Evaluation of peritalar subluxation in adult acquired flatfoot deformity using computed tomography and weightbearing multiplanar imaging

Kunas, Grace C.; Probasco, William V.; Haleem, Amgad M.; Burket, Jayme C.; Williamson, Emilie; Ellis, Scott J.

doi:10.1016/j.fas.2017.05.010

Cited by 35 publications

(20 citation statements)

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“…El pie plano adquirido del adulto es una deformidad común del pie caracterizada por el colapso de la columna medial (1), asociado generalmente a una disfunción del tendón del tibial posterior (DTTP) (2), un colapso longitudinal medial, una orientación en valgo del retropié y una abducción del antepié (3) . Esta patología tiene un origen complejo y multifactorial, involucrando así a todos los tejidos blandos posteromediales como el ligamento de Spring, el ligamento deltoideo y el tendón del tibial posterior (TTP) (4).…”

Section: Introductionunclassified

Tratamiento quirúrgico del pie plano adquirido del adulto. Caso clínico

et al. 2019

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El presente estudio describe un caso de una paciente de 55 años que presenta dolor e inflamación de un año de evolución en la zona interna del tobillo y dificultad para caminar y ponerse de puntillas. Tras realizar una exhaustiva valoración clínica y pruebas de imagen, se diagnostica a la paciente de pie plano adquirido del adulto con disfunción del tibial posterior, desgarro longitudinal del tendón tibial posterior y hallux abductus valgus bilateral. A continuación, se describe el procedimiento quirúrgico realizado, que consiste en 4 principales abordajes: reparación del tendón tibial posterior, fusión subastragalina, fusión cuneometatarsal de primer radio mediante la técnica de Lapidus y exostectomía del búnion de la cabeza del primer metatarsiano. En la evaluación postoperatoria se observó una disminución de la sintomatología dolorosa, así como una mejoría funcional considerable. Un mayor conocimiento de este tipo de técnicas quirúrgicas y de sus ventajas e inconvenientes permitiría que ante situaciones de fracaso del tratamiento conservador, un mayor número de pacientes puedan lograr un aumento en su calidad de vida. Es necesario un seguimiento a largo plazo de este tipo de casos, así como un estudio pormenorizado de las técnicas quirúrgicas que permitan un mayor abanico terapéutico para el tratamiento de este tipo de patologías.

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Tratamiento quirúrgico del pie plano adquirido del adulto. Caso clínico

et al. 2019

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“…The role the subtalar joint plays in the development of ankle joint disorders has been investigated extensively in recent years . It has been suggested that the subtalar joint morphology (e.g., convex vs. flat) and orientation (e.g., slope) specifically of the posterior facet may influence the evolution of ankle osteoarthritis .…”

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confidence: 99%

“…With the introduction of weightbearing computed tomography (CT) scans, a more detailed analysis of the subtalar joint during loading became possible . Recent studies using weightbearing CT have shown that the morphology of the posterior facet in the coronal plane differs between individuals . Although a promising technology for imaging the subtalar joint, weightbearing CT scans have yet to become a clinical standard.…”

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confidence: 99%

“…The role the subtalar joint plays in the development of ankle joint disorders has been investigated extensively in recent years. [1][2][3][4][5][6][7][8][9][10] It has been suggested that the subtalar joint morphology (e.g., convex vs. flat) and orientation (e.g., slope) specifically of the posterior facet may influence the evolution of ankle osteoarthritis. 6,10 In addition, assessment of the subtalar joint during reconstructive surgery (e.g., fixation of calcaneal or talus fractures, correcting osteotomies, etc.)…”

mentioning

confidence: 99%

“…5,11 Recent studies using weightbearing CT have shown that the morphology of the posterior facet in the coronal plane differs between individuals. 1,2,[5][6][7][8][9]12 Although a promising technology for imaging the subtalar joint, weightbearing CT scans have yet to become a clinical standard. Bearing this in mind, radiographs will continue to serve as the primary means to assess foot and ankle disorders, including subtalar pathology.…”

