Correlation of Clinical Evaluation and Radiographic Hindfoot Alignment in Stage II Adult-Acquired Flatfoot Deformity

Netto, César de César; Kunas, Grace C.; Soukup, Dylan S.; Marinescu, Anca; Ellis, Scott J.

doi:10.1177/1071100718762113

Cited by 57 publications

(22 citation statements)

References 40 publications

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“…17,35 This may suggest that the real alignment of the hindfoot may not be correctly assessed based on the conventional CR-CT sequence, particularly due to perspective distortion, which dramatically influences the value of the measured hindfoot alignment depending on the angle of rotation of the lower limb relative to the radiograph source, 3,5,41 and the absence of weightbearing in the case of conventional CT. It has also been shown that clinical evaluation of hindfoot alignment is not reliable 14 and that 2D evaluation through standard radiographs has poor reproducibility. 4,5,30 This might explain some cases of TAR implant failure where the alignment is thought to be correct but in fact is not in the 3D setting.…”

Section: Discussionmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, –1.12 to 1.36). Patients with greater residual malalignment ( P < .001) and those with longer follow-up ( P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV ( P = .042), with a threshold FAO value of −2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV ( P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. Level of Evidence: Level III, retrospective comparative series.

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Section: Discussionmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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“…Some feet may also exhibit a calcaneal valgus, but this is not always present with TTJ instability (18,19). Heel valgus occurs as a form of compensation from excessive internal talar rotation and plantar flexion (Figure 6) (20).…”

Section: Hindfoot Alignment and Biomechanicsmentioning

confidence: 99%

Pediatric Flatfeet—A Disease Entity That Demands Greater Attention and Treatment

Bresnahan

Juanto

2020

Front. Pediatr.

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Background: Pediatric flatfoot is a common deformity. Unfortunately, the common opinion has been that most children with this faulty foot structure will simply out-grow it, despite no radiographic evidence to support this claim. Every step on a deformed foot leads to excessive tissue strain and further joint damage. Many forms of conservative and surgical treatments have been offered. This study was aimed at investigating the effectiveness of non-surgical and surgical treatment options.Main Text: faulty-foot structure is the leading cause of many secondary orthopedic deformities. A wide range of treatments for pediatric flatfeet have been recommended from the “do-nothing” approach, observation, to irreversible reconstructive surgery. Most forms of conservative care lack evidence of osseous realignment and stability. A conservative surgical option of extra-osseous talotarsal joint stabilization provides patients an effective form of treatment without the complications associated with other irreversible surgical procedures.Conclusion: Pediatric flatfeet should not be ignored or downplayed. The sooner effective treatment is prescribed, the less damage will occur to other parts of the body. When possible, a more conservative corrective procedure should be performed prior to irreversible, joint destructive options.

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“…Weightbearing CT is an excellent modality for understanding complex 3-dimensional foot deformities including pes planovalgus and hallux valgus. 4,6,7,9,11,13 Lintz et al 16 demonstrated in a series of 135 feet that the FAO provides a highly reproducible means to measure hindfoot alignment with excellent inter- and intra-rater reliability. WBCT has also been shown to be more accurate than 2D imaging obtained via radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…The advent of this modality permits accurate assessment of complex foot deformity 3-dimensionally, such as pes planovalgus and hallux valgus. 4,[6][7][8][9]11,13,15 WBCT overcomes the well-documented operator and anatomical biases of previous modalities such as projection and rotation issues, 2,3,23 and standardized 3-dimensional biometrics have been validated to study hindfoot deformity. 16 WBCT has also been found to be more accurate than traditional CT for evaluation of the foot and ankle.…”

Section: Introductionmentioning

confidence: 99%

Impact of Coleman Block Test on Adult Hindfoot Alignment Assessed by Clinical Examination, Radiography, and Weight-Bearing Computed Tomography

Foran

Mehraban

Jacobsen

et al. 2020

Foot & Ankle Orthopaedics

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Background: Cavovarus foot constitutes a complex 3-dimensional deformity. The Coleman block test has traditionally been used to distinguish between forefoot- and hindfoot-driven deformity. However, there has been no objective evaluation of the Coleman block test using radiographs or weightbearing computed tomography (WBCT). The purpose of this study was to compare hindfoot alignment in adult cavovarus feet with and without the Coleman block using clinical examination, radiography, and WBCT. Methods: Six feet in 6 patients with a clinical diagnosis of cavovarus foot deformity were prospectively enrolled. All feet underwent clinical photography with the camera positioned at 0 degrees to the heel, hindfoot alignment view radiography with the beam positioned 20 degrees off the ground, and WBCT, both with and without the Coleman block in place. Clinical photos were characterized using the standing talocalcaneal angle (STCA), radiographs were characterized using the hindfoot alignment angle (HAA), and WBCTs were characterized using manual and automated hindfoot alignment angle (HAA) and foot and ankle offset (FAO). Using paired analyses, measurements taken with the Coleman block in place were compared to those taken without the Coleman block. Finally, the different methods of measuring hindfoot alignment were tested for correlation with each other. Mean age was 56 years (range 38-69). Results: On clinical photography, the STCA decreased by 3.8 degrees with addition of the block (from 10.0±6.6 degrees varus without block to 6.2±7.1 degrees varus with block; P = .001). On radiograph, HAA decreased by 9.0 degrees with addition of the block (from 16.8±8.4 degrees varus without block to 7.5±6.3 degrees varus with block; P = .07). On WBCT, hindfoot alignment angle changed an average of 3.2 degrees (33.4 degrees varus without block, 30.2 degrees varus with block; P = .008). On WBCT, FAO decreased by 1.4% (from 11.3% varus without block to 10.1% varus with block; P = .003). Clinical examination and automated WBCT measurements were strongly correlated with each other. Conclusion: Clinical examination, radiograph, and WBCT demonstrated improvements in hindfoot varus using the Coleman block test in adults, but no patient demonstrated complete resolution of deformity regardless of the measurement modality. Clinical examination correlated strongly with automated WBCT measurements. Level of Evidence: Level IV, retrospective case review.

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Correlation of Clinical Evaluation and Radiographic Hindfoot Alignment in Stage II Adult-Acquired Flatfoot Deformity

Abstract: Level II, prospective comparative study.

Cited by 57 publications

References 40 publications

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

Pediatric Flatfeet—A Disease Entity That Demands Greater Attention and Treatment

Impact of Coleman Block Test on Adult Hindfoot Alignment Assessed by Clinical Examination, Radiography, and Weight-Bearing Computed Tomography

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