Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography

Arena, Christopher B.; Sripanich, Yantarat; Leake, Richard; Saltzman, Charles L.; Barg, Alexej

doi:10.1177/10711007211014171

Cited by 21 publications

(16 citation statements)

References 49 publications

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“…measured the calcaneal moment arm (CMA) (Figure 1). 2 CMA was determined by measuring the horizontal distance between the most inferior aspect of the calcaneus identified on axial cross-sectional imaging and an extended line representing the longitudinal axis of the tibia on coronal cross-section in millimeters. Directionality of the CMA was denoted with positive values for valgus and negative values for varus.…”

Section: Methodsmentioning

confidence: 99%

Association Between Hindfoot Alignment and First Metatarsal Rotation

et al. 2021

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Background: The association between forefoot and hindfoot position for planus and cavus feet is fundamental to the treatment of these deformities. However, no studies have evaluated the association between hindfoot alignment and first metatarsal (M1) axial rotation. Understanding this possible relationship may help to understand the deformity and improve patient care. The purpose of this study is to determine a correlation between hindfoot alignment and metatarsal rotation as assessed by weightbearing computed tomography (WBCT). Methods: Patients who underwent weightbearing plain radiography (WBPR) and WBCT between 2015 and 2018 were evaluated. Hindfoot alignment was measured with the calcaneal moment arm (CMA). M1 rotation was measured using the Kim and Saltzman angles. Patient subgroups were created according to the severity of valgus/varus hindfoot alignment. Statistical analyses were performed to evaluate for association between variables. Results: Among the 196 patient feet included in the study, the average CMA was 6.0 ± 16.2 mm. The average Kim and Saltzman angles were 7.7 ± 12.9 degrees and 2.8 ± 13.1 degrees, respectively. The average Meary angle was 182.0 ± 11.9 degrees. A moderately strong association was found between the CMA and the Saltzman ( r = 0.641, P < .01) and Kim angles ( r = 0.615, P < .01). Hindfoot valgus was associated with M1 pronation and hindfoot varus with M1 supination. Additionally, inverse relationships between the Meary angle and the Saltzman ( r = −0.600, P < .01) and Kim angles ( r = −0.529, P < .01) were identified. Conclusion: In this well-defined cohort, we found substantial correlation between hindfoot alignment and M1 rotation. Hindfoot valgus was associated with M1 pronation, and hindfoot varus was associated with M1 supination. Surgeons correcting cavovarus/planovalgus deformities should be aware of this association and evaluate the need for first-ray derotation. Level of Evidence: Level III, retrospective cohort study.

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Section: Methodsmentioning

confidence: 99%

Association Between Hindfoot Alignment and First Metatarsal Rotation

et al. 2021

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“…Second, the learning curve, the correct patient selection, and the availability of sonographic assistance could be some of the obstacles to its generalization. On the other hand, the coronal rotation of the first metatarsal has been reported in the literature to be significantly different in the same foot between full weight-bearing status and non-weight-bearing status [17][18][19]. Thus, performing the ultrasound on the operating table is a limitation that although we have tried to solve by performing simulated weight-bearing with the linear ultrasound probe, it should be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative checking of the first ray rotation and sesamoid position through sonographic assistance

Tejero

González-Martín

Martínez-Franco

et al. 2022

Arch Orthop Trauma Surg

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Introduction Hallux valgus (HV) deformity affects the orientation of the metatarsophalangeal (MTP) joint in three planes. Displacement in the coronal plane results in axial rotation of the first metatarsal, with progressive subluxation of the first MTP joint. Multiple techniques have been described to correct the malrotation itself. However, none of them have checked intraoperatively the final position of the first metatarsal head and sesamoids previous to the fixation of the Lapidus procedure or first metatarsal bone osteotomies. The aim of this article is to describe a novel technique to check the first ray rotation and sesamoids position through sonographic assistance. Materials and methods Before fixation of the Lapidus procedure, with the ankle in maximal dorsiflexion, the surgeon takes the linear ultrasound probe and places it on the sole to visualize the sesamoids, which should be viewed at the same level, with the flexor hallucis longus (FHL) centered between both. Once the ideal position of the head of the first ray has been achieved, temporary fixation with K-wires is performed over the first TMT joint and M1–M2 joint for further sonographic verification of the sesamoids beneath the first metatarsal head. The height of the sesamoids relative to the second metatarsal head should be checked by sonographic control too. Results Four patients were included. Three females and one male. Their mean age was 76.4 years (R 61–72). Their mean BMI was 29 (R 27.5–32.24). The mean IMA (intermetatarsal angle) was 18.2 (R 17.2–19) degrees and the mean MPA (metatarsophalangeal angle) was 50 (R 36–63) degrees. Conclusions Sonographic assistance, is a widely available, inexpensive, and comparative imaging technique that can guide the first ray rotation and sesamoids position in HV surgery, theoretically improving radiological outcomes.

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“…A weight-bearing CT scan has the potential to provide new insights into static alignment in both planovalgus and cavovarus feet. Arena et al 44 sought to tie the newer measurements of hindfoot alignment by weight-bearing CT scans to measurements by the older radiographic hindfoot alignment view. Strong correlations between the 2 methods were seen and measurements with both imaging techniques were highly reliable.…”

Section: Progressive Collapsing Flatfoot Deformitymentioning

confidence: 99%