New Radiographic Parameters Assessing Forefoot Abduction in the Adult Acquired Flatfoot Deformity

Ellis, Scott J.; Yu, Jonathan S.; Williams, Benjamin R.; Lee, Cheol; Chiu, Ya-lin; Deland, Jonathan T.

doi:10.3113/fai.2009.1168

Cited by 83 publications

(106 citation statements)

References 11 publications

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“…Additionally, preoperative measurements of the lateral talonavicular incongruency angle, talonavicular coverage angle, and talo-first metatarsal angle did not differ significantly between the hindfoot moment groups indicating similar preoperative abduction deformity (Table 3). 7 Postoperative hindfoot alignment radiographs were taken at an average of 23.5 months (range, 12 to 47 months), and FAOS scores were obtained after an average of 3.1 years postoperatively (range, 1.8 to 4.4 years).…”

Section: Resultsmentioning

confidence: 99%

Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity

et al. 2015

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Background While previous work has demonstrated a linear relationship between the amount of medializing calcaneal osteotomy (MCO) and the change in radiographic hindfoot alignment following reconstruction, an ideal postoperative hindfoot alignment has yet to be reported. The aim of this study was to identify an optimal postoperative hindfoot alignment by correlating radiographic alignment with patient outcomes. Methods Fifty-five feet in 55 patients underwent flatfoot reconstruction for stage II AAFD by two fellowship-trained foot and ankle orthopedic surgeons. Hindfoot alignment was determined as previously described by Saltzman and El-Khoury. Changes in pre- and postoperative scores in each FAOS subscale were calculated for patients in postoperative hindfoot valgus (≥0 mm valgus, n=18), mild varus (>0 to 5 mm varus, n=17), and moderate varus (>5 mm varus, n=20). Analysis of variance and post-hoc Tukey’s tests were used to compare the change in FAOS scores between these three groups. Results At 22 months or more postoperatively, patients corrected to mild hindfoot varus showed a significantly greater improvement in the FAOS pain subscale compared to patients in valgus (p=0.04) and symptoms subscale compared to patients in moderate varus (p=0.03). Although mild hindfoot varus did not differ significantly from moderate varus or valgus in the other subscales, mild hindfoot varus did not perform worse than these alignments in any FAOS subscale. No statistically significant correlations between intraoperative MCO slide distances and FAOS subscales were found. Conclusions Our study indicates that correction of hindfoot alignment to between 0 and 5 mm of varus on the hindfoot alignment view (clinically a straight heel) following stage II flatfoot reconstruction was associated with the greatest improvement in clinical outcomes following hindfoot reconstruction in stage II AAFD.

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Section: Resultsmentioning

confidence: 99%

Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity

et al. 2015

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“…This difficulty stems from the fact that visualization of the anterior calcaneus is not always consistent, the hardware often obscures the bony interfaces, and the interface between the graft and calcaneus can remain apparent even when there appears to be bony bridging. It is unclear to what extent bony bridging must be present to consider the graft "healed" [13]. Furthermore, routine radiographs were generally only obtained at standard times postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Autograft and Allograft Unite Similarly in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity

Ellis

O’Malley

Elliott

et al. 2013

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…The TUC angle was considered positive when the line connecting the edges of the navicular articular surface intersected the line connecting the edges of the talar head articular surface lateral to the talonavicular joint (Figure 1b). Lateral incongruency angle was measured as described previously by Ellis et al (2009) (Figure 1c) 6 . The incongruency angle is determined from the intersection of a line beginning at the lateral most aspect of the talar articular surface (Point A) and extending to the most lateral extent of the navicular articular surface (Point C) with a line drawn from the lateral most aspect of the narrowest part of the talar neck (Point B) to Point A 6 .…”

Section: Methodsmentioning

confidence: 99%

Correlation of Postoperative Midfoot Position With Outcome Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity

et al. 2015

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Background No studies investigating the effect of midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from AP radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). Methods Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors’ institution that underwent flatfoot reconstruction for stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with two or more measurements in the abduction category were classified as the abduction group (n=30); those with one or fewer measurements in the abduction category were placed in the adduction group (n=25). Preoperative FAOS and postoperative FAOS with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. Results Patients corrected to a position of adduction showed a significantly lower improvement in the FAOS daily activities (p=0.012) and quality of life subscales (p=0.046). Mean improvement in subscale score for the adducted group was lower for pain (p=0.052) and sports activities (p=0.085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (p=0.372) between groups was found. Conclusions Correction of the talonavicular joint to a position of adduction following stage II AAFD is associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in the reconstruction of stage II AAFD. Level of Evidence Therapeutic Level III

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New Radiographic Parameters Assessing Forefoot Abduction in the Adult Acquired Flatfoot Deformity

Abstract: This data suggests that the IA is reliable and may help subclassify Stage II flatfoot deformity.

Cited by 83 publications

References 11 publications

Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity

Optimal Position of the Heel Following Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity

Autograft and Allograft Unite Similarly in Lateral Column Lengthening for Adult Acquired Flatfoot Deformity

Correlation of Postoperative Midfoot Position With Outcome Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity

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