Inter- and Intraobserver Reliability in the Radiographic Evaluation of Adult Flatfoot Deformity

Sensiba, Paul R; Coffey, Michael J.; Williams, Nathan E; Mariscalco, Michael W.; Laughlin, Richard T.

doi:10.3113/fai.2010.0141

Cited by 90 publications

(58 citation statements)

References 8 publications

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“…The averages of the first and second measurement were calculated and were used in all subsequent analyses. Intraclass correlation coefficients between the initial and second set of measurements were calculated and ranged from 0.61 to 0.99 (Table 1), similar to those obtained in other examinations of foot morphology (Sensiba et al 2010;Younger et al, 2011;Mall et al, 2006). The Kruskal-Wallis test was used to detect differences in measurements between sexes.…”

Section: Methodsmentioning

confidence: 50%

Linear and Angular Measurements of the Foot of Modern Humans: A Test of Morton'S Foot Types

Lautzenheiser

Kramer

2013

The Anatomical Record

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In his classic research, Morton established two functionally different configurations of the bipedal and non-bipedal primate foot: one optimized for stability, with a stiff longitudinal arch and adducted first metatarsal, and the other for compliance. Modern human feet were seen as conforming to the bipedal norm and variation from it as pathology, even though clinical evidence has been clear that variation from the norm of a stiff longitudinal arch or adducted first metatarsal exists. This study aims to document the variation in linear and angular measurements of the foot, using weight-bearing radiographs of 50 randomly selected people (25 men) from an urban US Level 1 trauma center. The radiographs were obtained to "rule-out" a foot fracture after trauma or as comparison films for a contralateral foot injury. Measurements were made using Osirix and correlations among the angular and length measurements were determined using Stata with P < 0.05 and Bonferroni correction for multiple comparisons. We found that foot length was not correlated with angular measurements, except for the angle between the first and fifth metatarsal. People with lower medial longitudinal arches also had more abducted first metatarsals and more vertical posterior facets, in accordance with Morton's foot types. Whether or not this variation in modern humans is linked to functionally important consequences remains to be determined in future research. With the new evidence of a more variable foot structure in fossil hominins, understanding the relationship between foot morphology and function becomes more urgent. Anat Rec, 296:1526Rec, 296: -1533Rec, 296: , 2013. V C 2013 Wiley Periodicals, Inc.Key words: Morton's foot types; arch; angles Conventional wisdom has dictated for almost a century that to be effective, the bipedal foot of a hominin is required to have both a medial longitudinal arch and an adducted (or in-line) first metatarsal (Morton, 2007; Elftman and Manter, 2009). This belief originated in the presence of clinical experience which indicated that many modern human feet are flat (planus) and/or have first metatarsals that substantially diverge from the longitudinal axis of the foot (Morton, 1924a,b) and that these conditions are associated with pain and dysfunction. With this paradigm in place, the extremes of variability in foot morphology of humans have been generally understood as representative of inherent pathology (Kanatli et al., 2012; Pique-Vidal, 1924d) and, therefore, not of interest in understanding the evolution and function of foot

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Section: Methodsmentioning

confidence: 50%

Linear and Angular Measurements of the Foot of Modern Humans: A Test of Morton'S Foot Types

Lautzenheiser

Kramer

2013

The Anatomical Record

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“…While Younger et al (14) reported that the TFMA was an accurate radiographic identifier, Sensiba et al (15) suggested that CPA had a higher interobserver reliability. The relationships of the PAL method with CPA, LTCA, and TFMA were examined in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are many studies comparing the radiological measures for diagnosing flatfoot (8,(13)(14)(15), there is no consensus on the radiologic evaluation of the MLA. While Younger et al (14) reported that the TFMA was an accurate radiographic identifier, Sensiba et al (15) suggested that CPA had a higher interobserver reliability.…”

Section: Discussionmentioning

confidence: 99%

“…Sensiba et al (15) reported that the CPA had the highest interobserver reliability compared to other radiologic measurements for the radiologic quantification of adult-acquired flatfoot deformity, which is a difficult condition to quantify radiographically. CPA is the preferred method for the determination of the pes planus and cavus in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Calcaneal Pitch Angle and Modified Projection Area Per Length Squared Method for Medial Longitudinal Arch Evaluation of the Foot

