3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

Abstract

Background:

Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA.

Methods:

A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet).

Results:

The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO (R² = 0.744), with a regression slope of 1.064.

Conclusions:

WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination.

Level of Evidence:

Level II, prospective comparative study.

Keywords

foot ankle offset PedCAT TALAS hindfoot alignment weightbearing computed tomography

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References

Aebi

Horisberger

Frigg

Radiographic study of pes planovarus. Foot Ankle Int. 2017;38(5):526‑531.

Arunakul

Amendola

Gao

Goetz

Femino

Phisitkul

Tripod index. Foot Ankle Int. 2013;34(10):1411‑1420.

Barg

Amendola

Henninger

Kapron

Saltzman

Anderson

AE.

Influence of ankle position and radiographic projection angle on measurement of supramalleolar alignment on the anteroposterior and hindfoot alignment views. Foot Ankle Int. 2015;36(11):1352‑1361.

Barg

Bailey

Richter

et al . Weightbearing computed tomography of the foot and ankle: emerging technology topical review. Foot Ankle Int. 2018;39(3):376‑386.

Baverel

Brilhault

Odri

Boissard

Lintz

Influence of lower limb rotation on hindfoot alignment using a conventional two-dimensional radiographic technique. Foot Ankle Surg. 2017;23(1):44‑49.

Buck

Hoffmann

Mamisch-Saupe

Espinosa

Resnick

Hodler

Hindfoot alignment measurements: rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs. Am J Roentgenol. 2011;197(3):578‑582.

Burssens

Peeters

Buedts

Victor

Vandeputte

Measuring hindfoot alignment in weight bearing CT: a novel clinical relevant measurement method. Foot Ankle Surg. 2016;22(4):233‑238.

Burssens

Peeters

Peiffer

et al . Reliability and correlation analysis of computed methods to convert conventional 2D radiological hindfoot measurements to a 3D setting using weightbearing CT. Int J Comput Assist Radiol Surg. 2018;13(12):1999-2008.

Burssens

Van Herzele

Leenders

et al . Weightbearing CT in normal hindfoot alignment—presence of a constitutional valgus? Foot Ankle Surg. 2018;24(3):213-218.

10.

Colin

Horn Lang

Zwicky

Hintermann

Knupp

Subtalar joint configuration on weightbearing CT scan. Foot Ankle Int. 2014;35(10):1057‑1062.

11.

Colville

MR.

Surgical treatment of the unstable ankle. J Am Acad Orthop Surg. 1998;6(6):368-377.

12.

Dagneaux

Moroney

Maestro

. Reliability of hindfoot alignment measurements from standard radiographs using the methods of Meary and Saltzman [published online ahead of print November 11, 2017]. Foot Ankle Surg. doi:10.1016/j.fas.2017.10.018.

13.

de Cesar Netto

Schon

Thawait

et al . Flexible adult acquired flatfoot deformity: comparison between weight-bearing and non-weight-bearing measurements using cone-beam computed tomography. J Bone Joint Surg Am. 2017;99(18):e98.

14.

Hintermann

Ruiz

Barg

Novel double osteotomy technique of distal tibia for correction of asymmetric varus osteoarthritic ankle. Foot Ankle Int. 2017;38(9):970‑981.

15.

Hirschmann

Pfirrmann

CWA

Klammer

Espinosa

Buck

FM.

Upright cone CT of the hindfoot: comparison of the non-weight-bearing with the upright weight-bearing position. Eur Radiol. 2014;24(3):553‑558.

16.

Lawlor

Kluczynski

Marzo

JM.

Weight-bearing cone-beam CT scan assessment of stability of supination external rotation ankle fractures in a cadaver model. Foot Ankle Int. 2018;39(7):850-857.

17.

Lintz

Welck

Bernasconi

et al . 3D biometrics for hindfoot alignment using weightbearing CT. Foot Ankle Int. 2017;38(6):684‑689.

18.

Méary

Filipe

Aubriot

Tomeno

Functional study of a double arthrodesis of the foot [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1977;63(4):345-359.

19.

Neri

Barthelemy

Tourné

Radiologic analysis of hindfoot alignment: comparison of Méary, long axial, and hindfoot alignment views. Orthop Traumatol Surg Res. 2017;103(8):1211‑1216.

20.

Reilingh

Beimers

Tuijthof

GJM

Stufkens

SAS

Maas

van Dijk

CN.

Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skeletal Radiol. 2010;39(11):1103‑1108.

21.

Richter

Lintz

Zech

Meissner

SA.

Combination of PedCAT weightbearing CT with pedography assessment of the relationship between anatomy-based foot center and force/pressure-based center of gravity. Foot Ankle Int. 2018;39(3):361‑368.

22.

Richter

Seidl

Zech

Hahn

PedCAT for 3D-imaging in standing position allows for more accurate bone position (angle) measurement than radiographs or CT. Foot Ankle Surg. 2014;20(3):201‑207.

23.

Robinson

Dyson

Halson-Brown

Reliability of clinical and radiographic measurement of rearfoot alignment in a patient population. Foot. 2001;11(1):2‑9.

24.

Saltzman

El-Khoury

GY.

The hindfoot alignment view. Foot Ankle Int. 1995;16(9):572‑576.

25.

Van Bergeyk

Van Younger

Van Carson

CT analysis of hindfoot alignment in chronic lateral ankle instability. Foot Ankle Int. 2002;23(1):37‑42.

26.

Vienne

Schöniger

Helmy

Espinosa

Hindfoot instability in cavovarus deformity: static and dynamic balancing. Foot Ankle Int. 2007;28(1):96‑102.

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