Category: Midfoot/Forefoot Introduction/Purpose: Weight-Bearing Computed Tomography (WBCT) measurements represent a reliable tool for radiographic analysis of the first ray, including multiplanar assessment in the axial, sagittal, and coronal planes. WBCT can allow for more reliable studies of pathologies, such as Hallux Rigidus (HR), which permits several anatomical points to be evaluated for a correct clinical-radiographic diagnosis. In addition, new software with an advanced semi-automated segmentation system obtains semi-automatic 3D measurements of WBCT scan data sets, minimizing the errors in reading angular measurements. The study`s objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HR, (2) to compare semi-automatic to manual measurements in the setting of HR, and (3) to compare semi-automatic measurements between a pathologic (HR) group and a control standard group. Methods: This was a retrospective, IRB approved study of patients with Hallux Rigidus deformity. The sample size calculation was based on the Metatarsus Primus Elevatus (MPE). A control group consisting of 20 feet without HR and a pathologic group consisting of 20 feet with HR was necessary for this study. All WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first Metatarsal-Proximal Phalanx Angle (1stMPP) (sagittal plane), (2) Hallux Valgus Angle (HVA), (3) first to second Intermetatarsal Angle (IMA), (4) Hallux Interphalangeal Angle (IPA), (5) first Metatarsal Lengths (1stML), (6) second Metatarsal Length (2ndML), (7) first Metatarsal Declination Angle (1stMD), (8) second Metatarsal Declination Angles (2ndMD), and (9) MPE. The semiautomatic 3D measurements were performed using the Bonelogic Software. The differences between pathologic and control cases were assessed with a Wilcoxon test and P<= 0.05 was considered significant. Results: Interobserver and intraobserver agreement and consistency for manual versus semi-automatic WBCT measurements assessed by ICC demonstrated excellent reliability. Manual and semi-automatic measurements were performed in individuals with HR. According to the Pearson's coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA, (ρ = 0.96); IMA, (ρ = 0.86); IPA, (ρ = 0.89); 1stML, (ρ = 0.96); 2ndML, (ρ = 0.91); 1stMD, (ρ = 0.86); 2ndMD, (ρ = 0.95) and, MPE, (ρ = 0.87). Agreement between the manual and semi-automatic methods was tested using a Bland- Altman plot and expressed excellent agreement between the methods. Comparison between the pathological group with HR and the control (standard) group allowed for the differentiating of the pathological (HR) from the non-pathological conditions for MPE (p < 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement and consistency. The software used differentiated pathological from non- pathological conditions only when submitted to semi-automatic MPE measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is an essential step toward the establishment of big data and can be integrated into clinical practice, facilitating decision making.
Category: Ankle; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: The same Consensus that proposed a new nomenclature for Flatfoot, Progressive Collapsing Foot Deformity (PCFD), also introduced a new classification system for the disease. The idea of staging was supplemented by the construction of a system combining deformity classes and its flexibilities, using clinical and radiographic signs. The capacity of the weight-bearing computed tomography (WBCT) in evaluating PCFD and all components of peritalar subluxation has been established. The objective of this study was to compare PCFD classifications performed utilizing clinical and conventional radiographs (CR) findings with classifications established using clinical and WBCT findings. We hypothesized that evaluations considering WBCT would significantly change PCFD classifications, portraying a different picture of the disease. Methods: This retrospective IRB-approved case-control diagnostic study evaluated 89 consecutive PCFD feet (84 patients) with different presentations of the disease. Three fellowship-trained foot and ankle surgeons performed chart reviews and CR evaluations, determining PCFD classifications for the studied subjects. After a two-week washout period, the sequence was randomized, and a new classification was executed using clinical data and WBCT assessment. One of the readers repeated the WBCT evaluation two weeks later for intrarater reliability purposes. Assessments included the presence or absence of classes, such as hindfoot valgus (A), midfoot abduction/sinus tarsi impingement (B), medial column instability (C), subtalar joint subluxation/subfibular impingement (D), and valgus of the ankle joint (E) as well as flexibility (1) and rigidity (2) of existing deformities. Fleiss kappa was used for interrater and Cohen's kappa for intrarater agreements. Differences between studied groups were determined by distribution comparison. Results: Mean BMI and age were 54.4 (+-17.1) and 33.6 (+-7.6) respectively. Interrater reliability was found to be moderate (0.55) and intrarater to be excellent (0.98). Evaluation using CR produced 22.8% of 1ABC, 13% of 1AC, 8,7% of 1ABCD and 7% of 2EABCD as most prevalent classifications. WBCT assessment found 31.5% of 1ABC, 11.2% of 1ABCD, 10.1% of 2ABCDE and 5.6% 1ABCDE. Class A was the most frequent component in CR (93.5%) and WBCT (94.5%). Class B had a higher prevalence in WBCT (94.38%) than in CR (71.7%) as well as Classes C (89.9% and 88.0%), D (44.9% and 29.3%) and E (31.5% and 23.9%). The percentage of combined flexible (1) and rigid (2) deformities was also higher in the WBCT evaluation (39.3% compared to 35.8%). Conclusion: As the new classification proposes the combination of different PCFD components to better support clinical decisions, proper identification of the classes is mandatory for a complete diagnosis. WBCT showed a different rate of deformity recognition, which increased the incidence of all classes, especially B (midfoot abduction/sinus tarsi impingement) and D (peritalar subluxation/subfibular impingement). An excellent intrarater agreement was found, which infers reliability of patient assessment combining clinical and WBCT evaluation. The obtained information could help providers to enhance comprehension of the disease and to supply patients with the most precise individual care.
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