Pes cavovarus in Charcot-Marie-Tooth compared to the idiopathic cavovarus foot: A preliminary weightbearing CT analysis

Bernasconi, Alessio; Cooper, Lucy; Lyle, Shirley; Patel, Shelain; Cullen, Nicholas; Singh, Dishan; Welck, Matthew

doi:10.1016/j.fas.2020.04.004

Cited by 26 publications

(16 citation statements)

References 34 publications

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“…Previous work using WBCT transformed our understanding of the adult acquired flat foot deformity. 4,14 In application to CMT pes cavovarus, Bernasconi et al 2 used WBCT to identify increased supination of the midfoot associated with CMT cases, compared to idiopathic cavovarus feet or neutrally aligned controls. However, whether this difference arose from abnormal osteology or joint malalignment, from single or multiple segments of the foot, remained unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Although this analysis revealed distinct differences in the talonavicular (TN) articulation relative to global foot alignment, it did not assess for abnormalities beyond the TN joint. Bernasconi et al 2 studied CMT cavovarus foot, idiopathic cavovarus foot and neutral control subjects, using various morphologic and alignment parameters for WBCT. These results identified a severe supination deformity among CMT patients but lacked further characterization of its anatomic components.…”

Section: Introductionmentioning

confidence: 99%

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Cavovarus With a Twist: Midfoot Coronal and Axial Plane Rotational Deformity in Charcot-Marie-Tooth Disease

Haupt

Michalski

et al. 2022

Foot Ankle Int.

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Background: The cavovarus deformity of Charcot-Marie-Tooth (CMT) disease is often characterized by a paradoxical relationship of hindfoot varus and forefoot valgus. The configuration of the midfoot, which links these deformities, is poorly understood. Accurate assessment of 3-dimensional alignment under physiologic loadbearing conditions is possible using weightbearing computed tomography (WBCT). This is the first study to examine the rotational deformity in the midfoot of CMT patients and, thus, provide key insights to successful correction of CMT cavovarus foot. Methods: A total of 27 WBCT scans from 21 CMT patients were compared to control WBCTs from 20 healthy unmatched adults. CMT patients with a history of bony surgery, severe degenerative joint disease, or open physes in the foot were excluded. Scans were analyzed using 3-dimensional software. Anatomic alignment of the tarsal bones was calculated relative to the anterior-posterior axis of the tibial plafond in the axial plane, and weightbearing surface in the coronal plane. Results: Maximal rotational deformity in CMT patients occurred at the transverse tarsal joints, averaging 61 degrees of external rotation (supination), compared to 34 degrees among controls ( P < .01). The talonavicular joint was also the site of peak adduction deformity in the midfoot, with an average talonavicular coverage angle measuring 12 degrees compared with −11 degrees in controls ( P < .01). Conclusion: This 3-dimensional WBCT analysis is the first to isolate and quantify the multiplanar rotational deformity in the midfoot of CMT patients. Compared with healthy unmatched control cases, CMT patients demonstrated increased axial plane adduction and coronal plane rotation at the talonavicular (TN) joint. These findings support performing soft tissue release at the TN joint to abduct and derotate the midfoot as a first step for targeted deformity correction. Level of Evidence: Level III, retrospective case-control study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cavovarus With a Twist: Midfoot Coronal and Axial Plane Rotational Deformity in Charcot-Marie-Tooth Disease

Haupt

Michalski

et al. 2022

Foot Ankle Int.

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“…Fourth, our study introduces a novel measurement method utilizing WBCT to assess hindfoot alignment, which may add clarity or even confusion to existing measurement techniques. Prior studies have described hindfoot alignment measurements utilizing WBCT, such as foot ankle offset, calcaneus offset, hindfoot alignment angle, 6 talar shift, and talocalcaneal alignment. 10 Although the authors find these parameters useful and well defined, they are not directly comparable to the radiographic measurement of calcaneal moment arm in HAV radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, WBCT provides more clinically useful information concerning alignment as it is performed under natural standing conditions. 2,[17][18][19][20]22,23,28,33,34,47 Multiple parameters have been previously used to assess the hindfoot alignment on WBCT, including the foot ankle offset, 5,6,17,19,23,29,[33][34][35]47 calcaneal offset, 5,6,19,29,35 and hindfoot alignment angle. 5,6,10,30 Although WBCT offers the theoretical benefits of increased accuracy present in crosssectional imaging coupled with physiologic alignment under weightbearing conditions, this technology is currently less prevalent in orthopedic clinics across the community where HAV radiographs are generally utilized.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography

