Journal article
Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity
Foot & ankle international, Vol.42(6), pp.768-775
06/2021
DOI: 10.1177/1071100720982907
PMID: 33508965
Abstract
Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls.
In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm
). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed.
values of less than .05 were considered significant.
Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% (
< .001) in FAO and 10.4 mm
(
= .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 (
= .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm
.
To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm
. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening.
Level III, retrospective comparative study.
Details
- Title: Subtitle
- Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity
- Creators
- Elijah Auch - University of IowaNacime Salomao Barbachan Mansur - Universidade Federal de São PauloThiago Alexandre Alves - Federal University of Minas Gerais, Belo Horizonte, BrazilChristopher Cychosz - Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USAFrancois Lintz - Clinique de L'Union, Saint Jean, France.Alexandre Leme Godoy-Santos - University of Sao Paulo, Sao Paulo - BrazilDaniel Soares Baumfeld - Universidade Federal de Minas GeraisCesar de Cesar Netto - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Foot & ankle international, Vol.42(6), pp.768-775
- DOI
- 10.1177/1071100720982907
- PMID
- 33508965
- ISSN
- 1071-1007
- eISSN
- 1944-7876
- Language
- English
- Date published
- 06/2021
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984304725602771
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