Reliability and Validity of Radiographic Measurements in Hindfoot Varus and Valgus

Lee, Kyoung Min; Chung, Chin Youb; Park, Moon Seok; Lee, Sang Hyeong; Cho, Jae-Hwan; Choi, In Ho

doi:10.2106/jbjs.i.01150

Cited by 111 publications

(125 citation statements)

References 18 publications

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“…However, we believe these indices were somewhat validated for clinical use in this study in terms of content validity, reliability, and responsiveness, although further validation of these indices is required. Planovalgus deformity is a complex three-dimensional malalignment characterized by hindfoot valgus, midfoot planus, midfoot pronation, relatively short lateral column, forefoot abduction, and forefoot supination [6,14,20]. Our results showed calcaneal lengthening corrected abduction of the forefoot and subluxation of the talonavicular joint as represented by postoperative reduction of the AP talus-first metatarsal angle.…”

Section: Discussionmentioning

confidence: 60%

“…In addition, only nine of 75 patients (12%) improved for this index according to the value of normal alignment. The lateral talocalcaneal angle, which reflects hindfoot valgus, also showed low convergent and discriminant validity in a previous study [14]. In terms of convergent validity, it has been reported that naviculocuboid overlap, AP talus-first metatarsal angle, and lateral talus-first metatarsal angle had a major correlation with that of foot pressure distribution [14].…”

Section: Discussionmentioning

confidence: 89%

“…Sixth, tibiocalcaneal angle on the calcaneal axial view was not measured, although this is an important parameter in evaluating hindfoot alignment. However, it has been reported that the radiographic parameters on the standing foot AP and lateral radiographs were clinically relevant in terms of reliability, discriminant validity, and convergent validity [14]. Seventh, newly developed radiographic indices, that is, relative calcaneal length and calcaneocuboid subluxation, were used without previous validation.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that increased tension in the plantar ligaments and plantar fascia contribute to create the bowstring effect, which restores the medial longitudinal arch [8,16,24]. Despite the relatively high reliability of the calcaneal pitch angle measurement, however, it has been shown to be a less valid method for discriminating hindfoot valgus and varus deformities and for correlating with foot pressure distribution [14]. In our study, calcaneal pitch angle improved to a mean value of 7.3°, but it did not reach the value of normal alignment.…”

Section: Discussionmentioning

confidence: 99%

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Calcaneal Lengthening for Planovalgus Foot Deformity in Patients With Cerebral Palsy

Sung

Chung

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Calcaneal lengthening has been used to correct planovalgus foot deformities in patients with cerebral palsy (CP). Questions/purposes This study was performed to investigate the amount of correction that can be achieved after calcaneal lengthening for the treatment of a planovalgus deformity in patients with CP and to provide cutoff values based on the preoperative radiographic measurements that suggest additional procedures to achieve satisfactory correction. Methods Seventy-five consecutive patients with CP who underwent calcaneal lengthening for planovalgus deformity were included. Radiographic indices were measured on preoperative and latest followup weightbearing foot radiographs. The cutoff values of the preoperative radiographic measurements between the corrected and undercorrected groups were analyzed. The cutoff values are the reference values that can judge the possibilities of sufficient correction of a planovalgus deformity by calcaneal lengthening. Results The mean age of the patients at the time of surgery was 11.0 ± 5.2 years and the minimum followup was 1.0 years (mean, 3.1 ± 2.2 years; range, 1.0-8.4 years). AP talus-first metatarsal angle, calcaneal pitch angle, talocalcaneal angle, lateral talus-first metatarsal angle, and naviculocuboid overlap showed major improvements after calcaneal lengthening. The cutoff values of preoperative measurements between the corrected and undercorrected groups were 23°AP talus-first metatarsal angle, 36°lateral talus-first metatarsal angle, and 72% naviculocuboid overlap. Conclusions Calcaneal lengthening with concomitant peroneus brevis lengthening is an effective procedure for correcting a planovalgus foot deformity in patients with CP. However, for patients with greater than 23°AP talusfirst metatarsal angle, 36°lateral talus-first metatarsal angle, and 72% naviculocuboid overlap, additional procedures for medial stabilization, such as tibialis posterior tendon reefing and talonavicular arthrodesis, should be considered as a result of the possibility of undercorrection with calcaneal lengthening alone.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Calcaneal Lengthening for Planovalgus Foot Deformity in Patients With Cerebral Palsy

Sung

Chung

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Settings assumed absolute agreement in a two-way random effects model. A coefficient of 1.0 designates a perfect correlation and [ 0.8 designates excellent reliability [6]. Interobserver intraclass coefficients for the preoperative mechanical axis angle, the Saltzman measurement, the Saltzman hindfoot angle, and the ankle line convergence angle all indicated excellent reliability being above the 0.9 level; the anatomic lateral distal tibial angle indicated excellent reliability being above the 0.8 level (Table 3).…”

Section: Interobserver and Intraobserver Reliabilitymentioning

confidence: 96%

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

118

161

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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...

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Radiology of the Pediatric Foot and Ankle

Christman

2019

The Pediatric Foot and Ankle

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Reliability and Validity of Radiographic Measurements in Hindfoot Varus and Valgus

Abstract: Naviculocuboid overlap, anteroposterior talonavicular coverage angle, and anteroposterior talus-first metatarsal angle are reliable and valid measures for the evaluation of hindfoot valgus and varus deformities.

Cited by 111 publications

References 18 publications

Calcaneal Lengthening for Planovalgus Foot Deformity in Patients With Cerebral Palsy

Calcaneal Lengthening for Planovalgus Foot Deformity in Patients With Cerebral Palsy

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

Radiology of the Pediatric Foot and Ankle

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