Abnormal Bone Morphology in Charcot-Marie-Tooth Disease

Michalski, Max; An, Tonya; Haupt, Edward T.; Yeshoua, Brandon; Salo, Jari; Pfeffer, Glenn B.

doi:10.1177/10711007211055460

Cited by 16 publications

(15 citation statements)

References 14 publications

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“…Michalski et al have recently demonstrated, using 3D techniques, that there is a change in the bony morphology of these bones. 26 Their study was done using the same software as this study and therefore it is likely that the automated analysis was able to account for these differences where manual measurement may not.…”

Section: Discussionmentioning

confidence: 99%

2D Manual vs 3D Automated Assessment of Alignment in Normal and Charcot-Marie-Tooth Cavovarus Feet Using Weightbearing CT

et al. 2022

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Background: The complex deformities in cavovarus feet may be difficult to assess and understand. Weightbearing computed tomography (WBCT) is increasingly used in evaluating complex deformities. However, the bone axes may be difficult to calculate in the setting of severe deformity. Computer-assisted 3D axis calculation is a novel approach that may allow for more accurate assessment of foot alignment or deformity. This study aimed to assess differences in measurements done manually on 2D slices of WBCT vs 3D computer models in normal and cavus feet. Methods: We retrospectively analyzed WBCT scans from 16 normal and 16 cavus feet in patients with Charcot-Marie-Tooth disease. Six measurements were assessed: talar–first metatarsal angle (axial plane), forefoot arch angle (coronal plane), and Meary angle, calcaneal pitch, and cuneiform and navicular to floor distances (sagittal plane). 2D measurements were performed manually and 3D measurements were performed using specialized software (Bonelogic, DISIOR). Bland-Altman plots and linear regression were used to analyze differences. Results: There were no significant biases in measured variables in normal feet. In the cavovarus group, automated assessment calculated increased sagittal plane deformity (fixed bias 7.31 degrees for Meary angle, 2.39 degrees for calcaneal pitch) and less axial plane deformity (fixed bias 10.61 degrees for axial talar–first metatarsal angle). The latter also demonstrated proportional bias indicating greater discrepancy with increasing adduction. Conclusion: Measurements were comparable in normal feet suggesting automated techniques can reliably assess the alignment of bony axes. However, automated calculations show greater sagittal and less axial deformity in cavovarus feet than measured by manual techniques. This discrepancy may relate to rotational deformity seen in cavovarus feet, which may not be easily assessed manually. 3D automated measurements may therefore play a role in better assessing and classifying the cavovarus foot, which may ultimately inform treatment algorithms. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

2D Manual vs 3D Automated Assessment of Alignment in Normal and Charcot-Marie-Tooth Cavovarus Feet Using Weightbearing CT

et al. 2022

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“…However, whether this difference arose from abnormal osteology or joint malalignment, from single or multiple segments of the foot, remained unclear. In a recent study, Michalski et al 12 demonstrated that CMT patients often have aberrant osseous morphology of the calcaneus and talus, in particular, demonstrating a more curved calcaneal body, horizontal posterior facet orientation, and reduced talar neck declination. Although these abnormalities contribute to notable differences between CMT and normal individuals, they are not sufficient to explain the severity of global deformity in cavovarus foot.…”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective cohort study approved by the Institutional Review Board. Patient selection and weightbearing computed tomography (WBCT) protocol were identical to the methodology in the corollary part of the study by Michalski et al 12 In summary, 27 scans in 21 patients met criteria for the study cohort; including 6 patients who had bilateral WBCTs. This group included 10 females and 11 males, with an average age of 27.5 years.…”

Section: Methodsmentioning

confidence: 99%

“…Michalski et al performed a computational analysis of the osteology of CMT hindfoot bones, noting specific differences in morphology compared with controls. 12 Further investigation of segmental bony and articular malalignment is needed to understand the global deformity. This study applied software adapted from aviation and aerospace engineering to perform high-powered 3D analysis of clinical WBCT.…”

Section: Introductionmentioning

confidence: 99%

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Cavovarus With a Twist: Midfoot Coronal and Axial Plane Rotational Deformity in Charcot-Marie-Tooth Disease

Haupt

Michalski

et al. 2022

Foot Ankle Int.

