glenoid height/width methods, which use the glenoid rim for bone loss estimations. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 36 consecutive preoperative bilateral computed tomography scans of patients eligible for a primary Latarjet procedure were selected from our institutional surgical database (mean patient age, 29 ± 9 years; 31 men and 5 women). The 3D models of both scapulae were generated using medical segmentation software and were used to map the anatomic concave surface area (ACSA) of the inferior glenoid using the diameter of the best-fit circle of the healthy glenoid. Bone loss was calculated as a ratio of the difference between surface areas of both glenoids (healthy and pathological) against the anatomic circular surface area of the healthy glenoid (the ACSA method). These results were compared with bone loss calculations using the best-fit circle and glenoid height/width methods. Inter- and intraobserver reliability were also calculated. Results: The mean (± SD) bone loss calculated using the ACSA, the best-fit circle, and glenoid height/width methods was 9.4% ± 6.7%, 14.3% ± 6.8%, and 17.6% ± 7.3%, respectively. The ACSA method showed excellent interobserver reliability, with an intraclass correlation coefficient (ICC) of 0.95 versus those for the best-fit circle (ICC, 0.71) and glenoid height/width (ICC, 0.79) methods. Conclusion: Quantification of instability-related glenoid bone loss is reliable using the 3D ACSA method.

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