Measuring hindfoot alignment in weight bearing CT: A novel clinical relevant measurement method

Burssens, Arne; Peeters, Johannes M.; Buedts, Kristian; Victor, Jan; Vandeputte, Geoffroy

doi:10.1016/j.fas.2015.10.002

Cited by 101 publications

(42 citation statements)

References 27 publications

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“…Consequently, motion and bone position of the subtalar joint may not be accurately defined with traditional non-weight-bearing imaging techniques. Recently, full weight-bearing standing CT devices such as PedCAT (Curvebeam, Warrington, USA) have been developed, allowing more functional diagnosis of foot problems 38,39 as well as more accurate measurements of bone alignment [40][41][42][43] . PedCAT dual scanning modality (3D functional imaging in full weight-bearing) in combination with the advancements of image-based analysis such as digital volume correlation (DVC) 44 can be exploited to analyse subtalar joint movement in vivo.…”

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confidence: 99%

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Fernández

Hoxha

Chan

et al. 2020

Sci Rep

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Accurate in vivo quantification of subtalar joint kinematics can provide important information for the clinical evaluation of subtalar joint function; the analysis of outcome of surgical procedures of the hindfoot; and the design of a replacement subtalar joint prosthesis. The objective of the current study was to explore the potential of full weight-bearing clinical computed tomography (ct) to evaluate the helical axis and centre of rotation of the subtalar joint during inversion and eversion motion. A subject specific methodology was proposed for the definition of the subtalar joint motion combining threedimensional (3D) weight-bearing imaging at different joint positions with digital volume correlation (DVC). The computed subtalar joint helical axis parameters showed consistency across all healthy subjects and in line with previous data under simulated loads. A sphere fitting approach was introduced for the computation of subtalar joint centre of rotation, which allows to demonstrate that this centre of rotation is located in the middle facet of the subtalar joint. Some translation along the helical axis was also observed, reflecting the elasticity of the soft-tissue restraints. This study showed a novel technique for non-invasive quantitative analysis of bone-to-bone motion under full weight-bearing of the hindfoot. Identifying different joint kinematics in patients with ligamentous laxity and instability, or in the presence of stiffness and arthritis, could help clinicians to define optimal patient-specific treatments. The subtalar joint describes an articulation between talus and calcaneus, forming one of two joints of the hindfoot with the tibiotalar or ankle joint above the talus and the subtalar joint below. The talus comprises of three facets (anterior, middle and posterior) that articulate with the mating facets on the calcaneus at the subtalar joint. The bones are connected by a complex of ligamentous structures that connect the talus to the calcaneus and both structures to the adjacent navicular bone, which is intricately involved in hindfoot and midfoot motion (Fig. 1). The subtalar joint is the primary joint involved in motion and posture of the hindfoot in the frontal plane. Motion is complex and it combines dorsiflexion, abduction and eversion in one direction and plantarflexion, abduction and inversion in the other 1. Problems associated to the subtalar joint can have a significant impact on function 2 , preventing participation in sports and normal daily activities. Common pathologies affecting the joint include instability following ligamentous injury 3 , and painful flat feet in children and adults. In addition, end stage ankle and hindfoot arthritis is a major problem that has been shown to affect quality of life as much as end stage heart disease 4,5. Although the incidence of subtalar joint arthritis is unknown, approximately 3.4% of the population aged over 50 has radiographic hindfoot arthritis, which is more than 300,000 people in the UK 6. The most common cause of subtalar joint arthri...

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confidence: 99%

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Fernández

Hoxha

Chan

et al. 2020

Sci Rep

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“…In this paper, the direction of body weight was approximated through the anatomical median axis of the tibia, and ground reaction force through the lowest point of the calcaneus. The issue of the approximation inherent to the 2D XR technique was investigated by Burssens et al 42 in a 2016 study stating that there is a good correlation between 2D HA and 3D HA, but that 3D HA overcomes the shortcomings encountered by 2D analysis. This paper was the first description of validated HA measurements using WBCT.…”

Section: Hindfoot Alignment (Ha) In 3d or The Concept Of 3d Biometrimentioning

confidence: 99%

Weight-bearing cone beam CT scans in the foot and ankle

Lintz¹,

et al. 2018

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The 3D anatomical complexity of the foot and ankle and the importance of weight-bearing in diagnosis have required the combination of conventional radiographs and medical CT.Conventional plain radiographs (XR) have demonstrated substantial limitations such as perspective, rotational and fan distortion, as well as poor reproducibility of radiographic installations. Conventional CT produces high levels of radiation exposure and does not offer weight-bearing capabilities.The literature investigating biometrics based on 2D XR has inherent limitations due to the technology itself and thereby can focus only on whether measurements are reproducible, when the real question is whether the radiographs are.Low dose weight-bearing cone beam CT (WBCT) combines 3D and weight-bearing as well as ‘built in’ reliability validated through industry-standardized processes during production and clinical use (quality assurance testing).Research is accumulating to validate measurements based on traditional 2D techniques, and new 3D biometrics are being described and tested.Time- and cost-efficient use in medical imaging will require the use of automatic measurements. Merging WBCT and clinical data will offer new perspectives in terms of research with the help of modern data analysis techniques.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170066

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“…Burssens et al 15 described a clinically reproducible method for measuring hindfoot alignment using WBCT. In a prospective case series with 60 patients divided into two groups (30 patients with varus alignment and 30 patients with valgus hindfoot alignment), these authors observed a positive correlation between the hindfoot alignment angles measured and concluded that WBCT can be used objectively for this measurement.…”

Section: Case Reportsmentioning

confidence: 99%

“…The advantages of this new technology include: the ability to obtain images with the patient in an orthostatic position, high resolution, possibility of reconstruction in three dimensions, rapid image acquisition, low rate of radiation exposure, small device size, and low cost in relation to conventional CT. 15 …”

Section: Introductionmentioning

confidence: 99%

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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Measuring hindfoot alignment in weight bearing CT: A novel clinical relevant measurement method

Cited by 101 publications

References 27 publications

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography

Weight-bearing cone beam CT scans in the foot and ankle

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

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