Akdoğan¹,

Akkaya²,

Akkaya³

et al. 2012

Balkan Med J

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Objective: To compare the calcaneal pitch angle (CPA) values measured on direct lateral radiographs of feet, and the modified projection area per length squared (PAL), which was calculated as a new method for the evaluation of the medial longitudinal arch (MLA) of the foot.Material and Methods: Direct lateral radiographs of patients who had weightbearing feet radiographies for any reason except trauma were retrospectively obtained from the archives. Direct lateral radiographs of the feet were printed and a transparent sheet was placed on it. A straight line was drawn between the most plantar process of the calcaneus and the head of the first metatarsal bone for the calculation of the PAL of the MLA. Two semilunar arcs were drawn upon this straight line. PAL1 and PAL2 were estimated using a point-counting technique. The CPA, lateral talo-calcaneal angles (LTCA), and talo-first metatarsal angles (TFMA) were measured. The correlations between PAL1, PAL2 of right and left feet and CPA, LTCA, and TFMA were explored.Results: Fifty patients (27 females, 23 males) with a mean age of 40.12 (4-78) years were evaluated. Significant correlations were detected between PAL1, PAL2 and CPA, and TFMA for both right and left feet (p<0.05).Conclusion: A significant correlation was detected between the modified PAL method as a new technique and the standard CPA method for MLA evaluation. The PAL method is suggested as a simple and practical method for MLA evaluation.

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“…Ankle anteroposterior radiography excluded the possibility of valgus at the talotibial joint evidenced by talar tilt in the ankle mortise [8]. In the anteroposterior view of the foot the anterior talocalcaneal angle (TCA1) or Kite's angle, talonavicular angle (TNA), talonavicular coverage angle (TNCA), and anterior talo-first metatarsal angle (TFMA1) were measured.…”

Section: Radiographic Assessmentmentioning

confidence: 99%

Double Column Foot Osteotomy to Correct Flexible Valgus Foot Deformity in Children with Spastic Cerebral Palsy

Bishay¹,

Morshed²,

Tarraf³

et al. 2016

Clin Res Foot Ankle

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Backgound: Mobile (flexible or correctable) hindfoot valgus deformity is common in children with spastic cerebral palsy (CP). It is accompanied by short lateral and long medial foot column. Patients and Methods:Eleven ambulatory children (20 feet) suffering spastic cerebral palsy (CP), two hemiplegic and nine diplegic, presenting with mobile (flexible) hindfoot valgus deformity, were evaluated neurologically, orthopaedically, and radiographically, and operated upon in the National Institute of Neuromotor System between September 2012 and September 2013. Double column foot osteotomy with medial cuneiform closing-wedge and cuboid opening-wedge without attacking the calcaneus was performed in all of them. Results:The results were followed-up clinically and radiographically over a period ranging from a year and half (18 months) to two years (24 months) with an average of a year and 9 months (21 months), and were graded into four categories as excellent, good, fair, and poor according to the total calculated score. According to the suggested grading system, there were 8 excellent results, 8 good results, 4 fair results, and no poor results. Conclusion:Double column foot osteotomy shortening the medial foot column and lengthening the lateral foot column to correct moderate to severe hindfoot valgus in ambulatory children with spastic cerebral palsy (CP), compared favourably with similar series, and offered option for achieving foot alignment, improving pain and skin problems and avoiding the problems associated with arthrodesis. Level of Evidence:The study is type IV therapeutic level of evidence.

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Inter- and Intraobserver Reliability in the Radiographic Evaluation of Adult Flatfoot Deformity

Cited by 90 publications

References 8 publications

Linear and Angular Measurements of the Foot of Modern Humans: A Test of Morton'S Foot Types

Linear and Angular Measurements of the Foot of Modern Humans: A Test of Morton'S Foot Types

Comparison of the Calcaneal Pitch Angle and Modified Projection Area Per Length Squared Method for Medial Longitudinal Arch Evaluation of the Foot

Double Column Foot Osteotomy to Correct Flexible Valgus Foot Deformity in Children with Spastic Cerebral Palsy

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