Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

Sutter, Reto; Pfirrmann, Christian W. A.; Espinosa, Norman; Buck, Florian M.

doi:10.1007/s00256-012-1543-x

Cited by 24 publications

(12 citation statements)

References 19 publications

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“…A recent study by Sutter et al [17] introduced the possibility of measuring hindfoot alignment on 3D models based on biplanar radiographs. Interreader agreement was considerably better than measurements on plain radiographs.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

et al. 2013

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OBJECTIVE: To investigate the ability of coronal non-weight-bearing MR images to discriminate between normal and abnormal hindfoot alignment. METHODS: Three different measurement techniques (calcaneal axis, medial/lateral calcaneal contour) based on weight-bearing hindfoot alignment radiographs were applied in 49 patients (mean, 48 years; range 21-76 years). Three groups of subjects were enrolled: (1) normal hindfoot alignment (0°-10°valgus); (2) abnormal valgus (>10°); (3) any degree of varus hindfoot alignment. Hindfoot alignment was then measured on coronal MR images using four different measurement techniques (calcaneal axis, medial/lateral calcaneal contour, sustentaculum tangent). ROC analysis was performed to find the MR measurement with the greatest sensitivity and specificity for discrimination between normal and abnormal hindfoot alignment. RESULTS: The most accurate measurement on MR images to detect abnormal hindfoot valgus was the one using the medial calcaneal contour, reaching a sensitivity/specificity of 86 %/75 % using a cutoff value of >11°valgus. The most accurate measurement on MR images to detect abnormal hindfoot varus was the sustentaculum tangent, reaching a sensitivity/specificity of 91 %/71 % using a cutoff value of <12°valgus. CONCLU-SION: It is possible to suspect abnormal hindfoot alignment on coronal non-weight-bearing MR images. KEY POINTS : • Abnormal hindfoot alignment can be identified on coronal non-weight-bearing MR images.• The sustentaculum tangent was the best predictor of an abnormally varus hindfoot.• The medial calcaneal contour was the best predictor of a valgus hindfoot. AbstractObjective To investigate the ability of coronal non-weightbearing MR images to discriminate between normal and abnormal hindfoot alignment. Methods Three different measurement techniques (calcaneal axis, medial/lateral calcaneal contour) based on weightbearing hindfoot alignment radiographs were applied in 49 patients (mean, 48 years; range 21-76 years). Three groups of subjects were enrolled: (1) normal hindfoot alignment (0°-10°v algus); (2) abnormal valgus (>10°); (3) any degree of varus hindfoot alignment. Hindfoot alignment was then measured on coronal MR images using four different measurement techniques (calcaneal axis, medial/lateral calcaneal contour, sustentaculum tangent). ROC analysis was performed to find the MR measurement with the greatest sensitivity and specificity for discrimination between normal and abnormal hindfoot alignment.Results The most accurate measurement on MR images to detect abnormal hindfoot valgus was the one using the medial calcaneal contour, reaching a sensitivity/specificity of 86 %/75 % using a cutoff value of >11°valgus.The most accurate measurement on MR images to detect abnormal hindfoot varus was the sustentaculum tangent, reaching a sensitivity/specificity of 91 %/71 % using a cutoff value of <12°valgus. Conclusion It is possible to suspect abnormal hindfoot alignment on coronal non-weight-bearing MR images.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

et al. 2013

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“…The most inferior aspect of the calcaneus was identified by finding the point under the calcaneus closest to the image of a lead marker line (a line positioned perpendicular to the long axis of the foot and film plate, which represent the plane of the floor in the coronal plane). Sutter et al 26 LAV radiographs and low-dose biplanar radiographs of a phantom Was defined by the line connecting the midpoints of 2 pairs of points on the cortex of the distal tibia. A minimum distance of 3 cm was maintained between these 2 pairs of points.…”

Section: Saltzman Et Al 23 Havmentioning

confidence: 99%

“…21,23,26,28 But problems arise when calcaneal axis has to be defined. Methods described for this purpose are ellipsis superimposition, 15 lowest contact point, 23 bisecting lines, 17,26,28 the 40% to 60% division, 21 and lateral wall of the calcaneus 22,24 (Table 4). There are different anatomical factors that affect this axis measurement, for instance, calcaneal orientation on varus-valgus foot, cuboidal body shape, concavely curved medial surface, and the medial tuberosity.…”

Section: Havmentioning

confidence: 99%

“…When assessing hindfoot alignment, both clinical and radiographic evaluation should be considered to make a complete appraisal of the pathology. Multiple techniques have been described for each analysis (visual examination, [12][13][14] goniometry, 2,[12][13][14] drawing lines on the skin, 22 employing measurement devices, 17,22 modified radiographs, 6,9,16 3-dimension biplanar radiographic assessment, 26 weightbearing computed tomography 7 and magnetic resonance imaging, 5,11 ellipsis superimposition, 15 lowest contact point, 23 lateral wall of the calcaneus, 22,24 bisecting lines, 17,26,28 and the 40% to 60% division 21 ), but none of them are widely accepted. Therefore, there is not an established algorithm for how to evaluate hindfoot coronal alignment.…”

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How Accurate Is Clinical Evaluation in Hindfoot Coronal Alignment?

