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

Cesar de Cesar Netto; Delaram Shakoor; Lauren Roberts; Apisan Chinanuvathana; Alireza Mousavian; Francois Lintz; Lew C Schon; Shadpour Demehri

doi:10.1016/j.fas.2018.10.008

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

Journal article

Peer reviewed

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

Cesar de Cesar Netto, Delaram Shakoor, Lauren Roberts, Apisan Chinanuvathana, Alireza Mousavian, Francois Lintz, Lew C Schon and Shadpour Demehri

Foot and ankle surgery, Vol.25(6), pp.790-797

12/2019

DOI: 10.1016/j.fas.2018.10.008

PMID: 30455094

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Abstract

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. 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. 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. 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 II-prospective comparative study.

Reproducibility of Results

Prospective Studies

Foot Deformities, Acquired - diagnosis

Humans

Middle Aged

Male

Cone-Beam Computed Tomography

Foot - diagnostic imaging

Young Adult

Aged, 80 and over

Physical Examination

Adult

Female

Weight-Bearing

Aged

Imaging, Three-Dimensional

Flatfoot - diagnosis

Details

Title: Subtitle: Hindfoot alignment of adult acquired flatfoot deformity: A comparison of clinical assessment and weightbearing cone beam CT examinations
Creators: Cesar de Cesar Netto - 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
Delaram Shakoor - Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States
Lauren Roberts - Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States
Apisan Chinanuvathana - 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
Alireza Mousavian - 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
Francois Lintz - Foot and Ankle Surgery Department, Clinique de l'Union, Saint-Jean, Toulouse, France
Lew C Schon - Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, United States
Shadpour Demehri - Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, United States
Resource Type: Journal article
Publication Details: Foot and ankle surgery, Vol.25(6), pp.790-797
DOI: 10.1016/j.fas.2018.10.008
PMID: 30455094
NLM abbreviation: Foot Ankle Surg
ISSN: 1268-7731
eISSN: 1460-9584
Publisher: France
Grant note: name: Carestream, Inc.; DOI: 10.13039/100012630, name: Zimmer/Biomet; name: Tornier; name: Wright Medical); name: Bonfix; name: Guidepoint Global; name: Gerson Lehrman Group; name: Spinesmith Celling Bioscience; name: Bioactive Surgical; name: Concepts in Medicine LLC; DOI: 10.13039/100013622, name: OMEGA; name: Smith & Nephew; name: Elsevier-publishing textbook royalty
Language: English
Date published: 12/2019
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984040374002771

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