Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view

Reilingh, Mikel L.; Beimers, Lijkele; Tuijthof, Gabriëlle J. M.; Stufkens, Sjoerd A. S.; Maas, Mario; Dijk, C. Niek van

doi:10.1007/s00256-009-0857-9

Cited by 187 publications

(116 citation statements)

References 28 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…This study showed a strong correlation between the Saltzman measurement and the Saltzman hindfoot angle that suggests they are both a strong indicator of hindfoot malalignment. However, the use of a hindfoot angle measurement is more desirable in determining the amount of malalignment for the planning of corrective treatment, has no magnification effects, and may be more clinically relevant [9].…”

Section: Discussionmentioning

confidence: 99%

“…It is not fully understood how the foot and ankle compensate for a given varus or valgus deformity of the knee [1-4, 7, 12, 13, 17]. It has been stated that if there is varus deformity in the knee, the subtalar joint compensates by going into eversion and valgus position [9,10]. However, with the valgus knee, the foot should compensate into varus [1,3,7,13] but there are no present data to support this and perhaps the subtalar joint aggravates the valgus orientation by going into more valgus [2,17].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Correlation of Knee and Hindfoot Deformities in Advanced Knee OA: Compensatory Hindfoot Alignment and Where It Occurs

Norton

Callaghan

Amendola

et al. 2015

Clinical Orthopaedics &Amp; Related Research

119

163

View full text Add to dashboard Cite

Background Many patients undergoing TKA have both knee and ankle pathology, and it seems likely that some compensatory changes occur at each joint in response to deformity at the other. However, it is not fully understood how the foot and ankle compensate for a given varus or valgus deformity of the knee. Questions/purposes (1) What is the compensatory hindfoot alignment in patients with end-stage osteoarthritis who undergo total knee arthroplasty (TKA)? (2) Where in the hindfoot does the compensation occur? Methods Between January 1, 2005, and December 31, 2009, one surgeon (JJC) obtained full-length radiographs on all patients undergoing primary TKA (N = 518) as part of routine practice; patients were analyzed for the current study and after meeting inclusion criteria, a total of 401 knees in 324 patients were reviewed for this analysis. Preoperative standing long-leg AP radiographs and Saltzman hindfoot views were analyzed for the following measurements: mechanical axis angle, Saltzman hindfoot alignment and angle, anatomic lateral distal tibial angle, and the ankle line convergence angle. Statistical analysis included two-tailed Pearson correlations and linear regression models. Intraobserver and interobserver intraclass coefficients for the measurements considered were evaluated and all were excellent (in excess of 0.8).Results As the mechanical axis angle becomes either more varus or valgus, the hindfoot will subsequently orient in more valgus or varus position, respectively. For every degree increase in the valgus mechanical axis angle, the hindfoot shifts into varus by À0.43°(95% confidence interval [CI], À0.76°to À0.1°; r = À0.302, p = 0.0012). For every degree increase in the varus mechanical axis angle, the hindfoot shifts into valgus by À0.49°(95% CI, À0.67°to À0.31°; r = À0.347, p \ 0.0001). In addition, the subtalar joint had a strong positive correlation (r = 0.848, r 2 = 0.72, p \ 0.0001) with the Saltzman hindfoot angle, whereas the anatomic lateral distal tibial One of the authors certifies that he (AA) has or may receive payments or benefits, during the study period an amount USD 100,000 to USD 1,000,000 from Arthrex (Naples, FL, USA), an amount less than USD 10,000 from Arthrosurface (Franklin, MA, USA), and an amount USD 100,000 to USD 1,000,000 from MTP Solutions (Logan, UT, USA). One of the authors certifies that he (JJC) has or may receive payments or benefits, during the study period an amount more than USD 1,000,001 from DePuy (Warsaw, IN, USA) and an amount less than USD 10,000 from Lippincott Williams & Wilkins (Riverwoods, IL, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each aut...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Correlation of Knee and Hindfoot Deformities in Advanced Knee OA: Compensatory Hindfoot Alignment and Where It Occurs

Norton

Callaghan

Amendola

et al. 2015

Clinical Orthopaedics &Amp; Related Research

119

163

View full text Add to dashboard Cite

show abstract

“…Although measurements of the medial distal tibial angle, tibiotalar surface angle, and talar tilting angle are well-accepted methods for assessment of ankle alignment in the coronal plane, the radiographic assessment of hindfoot alignment remains controversial. The angle between the tibial shaft axis and the calcaneal axis was measured by Cobey [5] and Buck et al [4] using the hindfoot alignment view, and by Reilingh et al [24] using long axial view radiographs. However, it is not easy to define specific landmarks of the calcaneus for appropriate definition of the calcaneal axis owing to its irregular shape [26].…”

Section: Discussionmentioning

confidence: 99%

“…To date, limited attention has been given to weightbearing hindfoot alignment [1,2,4,11,18,22,24,25,28,30,31] or possible compensatory mechanisms of the subtalar joint in patients with end-stage ankle arthritis [12,14,21,23]. Similarly, classification methods of hindfoot alignment remain controversial and are based mainly on clinical visual judgment or on radiographic measurement (eg, quantification of the tibiocalcaneal axis or the hindfoot ''apparent moment arm'') [8,9,21,25].…”

Section: Introductionmentioning

confidence: 99%

Does the Subtalar Joint Compensate for Ankle Malalignment in End-stage Ankle Arthritis?

