Flexible Adult Acquired Flatfoot Deformity

Netto, César de César; Schon, Lew C.; Thawait, Gaurav K.; Fonseca, Lucas Furtado da; Chinanuvathana, Apisan; Zbijewski, Wojciech; Siewerdsen, Jeffrey H.; Demehri, Shadpour

doi:10.2106/jbjs.16.01366

Cited by 124 publications

(24 citation statements)

References 41 publications

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“…de Cesar Netto et al 2 prospectively evaluated multiple parameters used in measuring adult valgus flatfoot deformity, comparing CT images with and without load from 20 patients diagnosed with flexible deformity. These authors demonstrated that WBTC produced similar measurements to those traditionally obtained from conventional X-ray imaging to stage adult valgus flatfoot deformity.…”

Section: Case Reportsmentioning

confidence: 99%

“…In this scenario, computed tomography (CT) allows acquisition of high-resolution images in different axes of the ankle and foot, and is usually used to evaluate fractures, degenerative changes, bone healing, and surgical planning for osteotomies, arthrodeses and arthroplasties. 2 …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, this imaging resource is limited, particularly in scenarios related to axial deviations and osteoarticular degeneration such as acquired flatfooted valgus, pes cavus, Charcot’s neuroarthropathy, osteoarticular deformities, diabetic foot, and dynamic ligament instability. 2 …”

Section: Introductionmentioning

confidence: 99%

“…Over the last decade, the cone beam computed tomography with load technique (WBCT) proved feasible and to have high reproducibility of the real situation of the ankle and foot with regard to body weight. 2 , 14 …”

Section: Introductionmentioning

confidence: 99%

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Weight-Bearing Computed Tomography of the Foot and Ankle: An Update and Future Directions

Godoy‐Santos

2018

Acta ortop. bras.

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Spatial understanding of osteoarticular deformities of the foot and ankle is vital to correct diagnosis and therapeutic decision making. Poor reproducibility in conventional standing radiography in three orthogonal views has driven the development of weight-bearing computed tomography (WBCT) technology over the last decade. We analyzed the available literature on WBCT imaging in patients with foot and ankle disorders by performing a literature review of relevant clinical studies in multiple databases including PubMed, MedLine, and Scopus from January 1999 to October 2017. WBCT imaging allows correct evaluation of foot and ankle anatomy with the patient in a standing position, providing images with high spatial resolution, short image acquisition time, low dose of radiation, and costs which are similar to other available imaging technologies. This diagnostic tool can be used for decision making in the treatment of deformities of the ankle, hindfoot, midfoot, and forefoot. Level of Evidence III; Systematic review of level III studies.

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Section: Case Reportsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Weight-Bearing Computed Tomography of the Foot and Ankle: An Update and Future Directions

Godoy‐Santos

2018

Acta ortop. bras.

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“…2,20,36 WB CBCT produces images comparable with traditional CT in quality but does so with the foot in a loaded condition and with a markedly lower radiation dose. 6,30 Many authors have recently demonstrated the efficacy and reliability of WB CBCT in different foot alignment measures 9,10,20,29,30 ; however, to the best of our knowledge, there has not been an investigation on professional basketball.…”

mentioning

confidence: 99%

Foot Alignment in Symptomatic National Basketball Association Players Using Weightbearing Cone Beam Computed Tomography

Bernasconi

Roberts

Pontin

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Weightbearing cone beam computed tomography (WB CBCT) allows detailed 3-dimensional imaging of the foot and ankle in a weightbearing state and provides improved accuracy and reliability of foot alignment measures, especially when compared with conventional radiographic views. Purpose: To describe the foot alignment in National Basketball Association (NBA) players with different symptomatic foot and ankle injuries using WB CBCT and to determine if any predominant morphotype would be identified. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 45 active NBA players (mean age, 24.4 years [range, 20-34 years]; N = 54 feet [29 right, 25 left]) were assessed using WB CBCT. Measurements included the following: (1) foot and ankle offset (FAO), (2) calcaneal offset (CO), (3) hindfoot alignment angle (HAA), (4) angle between the inferior and superior facets of the talus (Inftal-Suptal), (5) angle between the inferior facet of the talus and the horizontal floor line (Inftal-Hor), (6) forefoot arch angle (FAA), (7) navicular-to-floor distance, and (8) medial cuneiform–to-floor distance. Measurements were then compared with values available in the literature for a “normal” foot morphotype. Results: Among the 54 feet, the mean FAO was 0.48% (95% CI, –0.25% to 1.21%), the mean CO was 1.18 mm (95% CI, –0.50 to 2.87 mm), and the mean HAA was 1.42° (95% CI, –0.80° to 3.65°). The mean Inftal-Suptal angle was 5.31° (95% CI, 3.50°-7.12°), while the mean Inftal-Hor angle was 4.04° (95% CI, 2.56°-5.51°). The mean FAA was 15.84° (95% CI, 14.73°-16.92°), the mean navicular-to-floor distance was 38.30 mm (95% CI, 36.19-40.42 mm), and the mean medial cuneiform–to-floor distance was 26.79 mm (95% CI, 25.30-28.28 mm). None of these values were found to be significantly different when comparing forwards, guards, and centers. Conclusion: NBA players presenting with symptomatic foot and ankle injuries had a fairly “normal” foot morphology, with a tendency toward a varus hindfoot and a high-arched morphotype. No significant differences were found between players based on their position on the court. WB CBCT may help to shed light on anatomic risk factors for common injuries in professional players and may aid in the planning of specific prevention programs.

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Unique shape variations of hind and midfoot bones in flatfoot subjects—A statistical shape modeling approach

et al. 2022

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Flatfoot deformity is a prevalent hind‐ and midfoot disorder. Given its complexity, single‐plane radiological measurements omit case‐specific joint interaction and bone shape variations. Three‐dimensional medical imaging assessment using statistical shape models provides a complete approach in characterizing bone shape variations unique to flatfoot condition. This study used statistical shape models to define specific bone shape variations of the subtalar, talonavicular, and calcaneocuboid joints that characterize flatfoot deformity, that differentiate them from healthy controls. Bones of the aforementioned joints were segmented from computed tomography scans of 40 feet. The three‐dimensional hindfoot alignment angle categorized the population into 18 flatfoot subjects (≥7° valgus) and 22 controls. Statistical shape models for each joint were defined using the entire study cohort. For each joint, an average weighted shape parameter was calculated for each mode of variation, and then compared between flatfoot and controls. Significance was set at p < 0.05, with values between 0.05 ≤ p < 0.1 considered trending towards significance. The flatfoot population showed a more adducted talar head, inferiorly inclined talar neck, and posteriorly orientated medial subtalar articulation compare to controls, coupled with more navicular eversion, shallower navicular cup, and more prominent navicular tuberosity. The calcaneocuboid joint presented trends of a more adducted calcaneus, more abducted cuboid, narrower calcaneal roof, and less prominent cuboid beak compared to controls. Statistical shape model analysis identified unique shape variations which may enhance understanding and computer‐aided models of the intricacies of flatfoot, leading to better diagnosis and, ultimately, surgical treatment.

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Flexible Adult Acquired Flatfoot Deformity

Abstract: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 124 publications

References 41 publications

Weight-Bearing Computed Tomography of the Foot and Ankle: An Update and Future Directions

Weight-Bearing Computed Tomography of the Foot and Ankle: An Update and Future Directions

Foot Alignment in Symptomatic National Basketball Association Players Using Weightbearing Cone Beam Computed Tomography

Unique shape variations of hind and midfoot bones in flatfoot subjects—A statistical shape modeling approach

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