Relationship between talofibular impingement and increased talar tilt in incongruent varus ankle osteoarthritis

Abstract

Purpose This study aimed to evaluate the relationship between talofibular impingement and increased talar tilt in incongruent varus ankle osteoarthritis. Methods: Incongruent varus ankle osteoarthritis was defined as a talar tilt of more than 4° on standard ankle anteroposterior radiographs. We retrospectively reviewed 30 patients with unilateral incongruent varus ankle osteoarthritis with normal alignment of the contralateral ankle. All patients underwent bilateral weightbearing computed tomography and standing plain radiographs. The talar tilt and the distance between the talar lateral process and lateral malleolar tip were measured from a standing ankle anteroposterior radiograph of both sides. Talar and fibular spurs were assessed on the coronal and axial views of weightbearing computed tomography. After simulating the correction of the talar tilt in varus ankle osteoarthritis, talofibular bony impingement was reassessed. Results: On the varus side, the distance between the talar lateral process and the lateral malleolar tip was significantly shorter than that on the contralateral side ( p < .001). Talar spur was present in the varus side of all 30 patients on the axial view of weightbearing computed tomography and in the control side of 10 patients. After the simulation of talar tilt correction, talofibular impingement (overlap) occurred in all 30 patients with a larger extent in the severe talar tilt subgroup ( p < .001). Conclusion: Talofibular impingement by lateral gutter osteophytes is closely related to increased talar tilt in patients with incongruent varus ankle osteoarthritis. Therefore, lateral gutter osteophytes should be resected to stabilize mortise and improve clinical outcomes.

Functional gait analysis reveals insufficient hindfoot compensation for varus and valgus osteoarthritis of the knee

“…In the present study, the ankle alignment was also evaluated radiologically to screen for signs of osteoarthritis. Contrary to Tallroth's study, the mean TT was physiologic in both groups [33]. Nevertheless, measurements of the TT indicated that in valgus patients, the TT was oriented in valgus and in varus patients, and the TT was oriented in varus.…”

“…And in the varus group, the TT was oriented in varus (Table 2). Albeit the TT was significantly different between both groups, it was not pathological for neither of one of the groups [33]. Correlation analysis revealed that the TT significantly correlated with the mTFA (Pearson's cor = 0.32, p < 0.006) indicating that higher grades of valgus at the knee joint were associated with higher grades of valgus malalignment at the ankle joint and vice versa (Fig.…”

Development of a clinically useful multi‐segment kinetic foot model

“…Additionally, the midfoot lacks a typical movement pattern during a gait cycle in our sample likely because it is supposed to be stable in healthy individuals during walking, especially in the frontal and transverse planes. The midfoot is worth tracking clinically since reduced or increased mobility of the midfoot during walking can suggest pathological gait when compared to healthy controls [3, 19, 24].…”

Pressure change at ankle joint in supramalleolar osteotomy with or without fibular osteotomy according to different types of varus ankle

“…Although both stages 3a and 3b of arthritis are included in stage 3 of the modified Takakura's classification, their pathological characteristics and prognosis after joint preserving procedures, including supramalleolar osteotomy (SMO) and calcaneal osteotomy, are significantly different. [5][6][7] SMO is a representative joint preserving procedure, and this procedure is commonly performed with or without a fibular osteotomy (FO). SMO is effective in correcting the load axis of varus deformity and the articular surface at the distal ankle joint.…”

“…Several previous studies have reported good results in SMO without FO, [11][12][13] however, some studies have even reported good clinical results in SMO with FO. 4,5 Although several studies have reported the effectiveness of additional FO in SMO, they could not clearly establish the clinically necessary and definite indication of FO in performing SMO. Although, as a biomechanical method, some previous studies have conducted cadaveric studies, 14,15 the pathological characteristics of VAA may not be accurately reflected on cadavers, such as a quantitative tilting angle grade in the talotibial joint interface and amount of talus translation.…”