Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity

Netto, César de César; Godoy‐Santos, Alexandre Leme; Saito, Guilherme Honda; Lintz, François; Siegler, Sorin; O’Malley, Martin J.; Deland, Jonathan T.; Ellis, Scott J.

doi:10.2106/jbjs.19.00073

Cited by 72 publications

(86 citation statements)

References 20 publications

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“…In an 8-year cohort study, Christine L et al [ 32 ] found that weight gain was positively correlated with the risk of falling. Studies have shown that a higher BMI in older women increases their risk of falling; weight gain is closely related to hormonal changes in postmenopausal women, an increase in the incidence of flatfoot and a decline in lower-limb muscle quality [ 33 , 34 ]. Obese elderly women have high lean leg masses but lack muscle strength, so they have poor balance and stability and are prone to falls [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Identification of risk factors for falls in postmenopausal women: a systematic review and meta-analysis

et al. 2020

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The purpose of this study was to identify risk factors for falls in postmenopausal women and provide evidence for the primary prevention of falls in postmenopausal women. The protocol for this meta-analysis is registered with PROSPERO (CRD42020170927). We searched PubMed, the Cochrane Library and EMBASE for observational studies on the risk factors for falls in postmenopausal women. Review Manager 5.3 was used to calculate the relative risk (RR) or weighted mean difference (WMD) of potential risk factors related to falls. STATA 14.0 was used for the quantitative evaluation of publication bias. Eleven studies with 42,429 patients from 7 countries were included. The main risk factors for falls in postmenopausal women were patient sociodemographic risk factors (age: WMD = 0.37, 95% CI 0.

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Section: Discussionmentioning

confidence: 99%

Identification of risk factors for falls in postmenopausal women: a systematic review and meta-analysis

et al. 2020

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“…1,8,10-12,14,15,22 Both measurements, PTS and FAO, were found to be reliably assessed in patients with AAFD. 1,7,8,10,11,14,15,22…”

Section: Discussionmentioning

confidence: 89%

“…14,15 The potential importance of using the middle facet of the subtalar joint to identify PTS in patients with AAFD has been neglected until a recent study by de Cesar Netto and colleagues. 8 In this case-control study involving 30 patients with AAFD and 30 paired controls, the authors assessed middle facet coronal plane PTS at its anteroposterior midpoint by measuring the percentage of joint uncoverage and the incongruence angle between the opposing articular surfaces. They demonstrated an extremely high diagnostic accuracy for symptomatic AAFD using both middle facet measurements, with values of joint uncoverage above 17.9% showing a 100% specificity and 96.7% sensitivity, and incongruence angle measurements higher than 8.4 degrees providing 100% specificity and 100% sensitivity.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Posterior and Middle Facet Subluxation of the Subtalar Joint in Progressive Flatfoot Deformity

Silva

Mansur

et al. 2020

Foot Ankle Int.

