Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity

Bang, Katrina; Mansur, Nacime Salomão Barbachan; Garfinkel, Jonathan H.; Bernasconi, Alessio; Lintz, François; Deland, Jonathan T.; Ellis, Scott J.

doi:10.1177/1071100720920274

Cited by 42 publications

(29 citation statements)

References 43 publications

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“…Traditional and novel measurements in 3D can be used for thorough assessments before and after operation 61 . In addition to the effective Foot–Ankle-Offset 62 , 63 , other new indexes representing the overall foot deformities in a single value shall be defined, to support better the clinical decision making process. Also the current multi-planar measures of articular subluxations 19 can be ameliorated with complete 3D bone models.…”

Section: Discussionmentioning

confidence: 99%

Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools

Ortolani

Leardini

Pavani

et al. 2021

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Acquired adult flatfoot is a frequent deformity which implies multiple, complex and combined 3D modifications of the foot skeletal structure. The difficult thorough evaluation of the degree of severity pre-op and the corresponding assessment post-op can now be overcome by cone-beam (CBCT) technology, which can provide access to the 3D skeletal structure in weight-bearing. This study aims to report flatfoot deformities originally in 3D and in weight-bearing, with measurements taken using two different bone segmentation techniques. 21 such patients, with indication for surgical corrections, underwent CBCT (Carestream, US) while standing on one leg. From these scans, 3D models of each bone of the foot were reconstructed by using two different state-of-the-art segmentation tools: a semi-automatic (Mimics Innovation Suite, Materialise, Belgium), and an automatic (Bonelogic Ortho Foot and Ankle, Disior, Finland). From both reconstructed models, Principal Component Analysis was used to define anatomical reference frames, and original foot and ankle angles and other parameters were calculated mostly based on the longitudinal axis of the bones, in anatomical plane projections and in 3D. Both bone model reconstructions revealed a considerable valgus of the calcareous, plantarflexion and internal rotation of the talus, and typical Meary’s angles in the lateral and transverse plane projections. The mean difference from these angles between semi-automatic and automatic segmentations was larger than 3.5 degrees for only 3 of the 32 measurements, and a large number of these differences were not statistically significant. CBCT and the present techniques for bone shape reconstruction finally provide a novel and valuable 3D assessment of complex foot deformities in weight-bearing, eliminating previous limitations associated to unloaded feet and bidimensional measures. Corresponding measurements on the bone models from the two segmentation tools compared well. Other more representative measurements can be defined in the future using CBCT and these techniques.

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Section: Discussionmentioning

confidence: 99%

Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools

Ortolani

Leardini

Pavani

et al. 2021

Sci Rep

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“…WBCT has recently become an important diagnostic imaging tool to evaluate not only the severity of PCFD 10,11,[14][15][16]18,19 but also the widening and instability of DTFS injuries. 7,28,[33][34][35]43,49 The FAO was proposed by Lintz et al 38 as a 3D semiautomatic tool for a multiplanar assessment of foot deformity.…”

Section: Discussionmentioning

confidence: 99%

“…The FAO has been shown to be a very reliable measurement 12,17,39,54 and was recently validated to be used in the specific assessment of patients with PCFD. 10,11 It has been demonstrated by de Cesar Netto et al 11 that FAO represents in a single measurement multiple components of the multiplanar PCFD assessment, assessing longitudinal arch collapse (forefoot arch angle), PTS (subtalar horizontal angle), hindfoot valgus alignment (hindfoot moment arm), and forefoot/midfoot abduction (talonavicular coverage angle). Day et al 10 have also recently demonstrated that FAO measures also accurately demonstrate the amount of overall surgical correction following reconstructive surgical procedures in PCFD, with values of FAO decreasing from 9.8% preoperatively to a mean postoperative value of 1.3% (P < .001).…”

Section: Discussionmentioning

confidence: 99%

“…38,54 The measurement was recently validated to be used in the assessment of PCFD, demonstrating it to be extremely reliable and representing in a single measure the multiplanar characteristics of PCFD, more specifically the amount of hindfoot and subtalar joint valgus, forefoot abduction, and longitudinal arch collapse. 10,11 WBCT measurement of the DTFS incisura area in the axial plane was also recently described as an accurate and reliable way to distinguish patients with an unstable DTFS and controls. 28 The objective of this study was to assess and correlate the deformity severity in patients with PCFD, by means of FAO measurements, with the amount of DTFS widening and to compare with controls.…”

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confidence: 99%

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Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity

et al. 2021

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Background: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. Methods: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. Results: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% ( P < .001) in FAO and 10.4 mm2 ( P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 ( P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2. Conclusion: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. Level of Evidence: Level III, retrospective comparative study.

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“…Additionally, WBCT provides more clinically useful information concerning alignment as it is performed under natural standing conditions. 2,[17][18][19][20]22,23,28,33,34,47 Multiple parameters have been previously used to assess the hindfoot alignment on WBCT, including the foot ankle offset, 5,6,17,19,23,29,[33][34][35]47 calcaneal offset, 5,6,19,29,35 and hindfoot alignment angle. 5,6,10,30 Although WBCT offers the theoretical benefits of increased accuracy present in crosssectional imaging coupled with physiologic alignment under weightbearing conditions, this technology is currently less prevalent in orthopedic clinics across the community where HAV radiographs are generally utilized.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography

et al. 2021

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Background: Hindfoot alignment view (HAV) radiographs are widely utilized for 2-dimensional (2D) radiographic assessment of hindfoot alignment; however, the development of weightbearing computed tomography (WBCT) may provide more accurate methods of quantifying 3-dimensional (3D) hindfoot alignment. The aim of this study was to compare the 2D calcaneal moment arm measurements on HAV radiographs with WBCT. Methods: This retrospective cohort study included 375 consecutive patients with both HAV radiographs and WBCT imaging. Measurement of the 2D hindfoot alignment moment arm was compared between both imaging modalities. The potential confounding influence of valgus/varus/neutral alignment, presence of hardware, and motion artifact were further analyzed. Results: The intraclass correlation coefficients (ICCs) of interobserver and intraobserver reliability for measurements with both imaging modalities were excellent. Both modalities were highly correlated (Spearman coefficient, 0.930; P < .001). HAV radiographs exhibited a mean calcaneal moment arm difference of 3.9 mm in the varus direction compared with WBCT (95% CI, –4.9 to 12.8). The difference of hindfoot alignment between both modalities was comparable in subgroups with neutral/valgus/varus alignment, presence of hardware, and motion artifact. Conclusion: Both HAV radiographs and WBCT are highly reliable and highly correlated imaging methods for assessing hindfoot alignment. Measurements were not influenced by severe malalignment, the presence of hardware, or motion artifact on WBCT. On average, HAV radiographs overestimated 3.9 mm of varus alignment as compared with WBCT. Level of Evidence: Level III, retrospective comparative study.

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Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity

Cited by 42 publications

References 43 publications

Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools

Angular and linear measurements of adult flexible flatfoot via weight-bearing CT scans and 3D bone reconstruction tools

Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity

Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography

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