CT Analysis of Hindfoot Alignment in Chronic Lateral Ankle Instability

Bergeyk, Anthony B. Van; Younger, Alastair; Carson, Brent Van

doi:10.1177/107110070202300107

Cited by 114 publications

(98 citation statements)

References 19 publications

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“…Richter et al [33] assumed a 50:50 medial:lateral force distribution for intraoperative pedobarography without measuring healthy subjects. Others have found a medial displacement of the hindfoot in healthy subjects corresponding to a slight varus position of 1°to 6° [21,37,42]. This raises the question of why the best position of an ankle arthrodesis should be in 0°to 10°valgus according to Buck et al [5], Morrey and Wiedeman [29], and our results.…”

Section: Discussionmentioning

confidence: 55%

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Frigg

Nigg

Davis

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The Saltzman-el-Khoury hindfoot alignment view (HAV) is considered the gold standard for assessing the axis from hindfoot to tibia. However, it is unclear whether radiographic alignment influences dynamic load distribution during gait. Questions/purposes We evaluated varus-valgus alignment by the HAV and its influence on dynamic load distribution in ankle and tibiotalocalcaneal (TTC) arthrodesis. Patients and Methods We clinically assessed 98 patients (ankle, 56; TTC, 42) with SF-36 and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual hindfoot alignment, HAV angle, and dynamic pedobarography using a five-step method. For comparison, 70 normal feet were evaluated. Minimum followup was 2 years (average, 4.11 years; range, 2-6 years). Results The mean HAV angle was À0.8°± 7.8°for ankle and À1.2°± 6.9°for TTC arthrodesis. The HAV angle correlated with pedobarographic load distribution (r = 0.35-0.53). Radiographic alignment did not influence SF-36 or AOFAS scores; however, load distribution correlated to qualities of these scores. Visual alignment only predicted the corresponding HAV angle in 48%. To reproduce the dynamic load of healthy subjects, HAV angles of 5°to 10°valgus were needed. Conclusions Visual positioning is inadequate to determine intraoperative positioning and resulted in a varus position with a relatively large SD. The HAV should be used to assess the hindfoot alignment correctly. HAV angles of 5°to 10°valgus are needed to reproduce a physiologic gait pattern.

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Section: Discussionmentioning

confidence: 55%

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Frigg

Nigg

Davis

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The importance of hindfoot alignment (HFA) in the setting of hindfoot surgery has been described in the literature due to the relationship between alignment and operative outcome, 34,46,47 as in ankle arthrodesis and arthroplasty 4,5,11,17,21,30,32,48 or in knee arthroplasty. 7,[27][28][29]41 HFA measures based on 2D radiographs are flawed by many anatomical and operator-related bias, which have been extensively investigated in the literature.…”

Section: Introductionmentioning

confidence: 99%

3D Biometrics for Hindfoot Alignment Using Weightbearing CT

Lintz

Welck

Bernasconi³

et al. 2017

Foot Ankle Int.

140

162

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Background: Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups. Methods: In this retrospective cohort study, 135 data sets (57 normal, 38 varus, 40 valgus) from WBCT (PedCAT; CurveBeam LLC, Warrington, PA) were obtained from a specialized foot and ankle unit. 3D coordinates of specific anatomical landmarks (weightbearing points of the calcaneus, of the first and fifth metatarsal heads and the highest and centermost point on the talar dome) were collected. These data were processed with the TALAS system (CurveBeam), which resulted in an FAO value for each case. Intraobserver and interobserver reliability were also assessed. Results: In normal cases, the mean value for FAO was 2.3% ± 2.9%, whereas in varus and valgus cases, the mean was −11.6% ± 6.9% and 11.4% ± 5.7%, respectively, with a statistically significant difference among groups (P < .001). The distribution of the normal population was Gaussian. The inter-and intraobserver reliability were 0.99 +/-0.00 and 0.97 +/-0.02 Conclusions: This pilot study suggests that the FAO is an efficient tool for measuring hindfoot alignment using WBCT. Previously published research in this field has looked at WBCT by adapting 2D biometrics. The present study introduces the concept of 3D biometrics and describes an efficient, semiautomatic tool for measuring hindfoot alignment. Level of Evidence: Level III, retrospective comparative study.

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“…Congenital and acquired abnormalities of the foot and ankle are often associated with a varus or valgus misalignment of the hindfoot [1][2][3]. Hindfoot alignment is first estimated clinically during the physical examination, and is subsequently quantified on radiographs as a basis for treatment decisions, preoperative planning, and monitoring of the postoperative course [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

et al. 2012

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OBJECTIVE: To establish a hindfoot alignment measurement technique based on low-dose biplanar radiographs and compare with hindfoot alignment measurements on long axial view radiographs, which is the current reference standard. MATERIALS AND METHODS: Long axial view radiographs and low-dose biplanar radiographs of a phantom consisting of a human foot skeleton embedded in acrylic glass (phantom A) and a plastic model of a human foot in three different hindfoot positions (phantoms B1-B3) were imaged in different foot positions (20°internal to 20°external rotation). Two independent readers measured hindfoot alignment on long axial view radiographs and performed 3D hindfoot alignment measurements based on biplanar radiographs on two different occasions. Time for three-dimensional (3D) measurements was determined. Intraclass correlation coefficients (ICC) were calculated. RESULTS: Hindfoot alignment measurements on long axial view radiographs were characterized by a large positional variation, with a range of 14°/13°valgus to 22°/27°varus (reader 1/2 for phantom A), whereas the range of 3D hindfoot alignment measurements was 7.3°/6.0°to 9.0°/10.5°varus (reader 1/2 for phantom A), with a mean and standard deviation of 8.1°± 0.6/8.7°± 1.4 respectively. Interobserver agreement was high (ICC = 0.926 for phantom A, and ICC = 0.886 for phantoms B1-B3), and agreement between different readouts was high (ICC = 0.895-0.995 for reader 1, and ICC = 0.987-0.994 for reader 2) for 3D measurements. Mean duration of 3D measurements was 84 ± 15/113 ± 15 s for reader 1/2. CONCLUSION: Three-dimensional hindfoot alignment measurements based on biplanar radiographs were independent of foot positioning during image acquisition and reader independent. In this phantom study, the 3D measurements were substantially more precise than the standard radiographic measurements. Conclusion. 3D hindfoot alignment measurements based on biplanar radiographs were independent of foot-positioning during image acquisition and readerindependent. In this phantom study, the 3D measurements were substantially more precise than the standard radiographic measurements.

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CT Analysis of Hindfoot Alignment in Chronic Lateral Ankle Instability

Cited by 114 publications

References 19 publications

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

3D Biometrics for Hindfoot Alignment Using Weightbearing CT

Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

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