Prevalence and pattern of lateral impingements in the progressive collapsing foot deformity

Lalevée, Matthieu; Mansur, Nacime Salomão Barbachan; Rojas, Edward O; Lee, Hee Young; Ahrenholz, Samuel J.; Dibbern, Kevin; Lintz, François

doi:10.1007/s00402-021-04015-7

Cited by 21 publications

(28 citation statements)

References 21 publications

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“…Multiplanar weight-bearing CT has already proven its superiority in assessing subtalar joint subluxation [29][30][31][32], and subfibular impingement [16,33]. Adding a weight-bearing CT assessment in our readings may improve the reliability of this class [18,[34][35][36][37][38]. In the original PCFD publication [13], it is also unclear whether the presence of sinus tarsi impingement should be considered as peritalar subluxation (Class D) or midfoot abduction (Class B) sign.…”

Section: Discussionmentioning

confidence: 98%

“…This confusion might have decreased our reliability among readers. Lalevee et al [18] showed that sinus tarsi impingements were associated with both midfoot abduction and peritalar subluxation. Therefore, sinus tarsi impingement should be integrated into Class B and Class D. This might also reflect the fact that peritalar subluxation is not an independent deformity, as claimed by these authors, but rather a consequence of the other deformities.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, radiographic evidence of sclerosis on Gissane's angle in the Refined classification is associated with rigidity of the deformity (stage III) and a triple arthrodesis is suggested [3]. Malicky et al [16] showed that this sign was a consequence of sinus tarsi impingement, which is extraarticular [17], frequent [18], and independent of subtalar arthritis [16].…”

Section: Introductionmentioning

confidence: 99%

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A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

Lalevée

Mansur

Lee

et al. 2021

Arch Orthop Trauma Surg

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Introduction Bluman et al., flatfoot classification is based on posterior tibial tendon (PTT) dysfunction leading to a chronological appearance of several foot deformities. An expert consensus recently proposed a new classification named Progressive Collapsing Foot Deformity (PCFD) in which the focus was shifted to five different independent foot and ankle deformities and their flexibility or rigidity. The aim of this study was to compare Bluman and PCFD classifications. We hypothesize that both classifications will be reliable and that the PCFD classification will allow a larger distribution of the different types of foot deformity. Materials and methodsWe performed a retrospective IRB-approved study including 92 flatfeet. Three foot and ankle surgeons reviewed patient files and radiographs to classify each foot using both classifications. Bluman classification was performed one time as initially described and a second time after removing the Angle of Gissane sclerosis sign. Interobserver reliabilities were determined with Fleiss' kappa values. Results Interobserver reliabilities of Bluman and PCFD classifications were, respectively, substantial 0.67 and moderate 0.55. PCFD Class C and D reliabilities were, respectively, slight 0.07 and fair 0.28. The 276 readings were spread into 10 substages in Bluman and 65 subclasses in PCFD. The progressivity of the Bluman classification prevented the combination of flexible hindfoot valgus (II Bluman, 1A PCFD), midfoot abduction (IIB, 1B) and medial column instability (IIC, 1C) which was frequent in our study (112/276 readings, 40.6%). By removing the Angle of Gissane sclerosis sign from the Bluman classification, the prevalence of stage III decreased from 44.2 to 10.1%. Conclusions Bluman and PCFD classifications were reliable. The PCFD classification showed a larger distribution of different types of flatfeet but Classes C and D need better definition. The progressivity of Bluman classification causes inconsistencies and Gissane angle sclerosis sign is inappropriately used and might lead to incorrect surgical indications.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

Lalevée

Mansur

Lee

et al. 2021

Arch Orthop Trauma Surg

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“…The recent advent of weightbearing computed tomography (WBCT) allows for identification of bony impingement in the physiologic standing position. 6,19 WBCT has been shown to provide better sensitivity in detecting bony impingement, joint space narrowing, and malalignment compared to previous diagnostic modalities. 1,5,[15][16][17]19,20,23 However, WBCT is not yet available in all orthopaedic centers.…”

