Assessing the coronal plane deformity in Charcot Marie Tooth Cavovarus feet using automated 3D measurements

Ranjit, Srinath; Sangoi, Dhrumin; Cullen, Nicholas; Patel, Shelain; Welck, Matthew; Malhotra, Karan

doi:10.1016/j.fas.2023.02.013

Cited by 10 publications

(13 citation statements)

References 28 publications

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“…The method was previously validated in the foot and ankle literature. 1,6,9,17,18 As far as we know, this is the first study investigating perioperative WBCT findings in CMT feet using automated 3D measurements. Another major strength of this study is the relatively large number of CMT patients that were included.…”

Section: Discussionmentioning

confidence: 99%

“…1,6,9,18 FDA-approved clinical software for 3D anatomic modeling (Bonelogic 2.1; Disior, Helsinki, Finland), previously validated in the foot and ankle literature, was used for semiautomated 3D axis calculation. 1,6,9,17,18 Preoperative and postoperative WBCT analysis was performed using a cone-beam scanner (Onsight Extremity 3D CT; Carestream Health, Rochester, NY) and the Bonelogic software semiautomatically rendered a 3D isosurface of the bones from WBCT axial image stacks in DICOM format. 7,18 The software can automatically measure the angle between bone axes after the manual registration of the bones.…”

Section: Methodsmentioning

confidence: 99%

“…22 For the analysis of hindfoot sagittal alignment, sagittal Meary angle and calcaneal inclination angle (ie, calcaneal pitch angle) were evaluated. To investigate hindfoot axial and coronal alignment, axial talonavicular angle (TNA), axial Meary angle, talar tilt, and Saltzman view angle 17,22 were measured. TNA was defined as the angle between the talus longitudinal axis and the navicular axis in the axial view.…”

Section: Methodsmentioning

confidence: 99%

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3D Analysis of Joint-Sparing Charcot-Marie-Tooth Surgery Effect on Initial Standing Foot Alignment

Song,

Michalski,

Pfeffer

2024

Foot Ankle Int.

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Background: The complex deformities in cavovarus feet of Charcot-Marie-Tooth (CMT) disease are difficult to evaluate. The aim of this study was to quantify the initial standing alignment correction achieved after joint-sparing CMT cavovarus reconstruction using pre- and postoperative weightbearing computed tomography (WBCT). Methods: Twenty-nine CMT cavovarus reconstructions were retrospectively analyzed. Three-dimensional measurements were performed using semiautomated software (Bonelogic 2.1) to investigate changes in sagittal, axial, and coronal parameters. Pre- and postoperative data were compared, along with normative data. Correlation among the preoperative measurements and the amount of correction in sagittal, axial, and coronal parameters were analyzed. Results The sagittal, axial, and coronal malalignment of the hindfoot, and the sagittal and axial malalignment of the forefoot, was significantly improved after corrective surgery ( P < .05). Sagittal Meary angle (from 14.8 to 0.1 degrees), axial talonavicular angle (TNA, from 3.6 to 19.2 degrees), and coronal hindfoot alignment (from 11.0 to −11.1 degrees) showed significant changes postoperatively ( P < .001). Hindfoot, forefoot sagittal, and forefoot axial parameters reached comparable outcomes compared with normative value ( P > .05). Regarding amount of correction, Spearman correlation demonstrated that axial Meary angle and TNA were most strongly related to improvement in sagittal Meary angle and coronal hindfoot alignment. Conclusion: Preoperative and postoperative WBCT measurements demonstrated that joint sparing CMT cavovarus reconstruction significantly improved sagittal, axial, and coronal deformities of CMT, and sagittal Meary angle was restored toward normative values. Apparent axial plane correction, the majority of which occurred at the talonavicular joint, had the strongest correlation with deformity correction in multiple planes. This suggests that soft tissue releases and correction of the talonavicular joint may be a key component of a cavovarus foot correction. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

3D Analysis of Joint-Sparing Charcot-Marie-Tooth Surgery Effect on Initial Standing Foot Alignment

Song,

Michalski,

Pfeffer

2024

Foot Ankle Int.

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“…This study from London (UK) aimed to employ weightbearing CT (WBCT) scans, along with specialized 3D measurement software, to assess the unique deformities found in the coronal plane of cavovarus feet in CMT patients. 3 The study sought to compare these measurements with a control group comprising 30 normal feet. In the study, 30 cavovarus feet from skeletally mature CMT patients without prior foot and ankle surgeries were examined.…”

Section: Coronal Plane Deformity In Cmt-cavovarus Feet Using Automate...mentioning

confidence: 99%

Foot & Ankle

2023

Bone &Amp; Joint 360

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The October 2023 Foot & Ankle Roundup360 looks at: Risk factors for failure of total ankle arthroplasties; Effects of synovial fluid fracture haematoma to tissue-engineered cartilage; Coronal plane deformity in CMT-cavovarus feet using automated 3D measurements; Immediate weightbearing after ankle fracture fixation – is it safe?; Unlocking the mystery of Mueller-Weiss disease; Diabetic foot management: predictors of failure.

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“…The management of cavovarus feet in adults is challenging as clinical presentation is varied and there is a lack of evidence on managing specific deformities. 1,11,[21][22][23][24][25][26][27][28][29][30][31][32][33] Deformities are complex, multiplanar, and progressive, particularly when associated with neuromuscular disorders such as Charcot-Marie-Tooth disease (CMT). 3,13,[18][19][20]30,34 Current recommendations on surgical management are based on level IV and V studies and expert consensus group publications.…”

Section: Introductionmentioning

confidence: 99%

Forefoot Morphotypes in Cavovarus Feet: A Novel Assessment of Deformity

Malhotra,

Patel,

Cullen

et al. 2024

Foot Ankle Int.

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Background: The cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to analyze the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction. Methods: We included 20 cavovarus feet from 16 adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, range: 22-78 years, 14 males). Patients included had flexible deformities, with no previous surgery. Using specialized software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using morphologic data captured from normal feet in patients without pathology as a guide, the talonavicular joint of the cavovarus foot was digitally reduced to a “normal” position to simulate the correction that would be achieved during surgical correction. Models of the corrected position were exported and geometrically analyzed using Blender 3.64 to identify anatomical trends. Results: We identified 4 types of cavovarus forefoot morphotypes. Type 0 was defined as a balanced forefoot (2 cases, 10%). Type 1 was defined as a forefoot where the first metatarsal was relatively plantarflexed to the rest of the foot, with no significant residual adduction after talonavicular joint correction (12 cases, 60%). Type 2 was defined as a forefoot where the second and first metatarsals were progressively plantarflexed, with no significant adduction (4 cases, 20%). Type 3 was defined as a forefoot where the metatarsals were adducted after talonavicular derotation (2 cases, 10%). Conclusion: In this relatively small cohort, we identified 4 forefoot morphotypes in cavovarus feet that might help surgeons to recognize and anticipate the residual forefoot deformities after hindfoot correction. Different treatment strategies may be required for different morphotypes to achieve balanced correction. Level of Evidence: Level IV, retrospective case series.

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Assessing the coronal plane deformity in Charcot Marie Tooth Cavovarus feet using automated 3D measurements

Cited by 10 publications

References 28 publications

3D Analysis of Joint-Sparing Charcot-Marie-Tooth Surgery Effect on Initial Standing Foot Alignment

3D Analysis of Joint-Sparing Charcot-Marie-Tooth Surgery Effect on Initial Standing Foot Alignment

Foot & Ankle

Forefoot Morphotypes in Cavovarus Feet: A Novel Assessment of Deformity

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