et al. 2021

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Background: Hindfoot alignment view (HAV) radiographs are widely utilized for 2-dimensional (2D) radiographic assessment of hindfoot alignment; however, the development of weightbearing computed tomography (WBCT) may provide more accurate methods of quantifying 3-dimensional (3D) hindfoot alignment. The aim of this study was to compare the 2D calcaneal moment arm measurements on HAV radiographs with WBCT. Methods: This retrospective cohort study included 375 consecutive patients with both HAV radiographs and WBCT imaging. Measurement of the 2D hindfoot alignment moment arm was compared between both imaging modalities. The potential confounding influence of valgus/varus/neutral alignment, presence of hardware, and motion artifact were further analyzed. Results: The intraclass correlation coefficients (ICCs) of interobserver and intraobserver reliability for measurements with both imaging modalities were excellent. Both modalities were highly correlated (Spearman coefficient, 0.930; P < .001). HAV radiographs exhibited a mean calcaneal moment arm difference of 3.9 mm in the varus direction compared with WBCT (95% CI, –4.9 to 12.8). The difference of hindfoot alignment between both modalities was comparable in subgroups with neutral/valgus/varus alignment, presence of hardware, and motion artifact. Conclusion: Both HAV radiographs and WBCT are highly reliable and highly correlated imaging methods for assessing hindfoot alignment. Measurements were not influenced by severe malalignment, the presence of hardware, or motion artifact on WBCT. On average, HAV radiographs overestimated 3.9 mm of varus alignment as compared with WBCT. Level of Evidence: Level III, retrospective comparative study.

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“…5 Weightbearing CT (WBCT) is taken in a physiologic, weightbearing stance that affords a functional representation of the deformity, which has helped advance our assessment of the deformity. 2,22 Existing measurements described in the literature for use with WBCT 4 are assessed on best-fit axial, coronal, and sagittal slices that may therefore be susceptible to some of the same flaws affecting weightbearing radiographic measurements discussed above. For this reason, semiautomated measurements done by plotting coordinates in multiple planes have been used to assess the 3D bony anatomy in order to gain an understanding of complex foot deformity not previously possible with 2D methods of assessment.…”

Section: Introductionmentioning

confidence: 99%

2D Manual vs 3D Automated Assessment of Alignment in Normal and Charcot-Marie-Tooth Cavovarus Feet Using Weightbearing CT

et al. 2022

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Background: The complex deformities in cavovarus feet may be difficult to assess and understand. Weightbearing computed tomography (WBCT) is increasingly used in evaluating complex deformities. However, the bone axes may be difficult to calculate in the setting of severe deformity. Computer-assisted 3D axis calculation is a novel approach that may allow for more accurate assessment of foot alignment or deformity. This study aimed to assess differences in measurements done manually on 2D slices of WBCT vs 3D computer models in normal and cavus feet. Methods: We retrospectively analyzed WBCT scans from 16 normal and 16 cavus feet in patients with Charcot-Marie-Tooth disease. Six measurements were assessed: talar–first metatarsal angle (axial plane), forefoot arch angle (coronal plane), and Meary angle, calcaneal pitch, and cuneiform and navicular to floor distances (sagittal plane). 2D measurements were performed manually and 3D measurements were performed using specialized software (Bonelogic, DISIOR). Bland-Altman plots and linear regression were used to analyze differences. Results: There were no significant biases in measured variables in normal feet. In the cavovarus group, automated assessment calculated increased sagittal plane deformity (fixed bias 7.31 degrees for Meary angle, 2.39 degrees for calcaneal pitch) and less axial plane deformity (fixed bias 10.61 degrees for axial talar–first metatarsal angle). The latter also demonstrated proportional bias indicating greater discrepancy with increasing adduction. Conclusion: Measurements were comparable in normal feet suggesting automated techniques can reliably assess the alignment of bony axes. However, automated calculations show greater sagittal and less axial deformity in cavovarus feet than measured by manual techniques. This discrepancy may relate to rotational deformity seen in cavovarus feet, which may not be easily assessed manually. 3D automated measurements may therefore play a role in better assessing and classifying the cavovarus foot, which may ultimately inform treatment algorithms. Level of Evidence: Level III, retrospective comparative study.

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Pes cavovarus in Charcot-Marie-Tooth compared to the idiopathic cavovarus foot: A preliminary weightbearing CT analysis

Cited by 26 publications

References 34 publications

Cavovarus With a Twist: Midfoot Coronal and Axial Plane Rotational Deformity in Charcot-Marie-Tooth Disease

Cavovarus With a Twist: Midfoot Coronal and Axial Plane Rotational Deformity in Charcot-Marie-Tooth Disease

Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography

2D Manual vs 3D Automated Assessment of Alignment in Normal and Charcot-Marie-Tooth Cavovarus Feet Using Weightbearing CT

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