Journal article
Tripod Index: A New Radiographic Parameter Assessing Foot Alignment
Foot & ankle international, Vol.34(10), pp.1411-1420
10/2013
DOI: 10.1177/1071100713488761
PMID: 23657663
Abstract
Background: No single radiographic measurement takes into account complete foot alignment. We have created the Tripod Index (TI) to allow assessment of complex foot deformities using a standing anteroposterior (AP) radiograph of the foot. We hypothesized that TI would demonstrate good intraobserver and interobserver reliability and correlate with currently accepted radiographic parameters, in both flatfoot and cavovarus foot deformities.
Methods: Three groups of patients were studied: 26 patients (30 feet) with flatfoot, 29 patients (30 feet) with cavovarus foot, and 51 patients (60 feet) without foot deformity as controls. Weight-bearing radiographs were obtained: foot AP with a hemispherical marker around the heel plus standard lateral and hindfoot alignment views. Radiographic measurements were made by 2 blinded investigators. Statistical analysis included intraclass correlation coefficients (ICCs), correlation of the TI with existing radiographic measurements using Pearson coefficients, and comparison between patient groups using analysis of variance.
Results: Intraobserver and interobserver ICCs of TI (0.99 and 0.98, respectively) were excellent. In the flatfoot group, TI significantly correlated with AP talonavicular coverage angle (r = 0.43), medial cuneiform-fifth metatarsal height (r = -0.59), coronal plane hindfoot alignment (r = 0.53), and clinical hindfoot alignment (r = 0.39). In the cavovarus foot group, TI correlated significantly with AP talonavicular coverage angle (r = 0.77), calcaneal pitch angle (r = 0.39), medial cuneiform-fifth metatarsal height (r = -0.65), coronal plane hindfoot alignment (r = 0.55), and clinical hindfoot alignment (r = 0.61). Statistically significant differences between flatfoot-control and cavovarus foot-control were found in TI, AP talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height, coronal plane hindfoot alignment, and clinical assessment of hindfoot alignment (all with P < .001).
Conclusion: The TI was demonstrated to be a valid and reliable radiographic measurement to quantify the magnitude of complex foot deformities when evaluating flatfoot and cavovarus foot.
Clinical relevance: The TI may be helpful as an integrated assessment of complex foot deformities. Further clinical studies are recommended.
Level of evidence: Level III, retrospective comparative study.
Details
- Title: Subtitle
- Tripod Index: A New Radiographic Parameter Assessing Foot Alignment
- Creators
- Marut Arunakul - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA, Department of Orthopaedic Surgery, Thammasat University, Pathumthani, ThailandAnnunziato Amendola - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USAYubo Gao - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USAJessica E Goetz - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USAJohn E Femino - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USAPhinit Phisitkul - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Foot & ankle international, Vol.34(10), pp.1411-1420
- DOI
- 10.1177/1071100713488761
- PMID
- 23657663
- ISSN
- 1071-1007
- eISSN
- 1944-7876
- Language
- English
- Date published
- 10/2013
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Internal Medicine
- Record Identifier
- 9984040270702771
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