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Correlation of Talar Anatomy and Subtalar Joint Alignment on Weightbearing Computed Tomography With Radiographic Flatfoot Parameters.
Foot Ankle Int. 2016 Aug; 37(8):874-81.FA

Abstract

BACKGROUND

Underlying bony deformity may be related to development of adult-acquired flatfoot deformity (AAFD). Multiplanar weightbearing (MP-WB) computed tomography can be used to identify subtalar deformity which may contribute to valgus hindfoot alignment. On coronal MP-WB images, 2 angles reliably evaluate the subtalar joint axis: the angle between the inferior facet of the talus and the horizontal (inftal-hor) and the angle between the inferior and superior facets of the talus (inftal-suptal). Although these angles have been shown to differ significantly between flatfoot patients and controls, no study has investigated their relationships with other components of AAFD. We hypothesized that these angles would correlate strongly with commonly used radiographic measures of AAFD.

METHODS

Forty-five patients with stage II AAFD and 17 control patients underwent MP-WB imaging and standard weightbearing radiographs. MP-WB measurements were correlated with standard radiographic measurements of AAFD. Differences between AAFD and control patients were assessed using independent samples t tests and Mann-Whitney U tests. To assess correlations between each MP-WB measurement and radiographic measurement, factorial generalized linear models (GLMs) were constructed.

RESULTS

Patients with AAFD differed from the controls in all measured angles (P ≤ .001 for each). After accounting for differences between flatfoot and control patients, inftal-hor was not significantly correlated with any of the radiographic angles. Inftal-suptal, however, correlated with the AP coverage angle, AP talar-first metatarsal angle, calcaneal pitch, Meary's angle, medial column height, and hindfoot alignment after accounting for differences between flatfoot patients and controls. Meary's angle alone explained 48% of the variation in inftal-suptal angles.

CONCLUSION

As measured on coronal MP-WB images, patients with stage II AAFD had more innate valgus in their talar anatomy as well as more valgus alignment of their subtalar joints than did control patients. It is possible that this information could be used to identify patients likely to have progression of deformity and may ultimately guide the approach to operative reconstruction.

LEVEL OF EVIDENCE

Level III, case-control study.

Authors+Show Affiliations

Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA codye@hss.edu.Weill Cornell Medical College, New York, NY, USA.Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA.Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27137795

Citation

Cody, Elizabeth A., et al. "Correlation of Talar Anatomy and Subtalar Joint Alignment On Weightbearing Computed Tomography With Radiographic Flatfoot Parameters." Foot & Ankle International, vol. 37, no. 8, 2016, pp. 874-81.
Cody EA, Williamson ER, Burket JC, et al. Correlation of Talar Anatomy and Subtalar Joint Alignment on Weightbearing Computed Tomography With Radiographic Flatfoot Parameters. Foot Ankle Int. 2016;37(8):874-81.
Cody, E. A., Williamson, E. R., Burket, J. C., Deland, J. T., & Ellis, S. J. (2016). Correlation of Talar Anatomy and Subtalar Joint Alignment on Weightbearing Computed Tomography With Radiographic Flatfoot Parameters. Foot & Ankle International, 37(8), 874-81. https://doi.org/10.1177/1071100716646629
Cody EA, et al. Correlation of Talar Anatomy and Subtalar Joint Alignment On Weightbearing Computed Tomography With Radiographic Flatfoot Parameters. Foot Ankle Int. 2016;37(8):874-81. PubMed PMID: 27137795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlation of Talar Anatomy and Subtalar Joint Alignment on Weightbearing Computed Tomography With Radiographic Flatfoot Parameters. AU - Cody,Elizabeth A, AU - Williamson,Emilie R, AU - Burket,Jayme C, AU - Deland,Jonathan T, AU - Ellis,Scott J, Y1 - 2016/05/02/ PY - 2016/5/4/entrez PY - 2016/5/4/pubmed PY - 2017/8/15/medline KW - flatfoot KW - hindfoot alignment KW - multiplanar weightbearing computed tomography KW - posterior tibial tendon insufficiency KW - subtalar joint SP - 874 EP - 81 JF - Foot & ankle international JO - Foot Ankle Int VL - 37 IS - 8 N2 - BACKGROUND: Underlying bony deformity may be related to development of adult-acquired flatfoot deformity (AAFD). Multiplanar weightbearing (MP-WB) computed tomography can be used to identify subtalar deformity which may contribute to valgus hindfoot alignment. On coronal MP-WB images, 2 angles reliably evaluate the subtalar joint axis: the angle between the inferior facet of the talus and the horizontal (inftal-hor) and the angle between the inferior and superior facets of the talus (inftal-suptal). Although these angles have been shown to differ significantly between flatfoot patients and controls, no study has investigated their relationships with other components of AAFD. We hypothesized that these angles would correlate strongly with commonly used radiographic measures of AAFD. METHODS: Forty-five patients with stage II AAFD and 17 control patients underwent MP-WB imaging and standard weightbearing radiographs. MP-WB measurements were correlated with standard radiographic measurements of AAFD. Differences between AAFD and control patients were assessed using independent samples t tests and Mann-Whitney U tests. To assess correlations between each MP-WB measurement and radiographic measurement, factorial generalized linear models (GLMs) were constructed. RESULTS: Patients with AAFD differed from the controls in all measured angles (P ≤ .001 for each). After accounting for differences between flatfoot and control patients, inftal-hor was not significantly correlated with any of the radiographic angles. Inftal-suptal, however, correlated with the AP coverage angle, AP talar-first metatarsal angle, calcaneal pitch, Meary's angle, medial column height, and hindfoot alignment after accounting for differences between flatfoot patients and controls. Meary's angle alone explained 48% of the variation in inftal-suptal angles. CONCLUSION: As measured on coronal MP-WB images, patients with stage II AAFD had more innate valgus in their talar anatomy as well as more valgus alignment of their subtalar joints than did control patients. It is possible that this information could be used to identify patients likely to have progression of deformity and may ultimately guide the approach to operative reconstruction. LEVEL OF EVIDENCE: Level III, case-control study. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/27137795/Correlation_of_Talar_Anatomy_and_Subtalar_Joint_Alignment_on_Weightbearing_Computed_Tomography_With_Radiographic_Flatfoot_Parameters_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100716646629?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -