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Foot Ankle Surg. 2018 Nov 5. pii: S1268-7731(18)30301-1. doi: 10.1016/j.fas.2018.10.008. [Epub ahead of print]

Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations.

Author information

1
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States; Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States. Electronic address: cesardecesarnetto@gmail.com.
2
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States.
3
Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
4
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States; Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States.
5
Foot and Ankle Surgery Department, Clinique de l'Union, Saint-Jean, Toulouse, France.
6
Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States.

Abstract

BACKGROUND:

Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging and weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Therefore, we compared clinical and WB CBCT assessment of HA in patients with AAFD.

METHODS:

In this prospective study, we included 12 men and 8 women (mean age: 52.2, range: 20-88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using intra-class correlation (ICC). Measurements were compared by paired T-tests, and p-values of less than 0.05 were considered significant.

RESULTS:

The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5-18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9-11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3-5.0) degrees; Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3-7.8) degrees; Tibial axis/Subtalar Joint Angle 7.0 (CI: 5.3-8.8) degrees, and Hindfoot Alignment Angle 22.8 (CI: 20.4-25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87-0.97) and inter-observer agreements (ICC range: 0.51-0.88) for all WB CBCT measurements.

CONCLUSIONS:

Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. We found the different CT measurements to be reliable and repeatable, and to significantly differ from the clinical evaluation of hindfoot valgus alignment.

LEVEL OF EVIDENCE:

Level II-prospective comparative study.

KEYWORDS:

Adult acquired flatfoot deformity; Cone beam CT; Flatfoot; Hindfoot alignment; Weightbearing; Weightbearing CT

PMID:
30455094
DOI:
10.1016/j.fas.2018.10.008

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