Does tibialis posterior dysfunction correlate with a worse radiographic overall alignment in progressive collapsing foot deformity? A retrospective study

Lalevée, Matthieu; Mansur, Nacime Salomão Barbachan; Schmidt, Eli; Carvalho, Kepler Alencar Mendes de; VandeLune, Christian; Bernasconi, Alessio; Wilken, Jason M.

doi:10.1016/j.fas.2022.02.004

Cited by 11 publications

(9 citation statements)

References 54 publications

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“…Although it was a prospective study, we could not evaluate the true linear evolution of PCFD over time. This is important for Class E deformities that might present earlier than anticipated 10 , 24 , 38 . Although patients had a history of PCFD and no ankle trauma, it is impossible to completely exclude the possibility that an ankle deformity could have occurred first.…”

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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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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“…Hind‐ and midfoot function relies heavily on the interplay of the peritalar bones and joints 4 . Posterior tibial tendonitis is a common presentation of PCFD and is assumed to be a primary cause of the deformity; however, recent research has concluded that dysfunction of the PTT may not be the main cause of deformity in PCFD 4–6 . Subluxation of the peritalar bones and joints is also frequently used as a marker for PCFD, specifically the anterior‐medial facet of the subtalar joint 7 .…”

Section: Introductionmentioning

confidence: 99%

“…however, recent research has concluded that dysfunction of the PTT may not be the main cause of deformity in PCFD. [4][5][6] Subluxation of the peritalar bones and joints is also frequently used as a marker for PCFD, specifically the anterior-medial facet of the subtalar joint. 7 When treating PCFD clinicians aim to preserve as much peritalar joint motion as possible, yet, joint-sacrificing procedures, such as realignment fusions, are often used to obtain and maintain correction of the deformity in more complex cases.…”

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confidence: 99%

Joint coverage analysis in progressive collapsing foot deformity

Knutson

Peterson

Lisonbee

et al. 2023

Journal Orthopaedic Research

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Progressive collapsing foot deformity (PCFD) is characterized by a progressive subluxation of the peritalar bones and respective joints. Two‐dimensional conventional radiographs are limited in their ability to visualize the peritalar bones and joints with adequate detail to describe the complex three‐dimensional deformity. An improved understanding of the relationship between joint coverage and deformity would allow clinicians to use coverage analysis to distinguish among the stages of PCFD. The aim of this study was to analyze the joint coverage of the six articular relationships within the talocrural, subtalar, and Chopart joints using weightbearing computed tomography (WBCT) scans. Ten individuals with a flexible hindfoot and ten individuals with a rigid hindfoot presentation of PCFD were compared to twenty‐seven asymptomatic control individuals. The three most relevant findings are: (I) the anterior‐medial facet of the subtalar joint contains the greatest reduction in coverage for patients with a rigid deformity, (II) an increase in talonavicular overlap (TNO) moderately correlated with a decreased coverage in the: tibiotalar, anterior‐medial subtalar, talonavicular joints, and (III) the calcaneocuboid joint lacks radiographic values to adequately quantify alignment and coverage. To conclude, there were significant differences in coverage area of various articulating regions throughout the hind‐ and midfoot when comparing PCFD patients to asymptomatic control individuals. Relevant radiographic measures correlating to articular coverage areas of clinical interest were identified, possibly helping to better quantify PCFD in clinical practice.

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“…Stage IIA progressive collapsing foot deformity (PCFD) is characterized by a collapse of the middle arch, forefoot abduction, hindfoot valgus, and soft tissue dysfunction. 17,18,21,22 Surgeries usually include realignment using corrective osteotomies and soft tissue tensioning. 15,23,26 Lateral column lengthening (LCL) is one of the most frequently used osteotomies in PCFD alignment correction.…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening

Efrima,

Barbero,

Ramalingam

et al. 2023

Foot Ankle Int.

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Background: Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility. Methods: Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney U test were used to compare the safe zones between OCSTs. Results: The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies. Conclusion: Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures. Level of Evidence: Level III, retrospective comparative study.

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Does tibialis posterior dysfunction correlate with a worse radiographic overall alignment in progressive collapsing foot deformity? A retrospective study

Cited by 11 publications

References 54 publications

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

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

Joint coverage analysis in progressive collapsing foot deformity

Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening

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