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Background: The cavovarus deformity of Charcot-Marie-Tooth (CMT) disease is often characterized by a paradoxical relationship of hindfoot varus and forefoot valgus. The configuration of the midfoot, which links these deformities, is poorly understood. Accurate assessment of 3-dimensional alignment under physiologic loadbearing conditions is possible using weightbearing computed tomography (WBCT). This is the first study to examine the rotational deformity in the midfoot of CMT patients and, thus, provide key insights to successful correction of CMT cavovarus foot. Methods: A total of 27 WBCT scans from 21 CMT patients were compared to control WBCTs from 20 healthy unmatched adults. CMT patients with a history of bony surgery, severe degenerative joint disease, or open physes in the foot were excluded. Scans were analyzed using 3-dimensional software. Anatomic alignment of the tarsal bones was calculated relative to the anterior-posterior axis of the tibial plafond in the axial plane, and weightbearing surface in the coronal plane. Results: Maximal rotational deformity in CMT patients occurred at the transverse tarsal joints, averaging 61 degrees of external rotation (supination), compared to 34 degrees among controls ( P < .01). The talonavicular joint was also the site of peak adduction deformity in the midfoot, with an average talonavicular coverage angle measuring 12 degrees compared with −11 degrees in controls ( P < .01). Conclusion: This 3-dimensional WBCT analysis is the first to isolate and quantify the multiplanar rotational deformity in the midfoot of CMT patients. Compared with healthy unmatched control cases, CMT patients demonstrated increased axial plane adduction and coronal plane rotation at the talonavicular (TN) joint. These findings support performing soft tissue release at the TN joint to abduct and derotate the midfoot as a first step for targeted deformity correction. Level of Evidence: Level III, retrospective case-control study.

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“…The radiological evaluation of cavus foot should also include the Coleman block test in order to assess the flexibility of the foot. In the recent literature, Dr. Michalski [36] and Dr. Tonya An [37] have conducted high quality research about bone morphology changes in cavus foot. Their research results indicate that the TN coverage angle (Figure 7) plays an important role in evaluating the effect of cavus foot correction.…”

Section: Radiological Evaluationmentioning

confidence: 99%

Evaluation and Management of Cavus Foot in Adults: A Narrative Review

Qin

Zhang

2022

JCM

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Objective: Cavus foot is a deformity defined by the abnormal elevation of the medial arch of the foot and is a common but challenging occurrence for foot and ankle surgeons. In this review, we mainly aim to provide a comprehensive evaluation of the treatment options available for cavus foot correction based on the current research and our experience and to highlight new technologies and future research directions. Methods: Searches on the PubMed and Scopus databases were conducted using the search terms cavus foot, CMT (Charcot–Marie–Tooth), tendon-transfer, osteotomy, and adult. The studies were screened according to the inclusion and exclusion criteria, and the correction of cavus foot was analyzed based on the current research and our own experience. At the same time, 3D models were used to simulate different surgical methods for cavus foot correction. Results: A total of 575 papers were identified and subsequently evaluated based on the title, abstract, and full text. A total of 84 articles were finally included in the review. The deformities involved in cavus foot are complex. Neuromuscular disorders are the main etiologies of cavus foot. Clinical evaluations including biomechanics, etiology, classification, pathophysiology and physical and radiological examinations should be conducted carefully in order to acquire a full understanding of cavus deformities. Soft-tissue release, tendon-transfer, and bony reconstruction are commonly used to correct cavus foot. Surgical plans need to be customized for different patients and usually involve a combination of multiple surgical procedures. A 3D simulation is helpful in that it allows us to gain a more intuitive understanding of various osteotomy methods. Conclusion: The treatment of cavus foot requires us to make personalized operation plans according to different patients based on the comprehensive evaluation of their deformities. A combination of soft-tissue and bony procedures is required. Bony procedures are indispensable for cavus correction. With the promotion of digital orthopedics around the world, we can use computer technology to design and implement cavus foot operations in the future.

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Abnormal Bone Morphology in Charcot-Marie-Tooth Disease

Cited by 16 publications

References 14 publications

2D Manual vs 3D Automated Assessment of Alignment in Normal and Charcot-Marie-Tooth Cavovarus Feet Using Weightbearing CT

2D Manual vs 3D Automated Assessment of Alignment in Normal and Charcot-Marie-Tooth Cavovarus Feet Using Weightbearing CT

Cavovarus With a Twist: Midfoot Coronal and Axial Plane Rotational Deformity in Charcot-Marie-Tooth Disease

Evaluation and Management of Cavus Foot in Adults: A Narrative Review

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