Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations

Shakoor, Delaram; Roberts, Lauren; Chinanuvathana, Apisan; Mousavian, Alireza; Lintz, François; Schon, Lew C.; Demehri, Shadpour

doi:10.1016/j.fas.2018.10.008

Cited by 41 publications

(39 citation statements)

References 44 publications

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“…Several studies have reported on the use of this technique for the early diagnosis of fractures, including the analysis of lower extremities in an upright position, the detection of syndesmosis injuries while using different angles for visualizing the lower extremities. This technology is also often used in dentistry in pediatric populations [ [32] , [33] , [34] , [35] ]. In addition, this technique enables a lower radiation dose compared to CT (comparison between dose on XR and CBCT) [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Farracho

Moutinot²,

Neroladaki

et al. 2020

European Journal of Radiology Open

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Highlights Scaphoid union is controversial regarding diagnosis of healing. XR is the most used modality with poor reliability and reproducibility. CBCT allows with higher confidence diagnosis of consolidation avoiding longer immobilisation. Evaluation for translation is better with CBCT than XR at un early follow up. Six weeks is a reasonable delay to perform the first imaging follows up in waist scaphoid fracture.

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Section: Discussionmentioning

confidence: 99%

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Farracho

Moutinot²,

Neroladaki

et al. 2020

European Journal of Radiology Open

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“…Weightbearing CT is an excellent modality for understanding complex 3-dimensional foot deformities including pes planovalgus and hallux valgus. 4,6,7,9,11,13 Lintz et al 16 demonstrated in a series of 135 feet that the FAO provides a highly reproducible means to measure hindfoot alignment with excellent inter- and intra-rater reliability. WBCT has also been shown to be more accurate than 2D imaging obtained via radiographs.…”

Section: Discussionmentioning

confidence: 99%

Impact of Coleman Block Test on Adult Hindfoot Alignment Assessed by Clinical Examination, Radiography, and Weight-Bearing Computed Tomography

Foran

Mehraban

Jacobsen

et al. 2020

Foot & Ankle Orthopaedics

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Background: Cavovarus foot constitutes a complex 3-dimensional deformity. The Coleman block test has traditionally been used to distinguish between forefoot- and hindfoot-driven deformity. However, there has been no objective evaluation of the Coleman block test using radiographs or weightbearing computed tomography (WBCT). The purpose of this study was to compare hindfoot alignment in adult cavovarus feet with and without the Coleman block using clinical examination, radiography, and WBCT. Methods: Six feet in 6 patients with a clinical diagnosis of cavovarus foot deformity were prospectively enrolled. All feet underwent clinical photography with the camera positioned at 0 degrees to the heel, hindfoot alignment view radiography with the beam positioned 20 degrees off the ground, and WBCT, both with and without the Coleman block in place. Clinical photos were characterized using the standing talocalcaneal angle (STCA), radiographs were characterized using the hindfoot alignment angle (HAA), and WBCTs were characterized using manual and automated hindfoot alignment angle (HAA) and foot and ankle offset (FAO). Using paired analyses, measurements taken with the Coleman block in place were compared to those taken without the Coleman block. Finally, the different methods of measuring hindfoot alignment were tested for correlation with each other. Mean age was 56 years (range 38-69). Results: On clinical photography, the STCA decreased by 3.8 degrees with addition of the block (from 10.0±6.6 degrees varus without block to 6.2±7.1 degrees varus with block; P = .001). On radiograph, HAA decreased by 9.0 degrees with addition of the block (from 16.8±8.4 degrees varus without block to 7.5±6.3 degrees varus with block; P = .07). On WBCT, hindfoot alignment angle changed an average of 3.2 degrees (33.4 degrees varus without block, 30.2 degrees varus with block; P = .008). On WBCT, FAO decreased by 1.4% (from 11.3% varus without block to 10.1% varus with block; P = .003). Clinical examination and automated WBCT measurements were strongly correlated with each other. Conclusion: Clinical examination, radiograph, and WBCT demonstrated improvements in hindfoot varus using the Coleman block test in adults, but no patient demonstrated complete resolution of deformity regardless of the measurement modality. Clinical examination correlated strongly with automated WBCT measurements. Level of Evidence: Level IV, retrospective case review.

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“…28 Although this debilitating disorder is commonly associated with dysfunction in the posterior tibial tendon, there are various other underlying bone and joint abnormalities including failure of the spring, talocalcaneal interosseous, and deltoid ligaments. 2,13,14,17,19,22,26,35 Because each component plays an important role in the structural stability of the medial longitudinal arch, compromise of these structures leads to various components of the overall deformity. AAFD presents with a combination of characteristic findings including collapse of the medial arch with plantar-medial migration of the talar head, abduction of the foot at the talonavicular joint, and hindfoot valgus alignment.…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Biometric Weightbearing CT Evaluation of the Operative Treatment of Adult-Acquired Flatfoot Deformity

et al. 2020

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Background: Assessment of operative correction of adult-acquired flatfoot deformity (AAFD) has been traditionally performed by clinical evaluation and conventional radiographic imaging. Previously, a 3-dimensional biometric weightbearing computed tomography (WBCT) tool, the foot ankle offset (FAO), has been developed and validated in assessing hindfoot alignment. The purpose of this study was to investigate the role of FAO in evaluating operative deformity correction in AAFD. Methods: In this prospective comparative study, 19 adult patients (20 feet) with stage II (flexible) flatfoot deformity underwent preoperative and postoperative standing WBCT examination at mean 19 months (range, 6-24) after surgery. Three-dimensional coordinates of the foot tripod and center of the ankle joint were acquired by 2 independent and blinded observers. These coordinates were used to calculate the FAO using dedicated software, and subsequently compared pre- and postoperatively. The FAO is a previously validated biometric measurement that represents centering of the foot tripod as well as hindfoot alignment, with a normal mean FAO of 2.3% ± 2.9%. In addition, Patient Reported Outcomes Measurement Information System (PROMIS) clinical outcomes scores were compared pre- and postoperatively with a mean follow-up of 22.6 months (range, 14-37). Results: There was significant correction of flatfoot deformity from a mean preoperative FAO of 9.8% to a mean postoperative value of 1.3% ( P < .001). Additionally, there was statistically significant improvement in all PROMIS domains ( P < .05), except depression, at an average follow-up of 22.6 months. Spring ligament reconstruction was the only procedure associated with a significant correction in FAO ( P = .0064). Conclusion: The FAO was a reliable and sensitive tool that was used to evaluate preoperative deformity as well as postoperative correction, with patients demonstrating both significant improvement in FAO as well as patient-reported outcomes. These findings demonstrate the role for biometric 3-dimensional WBCT imaging in assessing operative correction after flatfoot reconstruction, as well as the potential role for operative planning to address preoperative deformity. Level of Evidence: Level II, prospective comparative study.

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Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations

Cited by 41 publications

References 44 publications

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Impact of Coleman Block Test on Adult Hindfoot Alignment Assessed by Clinical Examination, Radiography, and Weight-Bearing Computed Tomography

Three-Dimensional Biometric Weightbearing CT Evaluation of the Operative Treatment of Adult-Acquired Flatfoot Deformity

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