Relationship Between Chronic Lateral Ankle Instability and Hindfoot Varus Using Weight-Bearing Cone Beam Computed Tomography

Lintz, François; Bernasconi, Alessio; Louise, Baschet; Fernando, Céline; Mehdi, Nazim; Netto, César de César

doi:10.1177/1071100719858309

Cited by 46 publications

(39 citation statements)

References 24 publications

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“…Negative measurements indicate varus alignment (center of the ankle positioned laterally to the bisecting line of the foot tripod), while positive values represent valgus alignment (center of the ankle joint located medially to the bisecting line of the foot tripod). 6,13,29,31,44 For this study, the mean FAO of included patients and 95% confidence intervals (95% CIs) were calculated. Patients with residual varus and valgus malalignment were identified as those with FAO values outside the 95% CI of the patient’s cohort, higher for valgus and lower for varus.…”

Section: Methodsmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, –1.12 to 1.36). Patients with greater residual malalignment ( P < .001) and those with longer follow-up ( P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV ( P = .042), with a threshold FAO value of −2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV ( P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. Level of Evidence: Level III, retrospective comparative series.

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Section: Methodsmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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“…Recent studies have also documented how the foot morphotype measurements used in this study (such as the FAO, the CO, the HAA, the Inftal-Suptal angle, the Inftal-Hor angle, the FAA, the navicular-to-floor distance and the medial cuneiform-to-floor distance) provide high intra-and inter-observer reliability. 10,11,14,15 Our comparative study showed that symptomatic professional male football players within the National Football League have a normally aligned hindfoot with a more pronated forefoot when compared to healthy controls, as demonstrated by significant differences in FAA, navicular-to-floor and medial-cuneiform-to-floor distance. However, although we could not perform a formal statistical analysis including data reported by other authors, values for these measurements from NFL players were still far higher than historical flatfeet (Table 2).…”

Section: Discussionmentioning

confidence: 69%

Foot Alignment in Symptomatic National Football League (Nfl) Athletes: A Weightbearing Ct Analysis

et al. 2021

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Objective: Our aim was to describe the foot alignment in National Football League (NFL) players with different symptomatic foot and ankle pathologies using weightbearing cone-beam computed tomography (WBCBCT), comparing them to normally aligned feet as control group. Methods: 41 feet (36 active NFL players) were assessed using WBCBCT and compared to 20 normally aligned controls from a normal population. Measurements included: Foot and Ankle Offset (FAO); Calcaneal Offset (CO); Hindfoot Alignment Angle (HAA); angle between inferior and superior facets of the talus (Inftal-Suptal); angle between inferior facet of the talus and the horizontal/floor (Inftal-Hor); Forefoot Arch Angle (FAA); navicular- and medial cuneiform-to-floor distance. Results: NFL athletes showed a neutrally aligned hindfoot when compared to controls (FAO: 1% vs 0.5%; CO: 2.3 mm vs 0.8 mm; HAA: 2.9° vs 0.8° in two groups, with all p > 0.05) and a normal morphology of the subtalar joint (no difference in Inftal-Suptal and Inftal-Hor angles). Conversely, in athletes we found a decreased medial longitudinal arch (FAA: 15° vs 18.3°, p = 0.03) with smaller navicular (38.2 mm vs 42.2 mm, p = 0.03) and medial cuneiform (27 mm vs 31.3 mm, p = 0.01) mean distances to the floor when compared to controls. Conclusion: In our series, NFL players presented a lower medial longitudinal arch than controls but a neutrally aligned hindfoot. WBCBCT may help shed light on anatomical risk factors for injuries in professional players. Level of Evidence III, Retrospective comparative study.

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“…17 Given the complexity of cavovarus foot deformity and surgical reconstruction, we believe further consideration should be given to in-depth study with WBCT. In this vein, Lintz et al 15 recently demonstrated that WBCT was used to make an association between hindfoot varus and chronic lateral ankle instability.…”

Section: Discussionmentioning

confidence: 99%

“…The advent of this modality permits accurate assessment of complex foot deformity 3-dimensionally, such as pes planovalgus and hallux valgus. 4,[6][7][8][9]11,13,15 WBCT overcomes the well-documented operator and anatomical biases of previous modalities such as projection and rotation issues, 2,3,23 and standardized 3-dimensional biometrics have been validated to study hindfoot deformity. 16 WBCT has also been found to be more accurate than traditional CT for evaluation of the foot and ankle.…”

Section: Introductionmentioning

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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Relationship Between Chronic Lateral Ankle Instability and Hindfoot Varus Using Weight-Bearing Cone Beam Computed Tomography

Cited by 46 publications

References 24 publications

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

Foot Alignment in Symptomatic National Football League (Nfl) Athletes: A Weightbearing Ct Analysis

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

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