Journal article
The Effect of Progressive Lateral Column Lengthening in a Novel Stage II-B Flatfoot Cadaveric Model Evaluated Using Software-Guided Radiographic Measurements of Foot Alignment
Foot & ankle international, Vol.43(8), pp.107110072210918-1109
05/24/2022
DOI: 10.1177/10711007221091817
Abstract
Background:
This work used software-guided radiographic measurement to assess the effects of progressive lateral column lengthening (LCL) on restoring alignment in a novel cadaveric model of stage II-B flatfoot deformity.
Methods:
A stage II-B flatfoot was created in 8 cadaveric specimens by transecting the spring ligament complex, anterior deltoid, and interosseous talocalcaneal and cervical ligaments. Weightbearing computed tomographic (WBCT) scans were performed with specimens under 450 N of compressive load in the intact, flat, and 6-, 8-, and 10-mm lateral column–lengthening conditions. Custom software-guided radiographic measurements of the lateral talo–first metatarsal (Meary) angle, anteroposterior talo–first metatarsal angle, naviculocuneiform overlap, and 2 new measures (plantar fascia [PF] distance and angle) were recorded on digitally reconstructed radiographs. Four anonymized analysts performed measurements twice. Intra- and interobserver agreement was assessed using intraclass correlation coefficients (ICCs).
Results:
Six-millimeter LCL restored alignment closest to the intact foot in this new cadaveric model, whereas 10-mm lengthening tended toward overcorrection. The PF line displaced laterally in the flatfoot condition, and LCL restored the PF line to a location beneath the talonavicular joint. Interobserver agreement was excellent for PF distance (ICC = 0.99) and naviculocuboid overlap (ICC = 0.91), good for Meary angle (ICC = 0.81) and PF angle (ICC = 0.69), and acceptable for the talonavicular coverage angle (ICC = 0.65).
Conclusion:
In this stage II-B cadaveric flatfoot model, cervical ligament transection was essential to create deformity after the medial hindfoot ligaments were transected. Software-guided radiographic measurement proved reliable; standardized implementation should improve comparability between studies of flatfoot deformity. The novel PF distance performed most consistently (ICC = 0.99) and warrants further study. With this model, we found that a 6-mm LCL restored alignment closest to the intact foot, whereas 10-mm lengthening tended toward overcorrection.
Clinical Relevance:
Future joint-sparing flatfoot corrections may consider using a relatively small LCL combined with other bony and/or anatomic ligament/tendon reconstructions.
Details
- Title: Subtitle
- The Effect of Progressive Lateral Column Lengthening in a Novel Stage II-B Flatfoot Cadaveric Model Evaluated Using Software-Guided Radiographic Measurements of Foot Alignment
- Creators
- John E. Femino - University of IowaAndrew Kern - University of IowaRoss Schumer - UnitedHealth GroupChristopher Anthony - Annenberg Public Policy CenterAdam J. Kruse - Brooke Army Medical Center, Fort Sam Houston, TX, USAJessica Goetz - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Foot & ankle international, Vol.43(8), pp.107110072210918-1109
- DOI
- 10.1177/10711007221091817
- ISSN
- 1071-1007
- eISSN
- 1944-7876
- Language
- English
- Date published
- 05/24/2022
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation
- Record Identifier
- 9984303982802771
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