The inter- and intraobserver reliability for the radiological parameters of flatfoot, before and after surgery

Böck, Peter; Pittermann, Michael; Chraim, Michel; Rois, Stefan

doi:10.1302/0301-620x.100b5.bjj-2017-1279

Cited by 24 publications

(24 citation statements)

References 21 publications

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“…As shown in Table 5, the implant in situ group presents better surgical outcomes than the extrusion group. Bock et al reported a high inter-observer reliability in the anteroposterior talonavicular angle, lateral talometatarsal 1 angle, and calcaneal pitch angle preoperatively and postoperatively [14]. We are thus convinced that our study further confirms the improvement of foot alignment based on Bock et al’s recommended radiographic parameter.…”

Section: Discussionsupporting

confidence: 76%

Body Weight Effects on Extra-Osseous Subtalar Arthroereisis

Hsieh

Lee

Tseng

et al. 2019

JCM

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Implant extrusion in subtalar arthroereisis is a common complication for pediatric flexible flatfoot. However, there were a limited number of articles addressing the body weight effects on implant extrusion after the procedure. We conducted a 24-month follow-up assessment after subtalar arthroereisis. Surgical patients who underwent the Vulpius procedure were retrospectively collected from May 2010 to January 2017, including 59 cases of both feet having implants in situ and 43 cases of both feet having implant extrusion. The average age of 102 patients was 9 years old. The mean body mass index (BMI) of the implant in situ group was 19.5, whilst the extrusion group was 21.2 (p = 0.035). The inter-observer correlation was excellent. There were 11 cases (39.3%) of bilateral extrusion in the overweight group (BMI ≥ 24) and 13 cases (23.2%) in the low body weight group (BMI ≤ 18.5) (p < 0.0004). Postoperative radiographic angles were corrected in both the implant in situ group and the extrusion group. Nonetheless, the implant in situ group revealed better postoperative outcomes of Meary’s angle and the talonavicular angle from an anterior-posterior view, and the talar inclination angle from a lateral view. We conclude that a higher BMI is related to implant extrusion and worse results after subtalar arthroereisis. Further prospective study to investigate whether preoperative weight loss results in improved surgical outcomes is warranted in the future.

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Section: Discussionsupporting

confidence: 76%

Body Weight Effects on Extra-Osseous Subtalar Arthroereisis

Hsieh

Lee

Tseng

et al. 2019

JCM

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“…We observed comparable measurements for standardized radiographic parameters of flatfoot, as well as excellent and good to excellent reliability for measurements using DRR, consistent with values reported in previous studies using XR. 3,18,[20][21][22]27,28 In a cohort of 72 patients who underwent operative correction for PCFD, measurements made using DRR generated from preoperative WBCT were comparable to measurements from preoperative XRs taken during each patient's evaluation. All parameters measured were within the previously published ranges typical for PCFD.…”

Section: Discussionmentioning

confidence: 87%

Assessment of Flatfoot Deformity Using Digitally Reconstructed Radiographs: Reliability and Comparison to Conventional Radiographs

Fuller

Kim

et al. 2022

Foot Ankle Int.

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Background: Digitally reconstructed radiographs (DRRs) generated from weightbearing computed tomography (WBCT) may potentially substitute for weightbearing plain radiographs (XRs) but have not been clinically validated. This study aims to test the reliability of 6 radiographic parameters of progressive collapsing foot deformity (PCFD) as measured on DRR, to investigate whether DRR represents comparably to XR through the same measurements, and to compare agreement of DRR and XR measurements of a standardized arch height parameter with reference measurements made on WBCT. Methods: DRR generated from preoperative WBCT of 71 patients (72 feet) treated surgically for PCFD were retrospectively compared with preoperative weight-bearing XR after exclusion criteria were applied. Six radiographic measurements were performed, including Meary angle, calcaneal pitch (CPA), medial cuneiform height (MCH), AP talar–first metatarsal angle (T-1MT), talonavicular coverage (TNCA), and talar incongruency (TIA). Arch height was measured on XR, DRR, and WBCT using a validated, standardized, navicular-based index. Intraclass correlation coefficients assessed DRR intraobserver and interobserver reliability. Paired samples t tests tested differences between XR and DRR. Bland-Altman limits of agreement analysis compared DRR and XR agreement with WBCT measurements. Results: Measurements were within standard PCFD ranges on XR and DRR. All measurements demonstrated excellent intrarater reliability and good to excellent interrater agreement, consistent with previous literature on XR. No differences were found for Meary, CPA, or TNCA. Minor differences were observed for MCH, T-1MT, and TIA. DRR measurements demonstrated greater agreement with WBCT than XR measurements. Conclusion: DRR from WBCT may be a promising substitute for XR in the clinical evaluation of PCFD. Radiographic measurements made on DRR demonstrated good to excellent reliability. Although small differences were found between XR and DRR for certain measurements, DRR more accurately represented medial arch anatomy compared to gold standard WBCT data than XR. If validated as a clinical substitute, DRR could eventually obviate XR where WBCT is available. Level of Evidence: Level III, retrospective cohort study.

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“…In our study, we utilized calcaneal pitch angle, talonavicular coverage angle, and lateral talus–first metatarsal angle (Meary angle) as the radiographic parameters to evaluate adult acquired flatfoot deformity (AAFD) because these measurements have been shown to have high inter- and intraobserver reliability both before and after reconstructive surgery. 2 We used the C1 Cobb angle to analyze change of orientation of the first tarsometatarsal joint of Cotton osteotomy. Although data are lacking regarding the reliability of the C1 Cobb angle, the angle does describe the articulations of medial cuneiform and directly affects the alignment of the first metatarsal.…”

Section: Materials and Methods Sectionmentioning

confidence: 99%