Wang

Saltzman

Chalayon

et al. 2015

Clinical Orthopaedics &Amp; Related Research

106

View full text Add to dashboard Cite

Background Patients with ankle arthritis often present with concomitant hindfoot deformity, which may involve the tibiotalar and subtalar joints. However, the possible compensatory mechanisms of these two mechanically linked joints are not well known. Questions/purposes In this study we sought to (1) compare ankle and hindfoot alignment of our study cohort with end-stage ankle arthritis with that of a control group; (2) explore the frequency of compensated malalignment between the tibiotalar and subtalar joints in our study cohort; and (3) assess the intraobserver and interobserver reliability of classification methods of hindfoot alignment used in this study. Methods Between March 2006 and September 2013, we performed 419 ankle arthrodesis and ankle replacements (380 patients). In this study, we evaluated radiographs for 233 (56%) ankles (226 patients) which met the following inclusion criteria: (1) no prior subtalar arthrodesis; (2) no previously failed total ankle replacement or ankle arthrodesis; (3) with complete conventional radiographs (all three ankle views were required: mortise, lateral, and hindfoot alignment view). Ankle and hindfoot alignment was assessed by measurement of the medial distal tibial angle, tibial talar surface angle, talar tilting angle, tibiocalcaneal axis angle, and moment arm of calcaneus. The obtained values were compared with those observed in the control group of 60 ankles from 60 people. Only those without obvious degenerative changes of the tibiotalar and subtalar joints and without previous surgeries of the ankle or hindfoot were included in the control group. Demographic data for the patients with arthritis and the control group were comparable (sex, p = 0.321; age, p = 0.087). The frequency of compensated malalignment between the tibiotalar and subtalar joints, defined as tibiocalcaneal angle or moment arm of the calcaneus being greater or smaller than the same 95% CI statistical cutoffs from the control group, was tallied. All ankle radiographs were independently measured by two observers to determine the interobserver reliability. One of Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangement etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This ...

show abstract

“…Measurements on long axial view radiographs are characterized by a superior interreader agreement, compared to Cobey view radiographs [11]. However, all hindfoot alignment measurements based on standard radiographs have a considerable interobserver variability and even moderate malpositioning can lead to substantial measurement errors [12,11].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

et al. 2012

View full text Add to dashboard Cite

OBJECTIVE: To establish a hindfoot alignment measurement technique based on low-dose biplanar radiographs and compare with hindfoot alignment measurements on long axial view radiographs, which is the current reference standard. MATERIALS AND METHODS: Long axial view radiographs and low-dose biplanar radiographs of a phantom consisting of a human foot skeleton embedded in acrylic glass (phantom A) and a plastic model of a human foot in three different hindfoot positions (phantoms B1-B3) were imaged in different foot positions (20°internal to 20°external rotation). Two independent readers measured hindfoot alignment on long axial view radiographs and performed 3D hindfoot alignment measurements based on biplanar radiographs on two different occasions. Time for three-dimensional (3D) measurements was determined. Intraclass correlation coefficients (ICC) were calculated. RESULTS: Hindfoot alignment measurements on long axial view radiographs were characterized by a large positional variation, with a range of 14°/13°valgus to 22°/27°varus (reader 1/2 for phantom A), whereas the range of 3D hindfoot alignment measurements was 7.3°/6.0°to 9.0°/10.5°varus (reader 1/2 for phantom A), with a mean and standard deviation of 8.1°± 0.6/8.7°± 1.4 respectively. Interobserver agreement was high (ICC = 0.926 for phantom A, and ICC = 0.886 for phantoms B1-B3), and agreement between different readouts was high (ICC = 0.895-0.995 for reader 1, and ICC = 0.987-0.994 for reader 2) for 3D measurements. Mean duration of 3D measurements was 84 ± 15/113 ± 15 s for reader 1/2. CONCLUSION: Three-dimensional hindfoot alignment measurements based on biplanar radiographs were independent of foot positioning during image acquisition and reader independent. In this phantom study, the 3D measurements were substantially more precise than the standard radiographic measurements. Conclusion. 3D hindfoot alignment measurements based on biplanar radiographs were independent of foot-positioning during image acquisition and readerindependent. In this phantom study, the 3D measurements were substantially more precise than the standard radiographic measurements.

show abstract

Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view

Cited by 187 publications

References 28 publications

Correlation of Knee and Hindfoot Deformities in Advanced Knee OA: Compensatory Hindfoot Alignment and Where It Occurs

Correlation of Knee and Hindfoot Deformities in Advanced Knee OA: Compensatory Hindfoot Alignment and Where It Occurs

Does the Subtalar Joint Compensate for Ankle Malalignment in End-stage Ankle Arthritis?

Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

Contact Info

Product

Resources

About