Diagnostic accuracy of measurements in progressive collapsing foot deformity using weight bearing computed tomography: A matched case-control study

Lintz, François; Bernasconi, Alessio; Li, Shuyuan; Lalevée, Matthieu; Fernando, Céline; Barg, Alexej; Dibbern, Kevin

doi:10.1016/j.fas.2021.12.012

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…18,20,33 Additionally, FAO values greater than 4.6% have a specificity of 100% and a sensitivity of 89.2% for diagnosis of PCFD. 19 In the present study, the PCFD group had a mean FAO value of 9.7%, suggesting that the cohort included is a true PCFD cohort. Similarly, the control group had a FAO value of 1.6%, suggesting that this cohort would not meet criteria for a PCFD diagnosis.…”

Section: Discussionmentioning

confidence: 48%

The Role of the Transverse Arch in Progressive Collapsing Foot Deformity

Schmidt,

Lalevée,

Kim

et al. 2023

Foot Ankle Int.

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Background: The transverse arch (TA) has recently been shown to significantly increase the intrinsic stiffness of the midfoot when coupled with the medial longitudinal arch (MLA). Progressive collapsing foot deformity (PCFD) is a complex deformity that ultimately results in a loss of stiffness and collapse of the MLA. The role of the TA has not been investigated in patients diagnosed with this disorder using weightbearing CT (WBCT). Therefore, this study aims to answer the following questions: (1) Is the curvature of the TA decreased in PCFD? (2) Where within the midfoot does TA curvature flattening happen in PCFD? Methods A retrospective review of weightbearing CT images was conducted for 32 PCFD and 32 control feet. The TA curvature was assessed both indirectly using previously described methods and directly using a novel measurement termed the transverse arch plantar (TAP) angle that assesses the angle formed between the first, second, and fifth metatarsals in the coronal plane. Location of TA collapse was also assessed in the coronal plane. Results: The TAP angle was significantly higher in PCFD (mean 115.2 degrees, SD 10.7) than in the control group (mean 100.8 degrees, SD 7.9) ( P < .001). No difference was found using the calculated normalized TA curvature between PCFD (mean 17.1, SD 4.8) and controls (mean 18.3, SD 4.0) ( P = .266). Location of collapse along the TA in PCFD was most significant at the second metatarsal and medial cuneiform. Conclusion: The TA is more collapsed in PCFD compared to controls. This collapse was most substantial between the plantar medial cuneiform and the plantar second metatarsal. This may represent a location of uncoupling of the TA and MLA. Level of Evidence: Level III, retrospective case control.

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Section: Discussionmentioning

confidence: 48%

The Role of the Transverse Arch in Progressive Collapsing Foot Deformity

Schmidt,

Lalevée,

Kim

et al. 2023

Foot Ankle Int.

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“…2 The capability in further assessing deformity components with this method was demonstrated by prior studies and could explain the differences in class frequencies. 1,7 Although class A (83.9% in WBCT vs 89.5% in CR; P = .55), a greatly clinical determination, and class E (27.7% in WBCT vs 22.5% in CR; P = .158), simply noted by an ankle radiograph, demonstrated similar occurrences, the others did not. Considering sinus tarsi impingement as a sign of class B by consensus increased its occurrence when WBCT was used (89.9% in WBCT vs 76.4% in CR; P < .001), probably due an improved recognition when using multiple planes.…”

Section: Discussionmentioning

confidence: 92%

“…The lack of diagnostic threshold values for each deformity might be related to this finding. 4,7 Also, many classes are determined by estimated angles (class B and the talonavicular coverage) or a combination of indirect signs and clinical dynamic assessment (class D and class C, respectively). 5,8 This study has several limitations that must be discussed, most of them already considered in our previous article.…”

Section: Discussionmentioning

confidence: 99%

Influence of Weightbearing Computed Tomography in the Progressive Collapsing Foot Deformity Classification System

