No abstract

Purpose This study aimed to evaluate the relationship between talofibular impingement and increased talar tilt in incongruent varus ankle osteoarthritis. Methods: Incongruent varus ankle osteoarthritis was defined as a talar tilt of more than 4° on standard ankle anteroposterior radiographs. We retrospectively reviewed 30 patients with unilateral incongruent varus ankle osteoarthritis with normal alignment of the contralateral ankle. All patients underwent bilateral weightbearing computed tomography and standing plain radiographs. The talar tilt and the distance between the talar lateral process and lateral malleolar tip were measured from a standing ankle anteroposterior radiograph of both sides. Talar and fibular spurs were assessed on the coronal and axial views of weightbearing computed tomography. After simulating the correction of the talar tilt in varus ankle osteoarthritis, talofibular bony impingement was reassessed. Results: On the varus side, the distance between the talar lateral process and the lateral malleolar tip was significantly shorter than that on the contralateral side ( p < .001). Talar spur was present in the varus side of all 30 patients on the axial view of weightbearing computed tomography and in the control side of 10 patients. After the simulation of talar tilt correction, talofibular impingement (overlap) occurred in all 30 patients with a larger extent in the severe talar tilt subgroup ( p < .001). Conclusion: Talofibular impingement by lateral gutter osteophytes is closely related to increased talar tilt in patients with incongruent varus ankle osteoarthritis. Therefore, lateral gutter osteophytes should be resected to stabilize mortise and improve clinical outcomes.

Background: We do not yet fully understand how the subtalar joint position is related to the varus osteoarthritic ankle joint. The purposes of this study were (1) to investigate the coronal orientation of the calcaneus relative to the talus according to the ankle osteoarthritis stage, talar tilt (TT), and (2) to determine if there is TT threshold at which apparent subtalar compensation begins to fade. Methods: We retrospectively reviewed 132 ankles that underwent weightbearing computed tomography (WBCT) for varus ankle osteoarthritis. The TT, subtalar inclination angle (SIA), and calcaneal inclination angle (CIA) were measured using WBCT. Ankles were divided into 5 groups according to Takakura stage and 2 groups according to the apparent compensation status of the subtalar joint and compared the index of the inclination of the subtalar joint relative to the ankle (SIA) or the index of the inclination of the calcaneus relative to the ankle (CIA). Additionally, we explored the relationship between SIA or CIA and the TT. Results: Apparent subtalar compensation (SIA and CIA) was significantly lower in Takakura stages 3b and 4. The SIA and CIA significantly differed according to the apparent compensation status ( P < .001 and P = .030, respectively). The CIA of the noncompensated group varied widely, whereas the SIA was relatively constant. Furthermore, TT was greater than 9.5, which indicated a high probability of a noncompensated heel (sensitivity, 92.6%; specificity, 89.7%). Conclusion: The position of the calcaneus appears compensatory with coronal plane orientation in varus ankle osteoarthritis when the TT is ≤9.5 degrees. Level of Evidence: Level III, retrospective case control study.

Background The type of footwear is one of several factors that affect foot pressure. Despite its usefulness in identifying pathology and preventing and treating foot-related diseases, the type of shoes has been investigated and compared in only a few studies. This study aimed to investigate differences in plantar pressure, induced by flat, running, and high-heeled shoes in healthy, young women. Methods A total of 27 healthy women (27 feet) with a mean age of 21.5 ± 2.03 years were included in this study. Based on demographic data, radiologic measurements, clinical scores, temporal gait parameters, and kinematic parameters of gait, we confirmed the participants had normal feet. Then, pedobarographic data were measured by dividing each foot into seven regions to compare the three types of shoes. Peak plantar pressure and pressure-time integral were calculated using the Pedar-X system. The one-way analysis of variance and the Kruskal-Wallis test with Mann Whitney U -test were used for statistical analyses. Results Regarding the 7 regions of the foot, flat shoes resulted in a significantly higher pressure than running shoes in the hallux and lesser toes and the highest pressure in the metatarsal head (MTH) 3–5 and the hindfoot. In contrast, in the MTH 1 and MTH 2 regions, the high-heeled shoes had the highest measured pressure, followed by the flat shoes. Lastly, there was no high pressure in running shoes in any region except for the midfoot compared to the other shoes. Conclusions It can be inferred from our findings that flat and high-heeled shoes can generate a considerable burden on specific parts of the foot, which will aid in choosing appropriate shoes. Also, wearing running shoes places less burden on the overall foot.

Background In clinical fields, many types of insoles are used to not only realign movement patterns, but also treat pressure-related foot diseases. However, the characteristics of and plantar pressure in each type of insole are still unclear. Therefore, the aim of this study was to validate the plantar pressure-relieving effect of three representative types of insoles (metatarsal padding insole [MPI], lateral heel wedge insole [LHI], and arch support insole [ASI]) in asymptomatic men. Methods A total of 35 feet of 35 asymptomatic men with a mean age of 23.4 ± 2.0 years were included. Pedobarographic data were evaluated by dividing the foot into eight designated regions to compare the three types of insoles. Peak plantar pressure (PPP) and pressure time integral (PTI) were assessed using the Pedar-X system. A repeated measures analysis of variance was used for statistical analyses. Results In the hallux region, there was no statistically significant difference. MPI showed highest pressure in the 2nd–5th toe and midfoot region, but lowest in the central and lateral forefoot regions. Meanwhile, ASI showed highest pressure in the medial forefoot region but lowest in the lateral heel region. Lastly, pressure in the lateral heel region was highest in LHI. Overall, results of PTI were similar to those of PPP. Conclusions This study demonstrated that the three types of insole each could reduce and redistribute pressure of specific part of the foot to help select an appropriate insole for each purpose.