Lower limb alignment in patients with primary valgus ankle arthritis: A comparative analysis with patients with varus ankle arthritis and healthy controls

Rajan, Lavan; Kumar, Prashanth; Kim, Ji-Beom; Lee, Woo-Chun

doi:10.1016/j.fas.2022.09.008

Cited by 3 publications

(1 citation statement)

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“…Consequently, we believe that PCFD patients may experience more medial shear force within the ankle mortise when accompanied by a valgus-oriented hindfoot compared with non-PCFD patients. Although the contribution of proximal alignment to the development of valgus tibiotalar tilt in PCFD has not been extensively investigated, a similar finding was suggested in a radiographic study by Kim et al 15 The authors examined lower limb alignment in patients with primary valgus ankle arthritis and reported that individuals with a lower medial longitudinal arch (mean Meary angle: 31.6 degrees) had a more varus-oriented lower limb mechanical axis compared to those without a low medial longitudinal arch (mean Meary angle: 7.9 degrees). 15 These observations suggest that proximal malalignment may play a role in the development of medial ankle instability in PCFD, possibly increasing strain on the deltoid ligaments of the ankle joint, in conjunction with a varus lower limb mechanical axis and valgus hindfoot.…”

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confidence: 64%

Radiographic Analysis of Valgus Ankle Deformity With or Without Medial Longitudinal Arch Collapse

Kim,

Palmar,

Demetracopoulos

et al. 2024

Foot Ankle Int.

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Background: Establishing a surgical plan for ankle deformities necessitates a comprehensive understanding of the deforming forces involved, and the morphology of the ankle deformity plays an important role as well. Valgus tibiotalar tilt development has mostly been described in patients with a low medial longitudinal arch, as seen in progressive collapsing foot deformity (PCFD). However, some valgus ankles demonstrate no radiographic evidence of a collapsed medial arch. This study aims to investigate whether there are differences in the radiographic morphology of valgus ankle deformities between patients with and without a low medial longitudinal arch to explore if they have different etiologies. Methods: We retrospectively reviewed patients who underwent surgical treatment for asymmetric valgus ankle deformity at our institution between 2017 and 2021. Patients with a valgus tibiotalar tilt (TT) greater than 4 degrees and Meary angle greater than 30 degrees (mean: 38.9) were included in the PCFD group (n = 29). The non-PCFD group (n = 24) with TT greater than 4 degrees and Meary angle less than 4 degrees (mean: 0.3) was also established. In the weightbearing ankle anteroposterior view, the TT and medial distal tibial angle were measured. Additionally, to assess the mediolateral position of the talus, the talar center migration (TCM) and lateral talar dome–plafond distance (LTD-P) ratio in the coronal plane were measured. In weightbearing computed tomography (WBCT), the degree of axial plane talocalcaneal subluxation and the prevalence of sinus tarsi bony impingement were assessed. Intergroup comparison was conducted. Results: Both groups demonstrated a similar degree of TT, with a mean of 11.6 degrees in the PCFD group and 13.7 degrees in the non-PCFD group ( P = .2330). However, the PCFD group showed a significantly greater TCM and LTD-P ratio compared with those of the non-PCFD group ( P < .0001), indicating that PCFD patients have a more medially translated talus in ankle anteroposterior radiographs. WBCT showed that the PCFD group on average had 18 degrees greater axial plane talocalcaneal subluxation ( P < .0001) and 52% higher prevalence of sinus tarsi bony impingement ( P = .0002) compared with the non-PCFD group. Conclusion: This study suggests that valgus ankles may exhibit different radiographic morphologies depending on the status of the longitudinal arch. Valgus ankles in PCFD patients tend to have a more medially translated talus. This finding may suggest the presence of different deforming forces between the 2 groups and may indicate the need for different treatment strategies to address talar tilt. Level of Evidence: Level III, case-control.

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Section: Discussionsupporting

confidence: 64%