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Background: Adult acquired flatfoot deformity (AAFD) is a complex 3-dimensional pathology characterized by peritalar subluxation (PTS) of the hindfoot. For many years, PTS was measured at the posterior facet of the subtalar joint. More recently, subluxation of the middle facet has been proposed as a more accurate and reliable marker of symptomatic AAFD, enabling earlier detection. The objective of this study was to compare the amount of subluxation between the medial and posterior facets in patients with AAFD. Methods: In this institutional review board-approved retrospective comparative study, a total of 76 patients with AAFD (87 feet) who underwent standing weightbearing computed tomography (WBCT) as a standard baseline assessment of their foot deformity were analyzed. Two blinded fellowship-trained orthopedic foot and ankle surgeons with >10 years of experience measured subtalar joint subluxation (as a percentage of joint uncoverage) at the both posterior and middle facets. One of the readers also measured the foot and ankle offset (FAO). PTS measurements were performed at the sagittal midpoint of the articular facets using coronal plane WBCT images. Intra- and interobserver agreement was measured for PTS measurements using the intraclass correlation coefficient (ICC). The intermethod agreement between the posterior and middle facet subluxation was assessed using Spearman’s correlation and bivariate analysis. Paired comparison of the measurements was performed using the Wilcoxon test. A multivariate analysis and a partition prediction model were used to assess influence of PTS measurements on FAO values. P values of <.05 were considered significant. Results: ICCs for intra- and interobserver reliabilities were 0.97 and 0.93, respectively, for posterior and 0.99 and 0.97, respectively, for middle facet subluxation. The intermethod Spearman’s correlation between subluxation of the posterior and middle facets was measured at 0.61. In a bivariate analysis, both measurements were found to be significantly and linearly correlated ( P < .0001; R2 = 0.42). Measurements of middle facet subluxation were found to be significantly higher than those for posterior facet subluxation, with a median difference (using the Hodges-Lehman factor) of 17.7% ( P < .001; 95% CI, 10.9%-23.6%). We also found that for every 1% increase in posterior facet subluxation there was a corresponding 1.6-fold increase in middle facet subluxation. Only middle facet subluxation measurements were found to significantly influence FAO calculations ( P = .003). The partition prediction model demonstrated that a middle facet subluxation value of 43.8% represented an important threshold for increased FAO. Conclusion: This study is the first to compare WBCT measurements of subtalar joint subluxation at the posterior and middle facets as markers of PTS in patients with AAFD. We found a positive linear correlation between the measurements, with subluxation of the middle facet being significantly more pronounced than that of the posterior facet by an average of almost 18%. This suggests that middle facet subluxation may provide an earlier and more pronounced marker of progressive PTS in patients with AAFD. Level of Evidence: Level III, retrospective comparative cohort study.

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“…1 Currently, the middle facet is used as an isolated marker for PTS, with a mean subluxation (uncoverage) of approximately 45% in symptomatic patients with PCFD and 5% among controls. 8 Measurement of the amount of linear subluxation of the subtalar joint at the posterior facet in the coronal plane has also been proposed to indicate PTS, 7,9,30 but it was found to be less reliable. 9 Lateral subluxation was reported to cause sinus tarsi and subfibular impingement.…”

Section: Rationalementioning

confidence: 99%

Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity

et al. 2020

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Recommendation: Peritalar subluxation represents an important hindfoot component of progressive collapsing foot deformity, which can be associated with a breakdown of the medial longitudinal arch. It results in a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and pronation. Loss of peritalar stability allows the talus to rotate and translate on the calcaneal and navicular bone surfaces, typically moving medially and anteriorly, which may result in sinus tarsi and subfibular impingement. The onset of degenerative disease can manifest with stiffening of the subtalar (ST) joint and subsequent fixed and possibly arthritic deformity. While ST joint fusion may permit repositioning and stabilization of the talus on top of the calcaneus, it may not fully correct forefoot abduction and it does not correct forefoot varus. Such varus may be addressed by a talonavicular (TN) fusion or a plantar flexion osteotomy of the first ray, but, if too pronounced, it may be more effectively corrected with a naviculocuneiform (NC) fusion. The NC joint has a curvature in the sagittal plane. Thus, preserving the shape of the joint is the key to permitting plantarflexion correction by rotating the midfoot along the debrided surfaces and to fix it. Intraoperatively, care must be also taken to not overcorrect the talocalcaneal angle in the horizontal plane during the ST fusion (eg, to exceed the external rotation of the talus and inadvertently put the midfoot in a supinated position). Such overcorrection can lead to lateral column overload with persistent lateral midfoot pain and discomfort. A contraindication for an isolated ST fusion may be a rupture of posterior tibial tendon because of the resultant loss of the internal rotation force at the TN joint. In these cases, a flexor digitorum longus tendon transfer is added to the procedure. Level of Evidence: Level V, consensus, expert opinion.

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Subluxation of the Middle Facet of the Subtalar Joint as a Marker of Peritalar Subluxation in Adult Acquired Flatfoot Deformity

Cited by 72 publications

References 20 publications

Identification of risk factors for falls in postmenopausal women: a systematic review and meta-analysis

Identification of risk factors for falls in postmenopausal women: a systematic review and meta-analysis

Assessment of Posterior and Middle Facet Subluxation of the Subtalar Joint in Progressive Flatfoot Deformity

Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity

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