We compared bone and articular morphology of the talus and navicular in clinically diagnosed flatfeet and evaluated their potential contribution to talo-navicular joint instability. We used CT images to develop 3D models of talus and navicular bones of 10 clinically diagnosed flatfeet and 15 non-flatfeet. We quantified their global bone dimensions, inclination and dimensions of the articular surfaces and their curvatures. Additionally, ratios of six talar and navicular dimensions were calculated. The values for these parameters were then compared between both groups. In flatfeet, the talar head faced more proximal and its width was larger compared to non-flatfeet. Also the navicular cup faced more proximal and its depth was significantly increased. Furthermore, we observed a more protruding talar head compared to the navicular cup in the control group with the articular surface depth being relatively larger for the navicular cups when compared to the talus in flatfeet. The ratio of the talar and navicular articular surface height was decreased in flatfeet, suggesting increased height of navicular cups relative to the articulating talar heads. Our results show that flatfoot deformity is associated with morphological changes of talar and navicular articular surfaces that can favor medial arch collapse and forefoot abduction. Several authors tried to introduce more reproducible exams, such as measurement of the bone-to-bone relationships on MRI or weightbearing CT-scan images, to define foot function during weightbearing conditions. 5,6 CT-scan studies led to several outcomes, such as 3D changes in relationships among bones, 7,8 and alterations in joint contact characteristics. 9-11 These studies contributed to the conclusion that flatfoot deformity is associated with changes in bone-to-bone relationships.Evidence exists that anatomical configuration and morphology per se are associated with the development of flatfoot deformity. Dyal et al. 12 found that many patients with symptomatic flatfeet also presented a decreased foot arch on the contralateral, asymptomatic side. However, few authors explored further these morphological changes until now. Anderson et al. 13 investigated alterations of talar bone morphology in flatfeet and found significant differences with respect to controls. These differences concerned the ratios of bone length/width, bone length/height, and head length/ width. Flatfoot tali were narrower in width and shorter in height and had more oval shaped heads. Furthermore, Grasso et al. 14 observed different calcaneal morphotypes when comparing different plantar arch alterations, including pes planus deformity.Based on these observations we investigated if, in addition to the aberrant relationships between bones previously documented in flatfeet, a difference also exists in bone and articular surface morphology of the talo-navicular joint. We hypothesized that a decreased congruence of articular surfaces in flatfeet compared to a control group is associated with increased talonavicular jo...
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