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confidence: 99%

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Imaging of the subtalar joint: A novel approach to an old problem

Krähenbühl

Lenz

Lisonbee

et al. 2019

Journal Orthopaedic Research

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Evaluation of the subtalar joint using conventional radiographs is difficult. The purpose of this study was to assess how the posterior facet of the subtalar joint is projected on eight standard radiographic views of the foot and ankle. Weightbearing computed tomography (CT) scans of 27 volunteers without ankle pathology were performed. Eight standard views of the foot and ankle (antero‐posterior [AP] view, mortise view, subtalar view, four different Broden views) were reconstructed using digitally reconstructed radiographs (DRRs). The appearance of the posterior facet of the subtalar joint was assessed for each view. In addition, the position of the joint line was projected onto three‐dimensional (3‐D) models of the calcaneus. We found (i) on the AP view of the ankle joint, the posterior part of the posterior facet is visualized and appears convex (calcaneal side); (ii) on the mortise view of the ankle joint, a slightly more anterior part (compared to the AP view) is visualized and appears either convex or flat; (iii) on the subtalar view, the anterior part of the posterior facet is visualized and appears either convex, flat or concave; and (iv) using the Broden views, the posterior and anterior part of the posterior facet can be visualized. This study clarifies which parts of the posterior facet of the subtalar joint are visualized on eight standard views of the foot and ankle. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Results of More Than 11,000 Scans with Weight Bearing CT: Impact on Costs, Radiation Exposure, and Procedure Time

Richter¹

2019

Weight Bearing Cone Beam Computed Tomography (WBCT) in the Foot and Ankle

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Background: Weightbearing CT (WBCT) has been proven to more precisely measure bone position than conventional weightbearing radiographic series (R) and conventional CT (CT). The purpose of this study was to assess the benefit of using WBCT instead of R and/or CT as the standard imaging modality, evaluating image acquisition time, radiation dose, and cost-effectiveness. Methods: All patients who obtained a WBCT as part of standard of care from July 1, 2013 until March 15, 2019 were included in the study. Image acquisition time (T), radiation dose (RD) per patient, and costeffectiveness were analyzed and compared between the time period using WBCT (yearly average) and the parameters from 2012, i.e. before the availability of WBCT (RCT group). Results: 11,009 WBCT scans were obtained from 4987 patients (4,987 scans (45%) before treatment; 6,022 scans (55%) at follow-up). On a yearly average, 1,957 WBCTs (bilateral scans) and an additional 10.6 CTs (bilateral feet and ankles) were obtained (WBCT group). In 2012, 1,850 Rs (bilateral feet, dorsoplantar and lateral, metatarsal head skyline view) and 254 CTs were obtained from 885 patients (RCT group). The mean yearly RD was 4.3/4.8uSv for the WBCT/RCT groups (mean difference of .5 uSv; a decrease of 10% for the WBCT group; p < .01). Yearly mean T was 114/493 h in total (3.3/16.0 min per patient) for WBCT/RCT groups (mean difference of 379 h; a 77% decrease for the WBCT group; p < .01). Yearly cost-effectiveness was a mean profit of 43,959/À723 Euros for WBCT/RCT groups. Conclusions: 11,009 WBCT scans from 4,987 patients over a period of 5.6 years at a foot and ankle department resulted in 10% decreased RD, 77% decreased T, and increased financial profit (51 Euros per patient) for the institution.

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Evaluation of peritalar subluxation in adult acquired flatfoot deformity using computed tomography and weightbearing multiplanar imaging

Cited by 35 publications

References 14 publications

Tratamiento quirúrgico del pie plano adquirido del adulto. Caso clínico

Tratamiento quirúrgico del pie plano adquirido del adulto. Caso clínico

Imaging of the subtalar joint: A novel approach to an old problem

Results of More Than 11,000 Scans with Weight Bearing CT: Impact on Costs, Radiation Exposure, and Procedure Time

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