Slullitel

Álvarez

López

et al. 2017

Foot & Ankle Orthopaedics

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Background: Hindfoot coronal alignment is an important factor in the assessment of patients with many different foot and ankle complaints. A number of clinical and radiographic techniques have been described to measure hindfoot coronal alignment, but none of them are widely accepted. The purpose of the present study was to assess the correlation between clinical and radiographic hindfoot alignment measures and to evaluate the reproducibility of each. Methods: We evaluated 85 patients with foot and/or ankle symptoms. Hindfoot clinical alignment was measured from photographs. Each patient was placed at a distance of 1 m from the observer, with both feet placed parallel. Four photographs were taken, at a height of 40 cm: a posterior view of both lower limbs including knees, a posterior view focalized on the studied hindfoot, an anterior view of the foot, and the last view of the medial aspect of the foot. Radiographic alignment was quantified on long axial view radiographs. Patients were lying over the film cassette with a focus distance of 1 m and the beam pointed to the ankle joint. The inclination angle of the beam was 45 degrees to the floor. Measurements were independently made by 2 observers, who were asked to classify pictures into 3 categories: varus, neutral, and valgus. Radiographic measurements were made using the angle measurement tool on the radiograph viewer. The intraclass correlation coefficients (ICCs) and the 95% confidence interval (CI) of the ICC were used to quantify the inter-and intraobserver reliability for clinical assessment. Radiographic parameters were correlated by calculating the Pearson correlation coefficient (r). Results: The intraobserver ICC for clinical analysis was good for both observers, while the interobserver ICC was moderate for both measurements. Regarding radiographic assessment, there was significant intra-and interobserver reliability. The correlation between both methods was weak for both observers. Conclusions: We found only weak intra-and interobserver correlations between the clinical and radiographic assessment of hindfoot coronal alignment. It is therefore necessary to complement the clinical evaluation of hindfoot alignment with an objective measurement method such as a long axial view radiograph. Further studies comparing different measurement methods need to be performed to establish the most objective evaluation.

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“…Conventional x-ray imaging, however, suffers from limitations regarding magnification errors, image distortion, and the lack of 3-dimensional (3D) information (2)(3)(4). Moreover, the clinical parameters assessed from these images can be affected by projection biases that can alter the clinical decision-making process (5).…”

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confidence: 99%

Three-Dimensional Reconstruction of Foot in the Weightbearing Position From Biplanar Radiographs: Evaluation of Accuracy and Reliability

Rohan

Perrier

Ramanoudjame

et al. 2018

The Journal of Foot and Ankle Surgery

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The initial assessment and postoperative monitoring of patients with various abnormalities of the foot in clinical routine practice is primarily based on the analysis of radiographs taken in the weightbearing position. Conventional x-ray imaging, however, only provides a 2-dimensional projection of 3-dimensional (3D) bony structures, and the clinical parameters assessed from these images can be affected by projection biases. In the present work, we addressed this issue by proposing an accurate 3D reconstruction method of the foot in the weightbearing position from low-dose biplanar radiographs with clinical index measurement assessment for clinical routine practice. The accuracy of the proposed reconstruction method was evaluated for both shape and clinical indexes by comparing 3D reconstructions of 6 cadaveric adult feet from computed tomographic images and from biplanar radiographs. For the reproducibility study, 3D reconstructions from the biplanar radiographs of the foot of 6 able-bodied subjects were considered, with 2 observers repeating each measurement of anatomic landmarks 3 times. Baseline assessment of important 3D clinical parameters was performed on 17 subjects (34 feet; mean age 27.7, range 20 to 52 years). The average point to surface distance between the 3D stereoradiographic reconstruction and the computed tomographic scan-based reconstruction was 1 mm (range 0mm to 6mm). The selected radiographic landmarks were highly reproducible (95% confidence interval <2.0 mm). The greatest interindividual variability for the clinical parameters was observed for the twisting angle (mean 87°, range 73° to 100°). Such an approach opens the way for routine 3D quantitative analysis of the foot in the weightbearing position.

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Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

Cited by 24 publications

References 19 publications

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

How Accurate Is Clinical Evaluation in Hindfoot Coronal Alignment?

Three-Dimensional Reconstruction of Foot in the Weightbearing Position From Biplanar Radiographs: Evaluation of Accuracy and Reliability

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