et al. 2023

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Background: The objective of this study was to compare progressive collapsing foot deformity (PCFD) classifications performed using clinical and conventional radiographs (CR) with classifications established using clinical and weightbearing computed tomography (WBCT). Methods: This retrospective comparative study evaluated 89 consecutive PCFD feet (84 patients). Three readers performed chart reviews and CR evaluations, determining PCFD classifications that were previously published. After a washout period, the sequence was randomized, and a new classification was executed using clinical and WBCT assessment. One of the readers repeated the WBCT evaluation for intrarater reliability. Results: Interrater reliability for the WBCT was found moderate (0.55) and intrarater excellent (0.98). Evaluation using WBCT produced 29.6% of 1ABC (CR: 25.4%, P = .270), 11.6% of 1ABCD (CR: 6.9%, P = .081), and 6.4% of BC (CR: 3.3%, P = .090) as most prevalent. Class A was presented in 83.9% (CR: 89.5%, P = .55), class B in 89.9% (CR: 76.4%, P < .001), class C in 93.6% (CR: 86.2%, P = .004), class D in 46.4% (CR: 34.8%, P = .006), and class E in 27.7% (CR: 22.5%, P = .158) of the classifications performed by WBCT. Conclusion: WBCT showed a different rate of deformity recognition, which increased the incidence of all classes, especially B, C, and D. An excellent intrarater agreement was found, which infers assessment reliability combining clinical and WBCT evaluation. The obtained information could enhance disease understanding and supply patients with more precise care. Level of Evidence: Level III, retrospective comparative study.

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“…These results in patients with ankle valgus contrapose the findings of a previous study by our group, which described the influence of MFS on FAO values in PCFD without ankle valgus 5 . Lintz et al also described the MFS and FAO relationship in PCFD without ankle valgus by showing the highest accuracies for disease diagnosis using these metrics in isolation and when combined (100% sensitivity and 100% specificity) 36 . On the basis of our findings, FAO, HMA, and TAA are the imaging parameters most predictive of disease severity and progression in patients with Class E PFCD (Fig.…”

Section: Discussionmentioning

confidence: 99%

Decreased Peritalar Subluxation in Progressive Collapsing Foot Deformity with Ankle Valgus Tilting

Mansur,

Lalevee,

Shamrock

et al. 2023

JBJS Open Access

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Background: Middle facet subluxation (MFS) has been established as an early indicator of peritalar subluxation. However, when progressive collapsing foot deformity (PCFD) affects the ankle leading to a valgus talar tilt (Class E), structures and anatomic relationships distal to the ankle joint may be affected. Therefore, this study aimed to assess radiographic parameters of peritalar subluxation in patients with PCFD who either did or did not have a valgus ankle. Our hypothesis was that these parameters would differ in Class E patients, upsetting their capability to quantify deformity. Methods: We performed a prospective comparative study utilizing weight-bearing computed tomography (WBCT) images of 21 feet with PCFD and with valgus of the ankle and 64 with flexible PCFD without ankle involvement. Parameters including MFS, the medial cuneiform-to-floor distance, the forefoot arch angle, the talonavicular coverage angle, the hindfoot moment arm (HMA), the foot-ankle offset (FAO), and the talar tilt angle (TTA) were measured and compared. Variables that influence the presence of ankle valgus and overall alignment were assessed by multivariable regression models. Results: Patients with PCFD and ankle valgus demonstrated a higher mean HMA (20.79 mm [95% confidence interval (CI), 17.56 to 24.02 mm] versus 8.94 mm [95% CI, 7.09 to 10.79 mm]), FAO (14.89% [95% CI, 12.51% to 17.26%] versus 6.32% [95% CI, 4.96% to 7.68%]) and TTA (95% CI, 17.10° [14.75° to 19.46°] versus 2.30° [95% CI, 0.94° to 3.65°]) and lower mean MFS (21.84% [95% CI, 15.04% to 28.63%] versus 38.45% [95% CI, 34.55% to 42.34%]) compared with the group without ankle valgus (p < 0.0001 for all). The FAO was influenced by MFS in the group without ankle valgus (p <0.0001) but not in the group with ankle valgus (p = 0.9161). FAO values of ≥12.14% were a strong predictor (79.2%) of ankle valgus deformity. Conclusions: Subluxation of the middle facet was not as severe and did not influence the overall alignment in patients with PCFD who had valgus of the ankle (Class E). These findings suggest a distal peritalar reduction in the presence of a proximal deformity, making MFS an imprecise disease parameter in this scenario. An FAO value of ≥12.14% was a strong indicator of ankle deformity in patients with PCFD. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Diagnostic accuracy of measurements in progressive collapsing foot deformity using weight bearing computed tomography: A matched case-control study

Cited by 6 publications

References 35 publications

The Role of the Transverse Arch in Progressive Collapsing Foot Deformity

The Role of the Transverse Arch in Progressive Collapsing Foot Deformity

Influence of Weightbearing Computed Tomography in the Progressive Collapsing Foot Deformity Classification System

Decreased Peritalar Subluxation in Progressive Collapsing Foot Deformity with Ankle Valgus Tilting

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