Section: Introductionmentioning

confidence: 99%

Radiographic Cutoff Values for Predicting Lateral Bony Impingement in Progressive Collapsing Foot Deformity

et al. 2022

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Background: Lateral bony impingement is a major cause of lateral foot pain in progressive collapsing foot deformity (PCFD). Weightbearing computed tomography (WBCT) provides better sensitivity than standard radiographs for detecting impingement. However, many orthopaedic centers have not yet acquired WBCT imaging. This study aimed to (1) investigate the correlation of common radiographic parameters measured on standard weightbearing radiographs with talocalcaneal and calcaneofibular distance assessed with WBCT and (2) establish radiographic cutoff values to detect bony impingement as identified on WBCT. Methods: Ninety-one patients treated for PCFD with standard preoperative radiographs and WBCT were identified. Patients with asymmetric ankle arthritis (talar tilt >2 degrees) were excluded. The talocalcaneal distance at the sinus tarsi and calcaneofibular distance were measured in multiplanar reconstructed WBCT images. Impingement was defined as direct abutment between bones. The relationships between WBCT measurements and 4 common parameters (talonavicular coverage angle [TNC], talo–first metatarsal angle, calcaneal pitch, and hindfoot moment arm [HMA]) in standard radiographs were assessed with Pearson correlations. Receiver operating characteristic curve analysis evaluated the ability of radiographic cutoffs to detect sinus tarsi or calcaneofibular bony impingement, and the area under curve (AUC), sensitivity, specificity, negative and positive predictive value (PPV) were calculated. Results: Talocalcaneal distance narrowing at the sinus tarsi strongly correlated with TNC ( r = 0.64, P < .001), and the calcaneofibular distance narrowing correlated with the HMA moderately yet best among the parameters ( r = 0.55, P < .001). TNC (AUC = 0.837, 95% CI 0.745-0.906) and HMA (AUC=0.959, 95% CI 0.895-0.989) provided the best predictive ability for sinus tarsi and calcaneofibular bony impingement, respectively. A TNC threshold of 41.2 degrees had a 100% PPV for predicting sinus tarsi impingement, whereas an HMA threshold of 38.1 mm had a 100% PPV for calcaneofibular impingement. Conclusion: This study provides evidence that TNC and HMA measurements made on standing radiographs could be used to indicate potential lateral bony impingement in PCFD. Narrowing of talocalcaneal distance best correlated with abduction deformity of the foot, and the narrowing of calcaneofibular distance was best correlated with valgus hindfoot deformity. Level of Evidence: Level III, case control study.

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“…Subsequently, Conti et al (13) showed that surgical correction of this hyperpronation in hallux valgus decreased recurrence and improved patient-reported outcomes. Beyond hallux valgus deformity, assessing the tarsal bones in the coronal plane in other foot conditions, such as progressive collapsing foot deformity, cavovarus, and clubfoot, has shown promise for improving understanding and treatment (14)(15)(16)(17) .…”

Section: Introductionmentioning

confidence: 99%

Reliability of coronal plane rotation measurements in the medial column of the foot: a cadaveric study

et al. 2021

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Objective: To assess interobserver reliability of previously described coronal plane rotation measurements of medial column bones and to assess their ability to accurately quantify changes in rotational profile. Methods: Two cadaveric below-knee specimens were implanted with pins in each bone of the medial column. Weight-bearing computed tomography (CT) scans were acquired in a simulated standing position under neutral, supinated, and pronated conditions. For each specimen and condition, 2 observers measured the coronal plane rotation of the navicular, medial cuneiform, first metatarsal base, shaft, and head, and proximal phalanx of the hallux as previously described. The rotation of each pin was measured relative to the ground in the coronal plane for each condition. These measurements were defined as benchmarks for the rotational profile of each bone. The correlation between these benchmarks and direct bone measurements was then assessed. Intraclass correlation coeficiente was used to assess interobserver reliability. Pearson’s coefficient was used to evaluate correlations. Results: The interobserver reliability of direct bone measurements ranged from 0.98 to 0.99. Correlations between pin rotation and direct measurements ranged from ρ=0.87 to 0.99 across the neutral, supinated, and pronated conditions. Conclusion: Coronal plane rotation measurements of medial column bones described in this study are reliable tools. Level of Evidence III; Case-Control Study.

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Prevalence and pattern of lateral impingements in the progressive collapsing foot deformity

Cited by 21 publications

References 21 publications

A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

A comparison between the Bluman et al. and the progressive collapsing foot deformity classifications for flatfeet assessment

Radiographic Cutoff Values for Predicting Lateral Bony Impingement in Progressive Collapsing Foot Deformity

Reliability of coronal plane rotation measurements in the medial column of the foot: a cadaveric study

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